Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1996
Case Reports[Successful resuscitation of a hypothermic patient with extracorporeal circulation--a case report].
A case of cardiopulmonary arrest due to accidental hypothermia and its successful therapy is described. A 46-year-old man with deep accidental hypothermia (25.3 degrees C esophageal) was found outside showing respiratory and cardiac arrest. Resuscitation was immediately started and continuously performed during the transport to the University Hospital of Rostock, where a treatment with extracorporeal circulation was possible. ⋯ After seven days of intensive therapy, he recovered completely and could be transferred from the intensive care unit to the department of psychiatry without neurological deficits showing only healing of frostbite of the feet. Based on this case report, the use of extracorporeal circulation for adequate rewarming in combination with cardiopulmonary resuscitation is described. Compared to other therapeutic measures such as peritoneal dialysis or veno-venous haemofiltration treatment with extracorporeal circulation is the method of choice.
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Anaesthesiol Reanim · Jan 1995
Biography Historical Article[The "narcotization statistics" of Ernst Julius Gurlt of 1895--an early contribution to quality control in anesthesia].
The fifth compilation of anaesthetization statistics "Zur Narkotisirungsstatistik", presented by the surgeon Ernst Julius Gurlt in 1895 summarizes the answers to a questionnaire of the German Surgical Society given by 78 mainly large German surgical hospital departments. It comprises 55,395 anaesthetic procedures, most of them (34,412) performed under chloroform, although this substance was still associated with many more fatal complications than ether. ⋯ Details concerning premedication, the role of the anaesthetist, postoperative care, documentation and especially complications and how to prevent and deal with them are taken from 38 reprinted reports. Gurlt's activities initiated more than 100 years ago are to be seen as pioneer work in the field of anaesthesiological quality assessment.
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Anaesthesiol Reanim · Jan 1995
Review Comparative Study[Treatment of postoperative pain with peridural administration of opioids].
The advantages and disadvantages associated with epidural opioids require careful selection of the opioid and its dose regimen. There is no ideal opioid available for epidural use. Comparative pharmacokinetic data help selection of the appropriate epidural opioid. ⋯ Nalbuphine and butorphanol should not be selected for epidural use until the benefit/risk ratio is defined. The safety of patients is paramount. If patients are harmed by inappropriate opioids or dose regimens, this will unjustly discredit a valuable treatment of postoperative pain.
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Blood pressure, heart rate and perspiration were and still are the only clinical signs for recognizing the depth of balanced anaesthesia in combination with muscle relaxants. Even experienced anaesthetists sometimes have difficulties in recognizing the necessary depth of anaesthesia using these parameters and in relatively rare cases the very unpleasant symptom of awareness occurs. Nowadays, processed EEG monitoring (pEEG) is used scientifically and also clinically for exact controlling of general anaesthesia. ⋯ In agreement with other investigators we found that a sufficient depth of anaesthesia could be expected when the SEF 50 ranged between 2 and 6 Hz (4.9 +/- 0.9), the SEF 90 ranged between 10 and 13.5 Hz (11.9 +/- 0.6), the SEF 95 ranged between 14 and 16 Hz (14.8 +/- 0.8) and the delta-ratio ranged between 0.7 and 1.4 (1.1 +/- 0.2). Using this anaesthetic technique and a premedication with benzodiazepine, SEF 90 SEF 95 are the best parameters for monitoring the depth of anaesthesia. In one patient blood pressure and heart rate remained constant intraoperatively, but she described intensive dreams postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Patient-controlled analgesia (PCA) is a well-accepted technique in postoperative pain management. We used PCA in three different protocols to find the optimum application form. Our study compared 100 patients with radical prostatectomy or transperitoneal tumor nephrectomy in three groups using piritramide. ⋯ Although the dosage of piritramide was not different in the three groups, we recommend the protocol of group 3 because of the lower refusal of bolus application. Therefore, this seems to be the best patient-adapted application form. Even though respiratory complications in the group 3 scheme are not expected, monitoring of respiration and vigilance are recommended.