Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Jun 1985
Case Reports[Artificial respiration: yes or no? Ethical reflections on border-line questions in intensive care medicine].
Artificial ventilation is a symbol for intensive-care medicine. Within the framework of possibilities and limitations of intensive care, artificial ventilation is often discussed on a highly emotional plane. Three case reports serve to show that, to avoid inadequate treatment, it will be necessary to consider not only medical problems but also ethical, anthropological and psychological aspects when deciding about controlled respiration.
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Anasth Intensivther Notfallmed · Jun 1985
[Suppression of the adrenal cortex by infusion of etomidate in general anesthesia].
The effects of anaesthesia with fentanyl and prolonged etomidate infusion (0.8 mg/kg/h) on the peroperative and postoperative change in blood concentrations of aldosterone, cortisol, dehydroepiandrosterone, ACTH, epinephrine, norepinephrine, dopamine, glucose, lactate and free fatty acids (FFA) were investigated in connection with major abdominal surgery. During surgery and anaesthesia with prolonged etomidate infusion no significant alterations in plasma catecholamine concentrations were observed. ⋯ Despite this endogenous ACTH stimulus, aldosterone (121.8 +/- 19.4 pg/ml----58.4 +/- 10.4 pg/ml) and cortisol (12.3 +/- 2.84 micrograms/dl----5.79 +/- 1.2 micrograms/dl) and dehydroepiandrosterone (2.28 +/- 1.09 ng/ml----1.27 +/- 0.25 ng/ml) levels were markedly depressed in every patient during the perioperative period. Twenty-four hours after surgery the basal steroid values were within or above normal limits.