Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 2002
Historical Article[Early contributions for the development of nitrous oxide-oxygen anesthesia in central Europe].
The American dentist Horace Wells was the first to administer nitrous oxide for pain relief during painful tooth extractions. Since, however, an official demonstration of the pain-relieving properties of the gas at Massachusetts General Hospital in Boston ended in failure, use of the drug was abandoned. A few years later, Gardner Quincey Colton, a former coworker of Wells, took up Wells' idea to use nitrous oxide for pain relief and this was instrumental in its reintroduction into daily practice. ⋯ Among those who were fascinated by his pain-relieving concept was Paul Zweifel from Leipzig, one of the leading obstetricians of his time in Germany. Together with numerous of his pupils, he popularized the method, using new apparatus for a safer kind of administration. Further technical developments in the early twenties, such as the introduction of the circle system or the clinical use of oxygen-monitoring devices, were additional milestones in nitrous oxide/oxygen anaesthesia.
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Anaesthesiol Reanim · Jan 2002
Randomized Controlled Trial Comparative Study Clinical Trial[Cis-atracurium--an equivalent substitution for atracurium in pediatric anesthesia?].
Cis-atracurium is a stereoisomer of atracurium, about five times more potent than the racemate. Whereas cis-atracurium is routinely used in adults, its effects on children are still poorly defined. We compared equipotent doses of atracurium and cis-atracurium in children aged between 2 and 12 years regarding the quality of neuromuscular blockade, the intubation conditions and the occurrence of side-effects. ⋯ Flush and tachycardia occurred much less frequently and there were no significant differences in the two groups: two patients in group A and only one in group C. The authors conclude that atracurium and cis-atracurium lead to comparable neuromuscular effects in children aged between 2 and 12 years. Only the intubation conditions were better after atracurium, but atracurium was followed by urticaria more often than cis-atracurium.
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Anaesthesiol Reanim · Jan 2002
Review[Can lung protective ventilation methods modify outcome?--A critical review].
A large body of experimental and clinical work leaves no room for doubt that mechanical ventilation can contribute to the progression of a lung disease or, in the worst case, produce acute pulmonary damage. The pathophysiological processes involved have been described as barotrauma, volutrauma, atelectrauma and biotrauma. In response, a socalled lung-protective ventilation strategy has been proposed, especially for patients with acute respiratory distress syndrome (ARDS). ⋯ Of these, only prone positioning has become part of routine clinical management, while ECMO is applied in selected cases only. Unfortunately, thus far, none of these measures has passed the litmus test of a randomized controlled trial. Recent large prospective observational studies, however, suggest that only an optimized concert of therapeutic interventions, but not a single measure alone, may improve the outcome of ARDS patients.
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Anaesthesiol Reanim · Jan 2002
Case Reports[Do position control methods for central venous catheters prevent complications? Hydromediastinum caused by an initially correctly placed tri-lumen subclavian catheter by using intra-atrial ECG recording--a case report].
Central venous catheters (CVCs) can be associated with various complications which arise during insertion, with the catheter in situ or upon its removal. Here we report a case of secondary CVC malposition that occurred despite checks of CVC position by different methods. A subclavian triple-lumen catheter was retracted until intra-atrial ECG indicated reversal to a normal P-wave. ⋯ Moreover, repeated chest radiographs are useful in verifying a correct CVC position and detecting late complications. In summary, CVC complications can occur with delay, are potentially life-threatening and may necessitate repeated checks of catheter position. This case report discusses different approaches to detecting malposition and reviews rare CVC complications.
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When caring for patients with an incurable progressive disease, the physician experiences a feeling of powerlessness because there is no curative treatment that he can offer. The reaction to this must not be resignation, but active palliative medicine to achieve the best possible quality of life for the remaining time. Palliative medicine is a holistic concept of treatment in an outpatient or inpatient setting, integrating physical, psychological, social and spiritual aspects. ⋯ The decision-makers in our health care system are called upon to support palliative medicine and ensure access to palliative care all over the country. Palliative medicine was started to ease suffering, preserve or restore autonomy and maintain dignity. As an active life aid it is, in our opinion, an alternative to any demand for euthanasia.