Anästhesie, Intensivtherapie, Notfallmedizin
-
Myasthenics must be considered as surgical risk patients. It is imperative to know the exact pathophysiology of the disease pattern with its three types of crisis including their treatment in order to perform safe anaesthesia and to reduce the rate of perioperative complications. In the preoperative phase we must consider a few specific angles besides the routine manipulations: Treatment with cholinesterase inhibitors as practised in myasthenics is continued unchanged or with only slightly reduced dosage up to the day of the operation. ⋯ After surgery the patient is transferred to the intensive care ward in intubated position, extubation being performed only after spontaneous breathing has been safely assured. In postoperative analgetic treatment the opiate antagonist pentazocine (Fortral) showed the best results as far as our experience goes. With careful monitoring, however, it is also possible to employ other highly effective analgesics.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Anasth Intensivther Notfallmed · Jun 1986
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of volume substitutes 5 percent human albumin and 6 percent hydroxyethyl starch (40,000/0.5) in pediatric anesthesia].
Human albumin 5% (HA), frequently used in paediatric anaesthesia as a human plasma substitute, could be replaced by hydroxyethyl starch 6% (HES) 40,000/0.5 provided its use would not entail any disadvantages but rather advantages instead. This problem was studied by examining 30 children (mean body weight 32.5 kg) in general anaesthesia. During about 3 hours of surgery the patients lost up to 15 per cent (approx. 400 ml) of blood volume. ⋯ Serum [Na+] was reduced in those children who had been treated with HES, to 137.33 +/- 33.30 mmol/l; however, in those children who received HA with low sodium content (statistically significant difference = s.s.) the corresponding level was 134.15 +/- 2.36 mmol/l. Serum creatinine rose in each case from 60 to 80 mmol/l (s.s.), renal function being slightly impaired probably due to the anaesthesia and surgery. The value according to Quick's test and the partial thromboplastin time (PTT) remained in the normal range both with HA and HES treatment (in each case over 70% and below 25s, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
-
Anasth Intensivther Notfallmed · Jun 1986
[Intraoperative monitoring in artificial respiration of premature and newborn infants. II. Monitoring of arterial oxygenation].
Monitoring of adequate arterial oxygenation serves to avoid periods of hypoxaemia and hyperoxaemia with potentially life threatening or organ-damaging sequelae. Basic clinical monitoring, i.e., inspection and auscultation, is mandatory. ⋯ Invasive monitoring of gas exchange is essential in prolonged or intrathoracic interventions as well as in neonates with cardiopulmonary problems. paO2 can be estimated by capillary blood gas analysis; arterial blood gas analysis, however, is required for exact determination of paO2 and of the arterio-cutaneous pO2 gradient (atcDO2). Intraarterial fibre optic determination of oxygen saturation or determination of paO2 with an intraarterial Clark electrode does not appear to be well suited for intraoperative conditions.
-
Anasth Intensivther Notfallmed · Jun 1986
[Protective effect of lidocaine in maintaining the function of peripheral nerves].
The conduction preserving effect of lidocaine was investigated in sheathed vagus nerves of the rabbit. The nerves were preincubated for one hour in solutions containing either 5 (group I, n = 12) or 20 mmol/l glucose (group II, n = 12). ⋯ In contrast, A and C compound action potentials of nerves incubated without lidocaine were extinguished within 69 +/- 5 and 78 +/- 6 minutes, respectively (group I, p less than 0.001) or 106 +/- 9 minutes (group II, p less than 0.005). The results suggest that administration of subblocking concentrations of lidocaine by standard Bier block technique may increase the margin of safety during operations employing a pneumatic tourniquet, especially if the blood flow to the nerves is impaired by vascular diseases or local anaesthetics containing adrenaline.
-
Anasth Intensivther Notfallmed · Jun 1986
[Respiratory minute volumes following end expiratory CO2 values in artificial respiration in anesthesia].
During artificial ventilation of anaesthetised patients the respiratory minute volumes were estimated after end tidal CO2-values (eeCO2) and correlated to arterial blood gases. In men the mean respiratory minute volume of 130 ml/kg body weight (b.w.) was significantly above the 113 ml/kg b.w. of women. 9.7-year-old boys and 16-year-old men had higher minute volumes (178 ml/kg b.w. and 148 ml/kg b.w. respectively) in comparison to men of 23 years of age. In contrast, no significant difference was seen in the older age groups. ⋯ EeCO2-values of 3.8 to 4.2 per cent by volume stand for a very marked hyperventilation in the pulmonary healthy patient. The arterial alveolar difference of the CO2 pressure (aADCO2) was in the normal range between 1 and 5 mmHg. The end tidal CO2 estimation is a noninvasive and suitable method to exactly meet the ventilatory needs of the anaesthetised patient.