Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1994
Comparative Study[Anesthesia with the closed PhysioFlex system in comparison with conventional anesthesia procedures].
So far the anaesthetic technique of the closed circuit system in clinical routine could not be used adequately, because suitable mixtures of respiration gas components were not available and the maintenance of a sufficient gas volume in the anaesthetic circle system was not possible with the standard anaesthesia machines. The anaesthesia machine PhysioFlex was especially constructed to deliver anaesthetics in a closed circuit system. In this anaesthesia machine the concentrations of the respiratory gases and the gas volume in the circle system are automatically controlled by a feedback mechanism. ⋯ After the induction the desired inspiratory oxygen-concentration was reached within 5 minutes, the expiratory isoflurane-concentration within 10 minutes in the CC group and was maintained reliable. The consumption of liquid isoflurane was 12.9 ml/h in the HF group, 7.5 ml/h in the LF group and 5.3 ml/h in the CC group. The anaesthetic management was possible without any problems in all three groups.
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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)
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Anaesthesiol Reanim · Jan 1994
Comparative StudyA comparison of the accuracy of the Siemens injection vaporizer and the Enfluratec 3 vaporizer.
The accuracy of two Siemens injection vaporizers was examined under operating theatre conditions. For comparison, two Enfluratec 3 vaporizers were tested. The concentrations of enflurane produced by the vaporizers were measured both by an anaesthetic agent monitor and by chromatography. ⋯ The former vaporizers seem to be less robust than the Enfluratecs and should be used according to the manufacturer's recommendations. The pressures in the central system were higher than those called for. In addition, improper coupling of the Siemens apparatus to the ventilator may well have influenced the results.
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In obstetric anaesthesia, general anaesthesia combined with endotracheal intubation, spinal anaesthesia and peridural anaesthesia is used. The main risks of general anaesthesia are: difficult intubation, aspiration of acid gastric content in non-fasting patients, depression of the fetus with narcotics and the occurrence of awareness of the mother. ⋯ The specific risks of peridural anaesthesia are: maternal hypotension, the possibility of inadvertent intravenous injection of local anaesthetics leading to cardiac and cerebral intoxication, inadvertent intrathecal application of local anaesthetics followed by total spinal block which requires reanimation and inadvertent dura perforation followed by long-lasting headache. Most anaesthesia-related maternal deaths by far occur during Caesarean section performed under general anaesthesia, but at present there is no clear evidence that the anaesthetic risk of spinal or peridural anaesthesia, on the one hand, is lower than that one of general anaesthesia, on the other.
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Anaesthesiol Reanim · Jan 1994
Diaphragmatic movement studied with ultrasound during spontaneous breathing and mechanical ventilation with intermittent positive pressure ventilation (IPPV) and airway pressure release ventilation (APRV) in man.
Earlier knowledge about diaphragmatic movement during mechanical ventilation is based on radiological information. Since real-time bed-side monitoring is now possible the movement of the right hemidiaphragm was studied using ultrasound (US), both during spontaneous and mechanical ventilation. Nine healthy non-medicated volunteers lying supine were exposed to the following ventilation modes in random order: 1. breathing air at ambient pressure, or 2. at 7.6 mmHg of CPAP or 3. mechanical ventilation with airway pressure release ventilation (APRV), or 4. with IPPV, by mask. ⋯ The maximal movement was detected in the dome in four volunteers during spontaneous breathing with both ambient pressure and CPAP, but in the ventral part in seven and six volunteers, respectively, during APRV and IPPV. Diaphragmatic movement can be studied with US and the findings support the earlier study, with the diaphragm shifting towards the non-dependent regions of the lungs during mechanical ventilation. In this respect APRV is similar to IPPV.