Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1990
[Organization of courses in further education and continuing education as a means of ensuring quality standards].
Based on the "Standards of Postgraduate Specialisation in Anaesthesiology and Intensive Care Medicine" in the GDR, pedagogic and didactic aspects of training are presented. The learning process, the methods of teaching and the consolidation of knowledge are discussed.
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Anaesthesiol Reanim · Jan 1990
[Rectal premedication using ketamine-dehydrobenzperidol-atropine in childhood].
In 60 children aged between two and 12 years the effect of rectal application of ketamine, dehydrobenzperiodol and atropine was investigated. The children were divided into two groups. Applying equal doses of dehydrobenzperidol and atropine, group B (30 children) received the half dose of ketamine which group A (30 children) received. ⋯ Sedation was satisfactory although especially the children in group B remained responsive, but were in a state of psychic indifference and motoric sedation. The applied combination of drugs effected a moderate reduction of heart rate. In general, we found that rectal application of 1 mg/kg ketamine, 0.15 mg/kg dehydrobenzperidol and 0.01 mg/kg atropine in children resulted in good preoperative sedation and exhibited relatively few side-effects.
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Following a short review of the history of regional anaesthesia in children the anatomical and physiological differences to the adult are discussed. The procedure used for instituting a regional block in combination with light general anaesthesia is described. ⋯ With the aid of an electric nerve stimulator it is possible to perform peripheral nerve blocks without the need for child cooperation. The continuous caudal technique in which catheters can be advanced to upper thoracic levels in neonates and young infants, in contrast to adults, is discussed in detail.
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Anaesthesiol Reanim · Jan 1990
Comparative StudyCardiac dysrhythmias during nasal surgery--a comparison with lignocaine-adrenaline and prilocaine-octapressin during halothane anaesthesia.
The incidence of cardiac dysrhythmias and adequacy of haemostasis during nasal surgery under deep halothane anaesthesia were studied following nasal infiltration with 10 ml of either 1.5% lignocaine with adrenaline 1:200,000 or prilocaine 1.5% with octapressin 0.03 IU per ml. There was a significant difference in the incidence of cardiac dysrhythmias between patients given octapressin 2% and patients given adrenaline infiltration (18%) p greater than 0.01. Adequate haemostasis was observed in 84% of patients who received octapressin with no adverse effects compared to 94% of the group which received adrenaline (p greater than 0.01). We suggest for the use of lignocaine-adrenaline during halothane anaesthesia that adequate ventilation is assured, deep halothane anaesthesia given, the infiltration delayed 10 minutes after tracheal intubation, the rate of injection adjusted to 10 ml in a 10-minute period and a total dose of adrenaline does not exceed 0.6 microgram/kg.
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Anaesthesiol Reanim · Jan 1989
Randomized Controlled Trial Clinical Trial[A clinical study of selective gut decolonization in 204 long-term ventilated intensive care patients undergoing abdominal and accident surgery].
In a randomized clinical trial the effects of selective digestive decolonization (SDD) on the frequency of pneumonia and sepsis and the rate of lethality as well as the resistance quota and colonization of bacteria were studied in 102 surgical ICU-patients requiring prolonged mechanical ventilation. These patients received non-resorbable antibiotics: 4 x 100 mg of polymyxin B, 4 x 500 mg of amphotericin B, and 4 x 80 mg of tobramycin via gastric tube. One hundred and two patients served as controls. ⋯ A secondary colonization of the oropharynx in patients of the SDD-group could not be observed. 38.8% of the patients in the control group showed potentially pathogenic microorganisms in oropharyngeal swabs. A development of resistance of pseudomonas aeruginosa against tobramycin occurred in 2.3% of the patients in the SDD-group and in 3.1% of the patients in the control group. It can be concluded that the administration of non-resorbable antimicrobials against gram-negative aerobes is an effective method for prevention of potentially fatal pneumonia and sepsis, and for the first time a significant improvement of the survival rate could be demonstrated.