Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1993
Review[The importance of neuromuscular monitoring during anesthesia for neuroradiologic diagnosis].
Muscle relaxants are essential in anaesthesia for neuroradiological diagnosis. In addition, neurosurgical and neurological patients often face, because of their basic illness, respiratory danger, which can increase postoperatively through the use of muscle relaxants during anaesthesia. Because of their pharmacodynamic properties and side-effects, muscle relaxants must be clearly differentiated from one another and used selectively for the different phases of anaesthesia-intubation, calmness during examination and recovery from neuromuscular block with extubation. ⋯ For investigations with planned extubation, only the muscle relaxants atracurium and vecuronium with their medium-long effect should be applied. A high degree of safety is provided by neuromuscular block and especially in the recovery phase. Using relaxometers it is possible to determine individual relaxant requirements, avoid under- and overdoses, carry out an antagonism at the correct time and prevent residual relaxation situations so that respiratory insufficiency can be reliably excluded.
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Anaesthesiol Reanim · Jan 1993
[Early recognition of brain death--a contribution to organ explantation].
The criteria for brain death are presented and reference is made to the legally required observation period. To shorten the observation period, the Federal Medical Council (Bundesärztekammer) set out in 1986 possible aids to making decisions. The time at which extensive additional investigations should start makes it necessary to approximately determine the moment of brain death. The tear secretion test presented in this paper could be a further decision aid.
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Anaesthesiol Reanim · Jan 1992
Comparative Study[The humidification of anesthetic gases during anesthesia using heat and moisture exchangers].
This study looks at the question of whether anaesthetic gases are sufficiently moistened in a semi-closed system by the partial recycling of expired air with simultaneous absorption of CO2. During the inspiration phase only a maximum of 42% relative humidity at a temperature of 24.8 degrees C was reached. These values lie far below the demands of the American National Standard Institute (ANSI) of 70% relative humidity at 30 degrees C. ⋯ An improved version, the Humid Vent II, has been produced. Physiological values (37 degrees C, 100% relative humidity) are not achieved by any heat and moisture exchangers. This problem could possibly be solved by using infra-red light when warming the gases.
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Anaesthesiol Reanim · Jan 1992
Randomized Controlled Trial Comparative Study Clinical Trial[The effect of etomidate on the upper airway reflexes].
Clinical observations during anaesthesia and intubation of emergency patients are presented showing a differentiated impact of etomidate (Hypnomidate) on upper airway reflexes: a blockade of pharyngeal reflexes with sustained but possibly delayed laryngeal reflexes and a certain protection against laryngospasm and vomiting. In addition etomidate enables, preferably in combination, difficult intubation with sustained spontaneous breathing due to its low respiratory depressant effect. ⋯ The impact of anaesthetics on airway reflexes is generally concealed by muscular relaxants, and observations on this matter are difficult to make subject to quantifiable parameters and controlled studies; accordingly such observations are scarcely found in newer anaesthetic literature. In the development of new techniques for intubation and anaesthesia without muscle relaxation, these methodical problems deserve attention.
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Anaesthesiol Reanim · Jan 1992
Review[The treatment of status asthmaticus using ketamine--experimental results and clinical experience].
Intensive therapy of a patient with status asthmaticus must lead to a reduction of vital threat by improving respiratory and cardiac functions. Because of the bronchodilating effect of ketamine, analgesic sedation with ketamine and benzodiazepines is extremely useful for prolonged ventilation. At the beginning of this treatment it can be necessary to supplement the continuous intravenous infusion of ketamine and diazepam or ketamine and midazolam with small bolus doses of up to 3.5 mg/kg/h of ketamine. ⋯ Sixteen asthmatic patients were treated with analgesic sedation using ketamine and benzodiazepines, three of them without intubation and ventilation. In spite of the life-threatening situation and reanimation before admission to the intensive care unit, only one patient died. Our experience has shown that intensive therapy including analgesic sedation with ketamine and benzodiazepines, optimized by application of sympathomimetics and vasodilators, is suitable for overcoming the life-threatening situation of patients with status asthmaticus.