Anaesthesiologie und Reanimation
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Skilful analgesia is self-explanatory and needs no justification. In contrast to this, preclinical general anaesthesia is of relative value and depends, in part, on the professional qualities of the emergency physician. Analgesic and anaesthestic drugs should be administered via a safe intravenous line. ⋯ Butylscopolamin is used in colic pain, either alone or in combination with analgesic drugs. Haloperidol is indicated in acute psychotic syndromes as well as psychomotoric and alcohol-dependent excitation. On the whole, profound pharmacological and practical knowledge is necessary, although restricting oneself to just a few drugs increases the depth of one's personal experience.
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Anaesthesiol Reanim · Jan 2004
Biography Historical ArticleThe influence of Sir Robert Reynolds Macintosh on the development of anaesthesia.
Fifteen years ago, on the 28th of August 2004, one of the British pioneers of anaesthesiology, Sir Robert Reynolds Macintosh, died in Oxford. Since he had a major influence on the development of anaesthesia in Europe and the rest of the world, we felt it would be appropriate to review his life and work. Macintosh was the first Nuffield Professor of Anaesthetics in the University of Oxford, so we provide a brief biography of Lord Nuffield and describe the historical background to the creation of the chair. ⋯ We discuss the wartime research into survival at high altitudes, the design of life-jackets and the efficiency of methods of artificial ventilation, and then show how Sir Robert pioneered a more open approach to the problem of anaesthetic-related deaths. We list some of the anaesthesiological textbooks which were translated into German, and then describe how his overseas travels influenced the teaching of anaesthesiology all over the world. We record Sir Robert Macintosh's connections with East and West Germany and note how he encouraged the development of academic departments of anaesthesia worldwide.
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Anaesthesiol Reanim · Jan 2004
Clinical Trial[Remifentanil analgesia for aspiration of follicles for oocyte retrieval].
Remifentanil is an esterase-metabolized ultra-short acting mu-agonist opioid with a rapid clearance. The aim of this study was to determine the efficacy of remifentanil infusion for the short-lasting, but painful, transvaginal puncture for oocyte retrieval. Eighty consenting adult women (ASA I and II) aged 30.5 +/- 5 years and with a body weight of 69.1 +/- 9.1 kg were enrolled in this prospective study. ⋯ Some patients, however, showed motoric reactions to vaginal puncture, while in other cases significant and clinical relevant decreases in Hb-oxygen saturation occurred. Therefore, we no longer carry out remifentanil infusion for transvaginal oocyte retrieval. We now prefer a remifentanil infusion of 0.2 microg/kg/min and propofol (1 mg/kg initially with intermittent doses of 0.5 mg/kg) combined with assisted ventilation by mask.
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Anaesthesiol Reanim · Jan 2004
Case Reports[Blunt chest trauma with total rupture of the right main stem bronchus--a case report].
Tracheo-bronchial lesions in blunt chest trauma are rare--the incidence is about 1%--but potentially life-threatening events. Indirect signs such as pneumothorax, pneumomediastinum, subcutaneous emphysema or an insufficient expansion of the lungs after drainage of a pneumothorax are ominous. The fastest and most reliable method to assess the definite diagnosis of tracheo-bronchial lesion is fibre-optic tracheobronchoscopy. ⋯ Forty-eight hours later, synchronised independent lung ventilation with two ventilators was established to protect the surgical result. The ventilation was switched to conventional mode a further 48 hours later. Extubation and the remaining ICU stay were uneventful.