Zentralblatt für Chirurgie
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Airway disruptions after blunt chest trauma are rather infrequent with an incidence of about 1%. Even in large centers with many such casualties they are episodical. The clinical picture is not an uniform one, and typical clinical signs occur often without an airway lesion. ⋯ Both patients experienced a smooth recovery with good longterm results. In blunt chest trauma presenting with subcutaneous emphysema, pneumomediastinum, pneumothorax, hemoptysis and respiratory distress, tracheobronchial disruption should be considered. In this case, expert bronchoscopy, preferably by a surgeon with large thoracic experience, is mandatory.
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Blood transfusion became the subject of major interest because of a possible HIV-infection. It should not been forgotten, however, that HIV-infection is not the only of a wide variety of risks. ⋯ One possibility to avoid risks, is the use of autologous blood. The most important requirement, however, remains to operate with a minimal blood loss.
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Shock induced microcirculatory failure is proposed to be causative for the impairment of hepatic function, which contributes to the development of multiple organ failure. In order to quantify the interrelation between hepatic microcirculatory disturbances and organ dysfunction, we have analyzed hepatic microcirculation (in vivo microscopy), energy metabolism (ketone body ratio) and liver excretory function (bile flow) during hemorrhagic shock in rats. ⋯ Liver microcirculation in hemorrhagic shock is characterized by sinusoidal perfusion failure with a reduction of erythrocyte flux, leukocyte velocity and enhancement of leukocyte adherence to the microvascular endothelial lining. Correlation of the impairment of energy metabolism and liver dysfunction with these microcirculatory disturbances may indicate their crucial role in the development of shock-induced organ failure.
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Minimal invasive, or more specifically laparoscopic surgery is now the standard procedure in an increasing number of surgical specialties. Inflating the abdomen with CO2 for long periods confronts the anesthesiologist with a number of problems that influence the choice of anesthetic and the monitoring deemed necessary. The increased intraabdominal pressure (IAP) and for some operations the extreme Trendelenburg position can disturb alveolar ventilation and compromise oxygenation. ⋯ Balanced anesthesia or total intravenous anesthesia is to be preferred, and the drugs employed should have rapid elimination kinetics with a short recovery time, since wound closure time is drastically reduced. Inhalational anesthesia alone may inhibit hypoxic pulmonary vasoconstriction thereby unduly increasing oxygen desaturation. The necessary degree of muscle relaxation still remains to be defined.