Zentralblatt für Chirurgie
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Mechanical ventilation is the potential therapeutic approach to traumatic brain lesion and acute adult respiratory distress syndrome (ARDS) in the wake of severe injury in an accident. Aggravating cerebral symptoms, such as non-targeted defence reactions in coma, hemiplegia, synergism of extension, convulsions, pontine respiratory disorders, and intracerebral pressure beyond 30 Torr are diagnostic criteria for immediate mechanical ventilation of patients with brain trauma. The same action is indicated for cases of ARDS exhibiting, on top of the typical constellation of causes, hypoxia below 60 Torr paO2 and vital capacity below 15 ml/kg body weight or respiratory rates in excess of 30/min.
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Any patient admitted to an intensive care unit requires individual analgetic and sedative treatment, depending on type and severity of the disease with its associated physical and psychic problems. There is a wide range of possible medicaments and combinations of these from among which the authors investigated combinations of the short-action opiates fentanyl and alfentanyl and midazolam, a benzodiazepine, short-action as well. ⋯ Both analgosedation schemes yielded best results, when compared to other combinations also continuously administered through perfusion. Individually adapted synchronisation of the patients to respirator and therapeutic concept proved to be practicable at any time, in spite of that fixed combination of analgetic with sedative.
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An account is given by the authors of their own guidelines for surgical treatment of deformities of the anterior abdominal wall. The procedures described are based on experience obtained from 866 surgical interventions at the first author's clinic, between 1959 and 1987. Indications, techniques, and complications are discussed in some detail.