Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1997
Review[Ventilation modes and strategies in intensive care medicine].
Advances in ventilator technology and recent findings in pathophysiological mechanisms have resulted in a remarkable decrease in classical volume controlled and pressure controlled ventilation modes as treatment for severe acute respiratory insufficiency. New modes of ventilatory support enabling and encouraging patients' spontaneous breathing, such as Biphasic Positive Airway Pressure (BIPAP) and Airway Pressure Release Ventilation (APRV), make it possible to adapt ventilatory support better and more easily to suit patients' needs than conventional modes of controlled ventilation. Preservation and support of patients' spontaneous breathing improves pulmonary gas exchange and reduces stress imposed by mechanical ventilation. ⋯ Through this, the need for sedation and analgesia is considerably reduced and this may minimize systemic side-effects and complications from analgo-sedation and mechanical ventilation. The drugs should be administered in an adequate, individually adapted manner. Routinely-ordered and fixed combinations of drugs administered continuously are not adequate adequate as they further carry the risk of overdosing a different single drug with the corresponding side-effects (depression of respiratory drive, gut motility, etc.).
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Anaesthesiol Reanim · Jan 1997
Comparative Study[Mivacurium--a new muscle relaxant compared with atracurium and vecuronium].
This study investigates the effects of mivacurium (3 times ED95) on neuromuscular block, intubation conditions and general safety in comparison with equipotent doses of atracurium and vecuronium. Following Ethical Care Committee approval and informed consent, 90 ASA I+II patients aged 18 to 65 were studied undergoing elective ENT surgery. Anaesthesia was induced with 1.5 mg/kg propofol and 0.2 mg/kg alfentanil and maintained through continuous infusion of propofol (8 to 10 mg . kg-1 . h-1) and nitrous oxide in oxygen. ⋯ Facial flushing and mild bronchospasms as signs of histamine release resulted more often in the mivacurium (20%) and atracurium groups (23%) than in the vecuronium group (3%). In contrast to atracurium and vecuronium, recovery from mivacurium-induced neuromuscular blockade is rapid. However, the onset time after 3 times ED95 was significantly longer for mivacurium than for atracurium or vecuronium.
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Anaesthesiol Reanim · Jan 1997
Biography Historical Article[Professor Fritz Lotsch--a wrongfully forgotten German pioneer in anesthesia].
Like many of the contributors to the early development of anaesthesia in Germany. Prof. Fritz Lotsch (1879-1958) was a surgeon. ⋯ As early as 1903 Lotsch reported on clinical experience with the recently developed barbiturate "Veronal". Later he reported on advantages and disadvantages of combined anaesthesia using inhalation anaesthetics, opiates and barbiturates. In 1913 he recommended a special double cannula for intravenous infusion purposes which was only rediscovered decades later.
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The first narcosis with chloroform was performed by James Young Simpson on himself on November 4, 1847. The chemical substance had been first produced in 1831 almost simultaneously in the USA by Samuel Guthrie and in France by Eugène Soubeiran. Knowledge of the narcotic effect of chloroform spread rapidly, but very soon reports of sudden deaths mounted. ⋯ The story of the clinical use of chloroform ended in 1976 with the second edition of V. J. Collins' textbook.
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Anaesthesiol Reanim · Jan 1996
Comparative Study[Clinical experiences with fiber optic intubation with the Bonfils intubation fiberscope].
In a prospective study 107 patients were analyzed regarding difficulty of intubation. One hundred and three were intubated with the retromolar fibrescope named after Bonfils. The report gives an account of the intubation technique and experiences with this device. ⋯ For this technique, a sufficient opening of the mouth for the introduction of the apparatus is necessary. The rigid fibrescope cannot compete with the flexible optic, but supplements the repertoire of aids for difficult intubations. It could open up new areas of indication for safe and gentle intubation.