Anaesthesiologie und Reanimation
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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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In the present study the disposition of alfentanil after cessation of a constant rate infusion was compared with intravenous bolus injections. In 11 patients undergoing intervertebral disk surgery general anaesthesia was induced with midazolam, alfentanil and vecuronium; anaesthesia was maintained with a constant rate infusion (1.5 to 2 micrograms/kg/min, 1.0 micrograms/kg/min at the end of the infusion period) of alfentanil. The parameters of bolus injections were obtained from 5 patients undergoing lithotripter therapy; an intravenous bolus of 15 micrograms/kg was given. ⋯ There were no significant correlations between the total clearance of alfentanil and the total dose and between the duration of infusion and total clearance. The clinical implications of our study: After prolonged continuous infusions of alfentanil a significant reduction of the elimination rate has to be considered. The patients must be observed very carefully in the recovery room in order to prevent a possible respiratory depression.
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For an exact evaluation of the risks of operations it is necessary to assess both co-existing and concomitant diseases before the performance of anaesthesia. The relatively low incidence of neurological and muscular diseases (0.02 to 0.7/1,000) and the low probability of an operation of a patient suffering from these diseases lead to higher anaesthesiological risks during the operation and the perioperative period. The anaesthetist is usually not always aware of all the special pathophysiological problems which have to be taken into consideration when these patients have to be anaesthetized. In order to reduce the risk of anaesthesia of these patients, we discuss the most important of these uncommon neurological diseases regarding their special anaesthesiological management.
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Anaesthesiol Reanim · Jan 1994
Randomized Controlled Trial Comparative Study Clinical Trial[Mechanomyographic and electromyographic studies of endotracheal intubation with 2 different rocuronium dosages].
Rocuronium is a new, intermediate-acting, nondepolarizing relaxant with rapid onset of action leading to both good and very good intubation conditions. It was the aim of our study to investigate the onset of action, the intubation conditions and the course of relaxation using two different dosage regimes. Thirty consenting ASA 1 and 2 patients received either 0.6 mg/kg (2 x ED 95; group 1) or 0.06 mg/kg as priming dose followed by an intubating dose of 0.24 mg/kg rocuronium (group 2) four min later. ⋯ The clinical duration of action was significantly longer in group 1 (28.4 +/- 8.0 min) than in group 2 (14.8 +/- 2.5 min). It can be concluded that rocuronium which has shorter intubation times than atracurium and vecuronium is very useful for endotracheal intubation in both dosage regimes in long and very long lasting operations. Using the "priming principle" the patient has to be carefully controlled during priming time.
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Anaesthesiol Reanim · Jan 1994
Review[The present possibilities for routine use of blood-saving measures from the anesthesiologic point of view--theoretical basis and clinical practice. I. Potential risks of homologous transfusion; normovolemic hemodilution].
This paper, which is the first part of four, deals with the potential risks of homologous blood transfusion as well as with normovolemic hemodilution, an autologous transfusion method, which is easily to be applied and not expensive. Although the various methods of autologous transfusion are well known for many years the public discussion on the "AIDS-topic" has led to a growing interest in blood-saving measures. However, in contrast to the so-called "AIDS-topic" the potential risks of a transfusion-transmitted hepatitis as well as the immunologic effects of homologous blood are of much greater importance. ⋯ Moreover, drug-induced stimulation of the erythropoiesis by means of erythropoietin and the additional (intravenous) administration of iron may become a further component among autologous transfusion methods. Normovolemic hemodilution means exchange of autologous blood versus an artificial colloid. To make sure for normovolemia is to be considered a "conditio sine qua non" for "functioning" of normovolemic hemodilution.(ABSTRACT TRUNCATED AT 250 WORDS)