Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 2002
[Evaluation of emergency medicine knowledge and procedures after finishing the course "resuscitation specialty"].
Emergency medical services are an indispensable part of out-patient medical care. For this purpose, special qualifications are necessary and these are taught within the framework of a course entitled "Certificate for Emergency Medical Services". These courses are organized either as a block course, that is a one-week course, or as weekend courses in progression. ⋯ Accuracy regarding the volume requirements in the case of large-scale burns, as well as choosing the quantity (16.7% compared with 7.4%) and the correct solution (47.9% compared with 40.7%) was unsatisfactory. For these reasons, we strongly recommend intensifying training in block courses for the future qualification of doctors in emergency services. It would also be useful to conduct an oral exam at the end of the entire course, which could also entitle candidates to use this professional designation as one of their qualifications.
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Anaesthesiol Reanim · Jan 2002
Case Reports[Accidental hypothermia--a challenge for rescue service and intensive care].
Accidental hypothermia is a rare clinical picture with different causes. Specific features are shown by patients who have accidents in water, due to rapid cooling. The SARRRAH project (Search and Rescue, Resuscitation and Rewarming in Accidental Hypothermia) was launched to secure fast and professional medical care right up to rewarming by extracorporal circulation. ⋯ Five of the non-survivors belonged to the group of eight patients who were rewarmed by extracorporal circulation. With one exception, they also had the lowest core temperatures. Only a homogeneous and up-to-date documentation will allow further conclusions to be made for improving the concept of therapy.
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Several elements of the "open lung concept", like ventilation with small tidal volumes, were incorporated into various ventilatory strategies. Our study demonstrates how the whole concept can be applied in an animal model using a standardized protocol with the following possible results. Eighteen pigs weighing between 30 and 45 kg were anaesthetized, tracheotomized and ventilated. ⋯ Despite a short arterial systolic blood pressure drop of 23 +/- 11 mmHg during recruitment, no significant difference was detectable afterwards compared to the baseline. Using low tidal volumes alone, complete reopening was not achieved in an experimentally induced acute lung injury. After recruitment manoeuvres, it was possible to reopen the lung and keep it open by application of a sufficient PEEP.
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Anaesthesiol Reanim · Jan 2002
Historical Article[Early contributions for the development of nitrous oxide-oxygen anesthesia in central Europe].
The American dentist Horace Wells was the first to administer nitrous oxide for pain relief during painful tooth extractions. Since, however, an official demonstration of the pain-relieving properties of the gas at Massachusetts General Hospital in Boston ended in failure, use of the drug was abandoned. A few years later, Gardner Quincey Colton, a former coworker of Wells, took up Wells' idea to use nitrous oxide for pain relief and this was instrumental in its reintroduction into daily practice. ⋯ Among those who were fascinated by his pain-relieving concept was Paul Zweifel from Leipzig, one of the leading obstetricians of his time in Germany. Together with numerous of his pupils, he popularized the method, using new apparatus for a safer kind of administration. Further technical developments in the early twenties, such as the introduction of the circle system or the clinical use of oxygen-monitoring devices, were additional milestones in nitrous oxide/oxygen anaesthesia.
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Anaesthesiol Reanim · Jan 2002
Randomized Controlled Trial Comparative Study Clinical Trial[Cis-atracurium--an equivalent substitution for atracurium in pediatric anesthesia?].
Cis-atracurium is a stereoisomer of atracurium, about five times more potent than the racemate. Whereas cis-atracurium is routinely used in adults, its effects on children are still poorly defined. We compared equipotent doses of atracurium and cis-atracurium in children aged between 2 and 12 years regarding the quality of neuromuscular blockade, the intubation conditions and the occurrence of side-effects. ⋯ Flush and tachycardia occurred much less frequently and there were no significant differences in the two groups: two patients in group A and only one in group C. The authors conclude that atracurium and cis-atracurium lead to comparable neuromuscular effects in children aged between 2 and 12 years. Only the intubation conditions were better after atracurium, but atracurium was followed by urticaria more often than cis-atracurium.