Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1998
Randomized Controlled Trial Clinical Trial[Changes in blood coagulation in treatment with hydroxyethyl starch].
The aim of the study was to investigate the influence on coagulation and platelet function of two 6% medium molecular weight hydroxyethylstarch solutions (HES, MW 200,000, DS 0.5) made of potato (K) and corn (M) starch. Twenty patients undergoing elective vertebral disc surgery were randomly assigned to one of the groups. Haemoglobin, haematocrit, protein concentration, fibrinogen, antithrombin III, factor VIII:C, von-Willebrand-factor, prothrombin time, activated partial thromboplastin time and platelet maximum aggregation and maximum gradient of aggregation (inductors: ADP, epinephrine, collagen and ristocetin) were measured before infusion and 30, 240 minutes and one day after infusion. ⋯ The infusion of a medium molecular weight solution is an effective and cost-saving method in volume therapy. Despite the physicochemical differences of the two HES solutions, there were no clinically apparent effects on coagulation and platelet function. Both preparations of HES up to a volume of 1,000 ml can be used equally in the clinical setting.
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Anaesthesiol Reanim · Jan 1998
Comparative Study[Value of aspiration of tracheal secretions and bronchoalveolar lavage in diagnosis of nosocomial pneumonia in ventilated patients].
The diagnostic value of endotracheal aspirates with quantitative assessment and bronchoalveolar lavage (BAL) was investigated in 104 mechanically ventilated patients in an anaesthesiologic/surgical intensive care unit. Patients were either considered as "pneumonia positive" (77 patients) according to clinical, radiological or laboratory criteria or "pneumonia negative" (27 patients). Using a threshold of 10(5) colony forming units (cfu) per ml for endotracheal aspirates and 10(4) cfu/ml for BAL-fluid, the results were similar for both techniques (sensitivity 74% and 77% respectively; specifity 63%). ⋯ Performance of BAL is indicated in patients with clinical signs of nosocomial pneumonia and negative results in endotracheal aspirates (< 10(5) cfu/ml). Nevertheless, diagnostic uncertainty will remain in about 15% of all cases, even when both techniques are applied. The primary use of invasive bronchoscopic techniques, such as BAL, in diagnosis of nosocomial pneumonia has to be considered critically.
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Anaesthesiol Reanim · Jan 1998
Case Reports[Neurologic symptoms in acute thoracic aortic dissection--a case report].
Acute thoracic aortic dissection is a life-threatening illness. It is often difficult to diagnose preclinically due to its many possible symptoms. One out of three patients has neurological deficits. ⋯ Therefore, every emergency physician should know the signs and risk factors of this disease. The most important goals of prehospital therapy are management of pain and anxiety and pharmacological control of the systolic blood pressure and heart rate. We report on a 46-year-old female patient who developed neurological deficits caused by an acute thoracic aortic dissection.
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Despite intensive therapeutic efforts, adult respiratory distress syndrome (ARDS) is still associated with a lethality ranging from 50 to 80%. Besides hypoxemia, fatal outcome is caused by myocardial insufficiency due to a progressive decrease in pulmonary vascular conductance. Inhalation of NO can selectively dilate pulmonary vessels in ventilated lung regions, thus increasing mean pulmonary artery conductance and decreasing venous admixture. ⋯ In severe ARDS, oxygenation significantly improves with the initiation of NO inhalation, but this effect declines over time. With NO, FiO2 and ventilatory pressures can be lowered. Whether the theoretically reduced oxygen toxicity and the reduced invasiveness of mechanical ventilation with NO reduces patient mortality must be determined in larger patient groups.
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Anaesthesiol Reanim · Jan 1998
Comparative Study[Exposure of recovery room personnel to inhalation anesthetics].
Both desflurane and sevoflurane have a favourable blood/gas distribution coefficient. There is concern, however, that environmental contamination is higher when these agents are employed since they must be used in relatively high concentrations. Our study seeks to determine the degree of exposure of recovery room staff to trace amounts of these two agents. ⋯ We conclude that the exposure to the inhalational anaesthetics in the climatised recovery room was low. The threshold values of 100 ppm for nitrous oxide and 10 ppm for isoflurane recommended by German law were not exceeded. When the new volatile anaesthetics are used, exposure of recovery room staff to trace concentrations of these agents is higher, but the concentrations do not exceed the levels allowed applicable German health regulations.