Zeitschrift für Kardiologie
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Review
[Diagnosis, prevention and therapy of pulmonary complications in heart surgery interventions].
Pulmonary complications after cardiac surgery may be caused by preexisting disorders of the respiratory system, common risk factors (e.g., smoking), kind and duration of the surgical procedure, and the anesthesia performed. Preoperative lung function measurements do not allow a valid assessment of the frequency and severity of postoperative complications. However, the efficacy of the peroperative management with bronchodilating agents (beta 2-agonists, theophylline, corticosteroids) in patients with airflow limitation should be based on repeated lung-function testing. ⋯ Atelectasis and gas-exchange disturbances during anesthesia can be treated by ventilation with PEEP. An adequate and immediate management of postoperative pulmonary complications (atelectasis, respiratory failure, pneumonia) improves the outcome of patients after cardiac surgery. The role of perioperative physiotherapy for the reduction of pulmonary complications after cardiac surgery is not well established.
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Case Reports
[Successful treatment of flecainide (Tambocor) poisoning--effect of hemodialysis/hemoperfusion?].
After suicidal ingestion of 3 g flecainide a 34-year-old woman showed somnolence, cerebral convulsion, disturbances of atrioventricular and intraventricular conduction and ventricular asystole. The maximum flecainide plasma level was 4900 ng/ml; this level is extremely high and exceeds the maximum therapeutic level by five times. ⋯ The initial decrease in flecainide plasma levels during extracorporeal elimination occurred much quicker (4.5-8.5 h plasma halflife) than the spontaneous decrease rate of flecainide in humans (12-20 h plasma half-life). We conclude that, perhaps, hemodialysis/hemoperfusion therapy is an efficient method for decreasing toxic plasma levels of flecainide and for improvement of the clinical course of this intoxication.