Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Oct 1990
[The effect of positive end expiratory pressure on the blood flow velocity in the basal cerebral arteries during general anesthesia].
The effects of incremental positive end-expiratory pressure (PEEP) on middle cerebral artery (MCA) blood flow velocity and pulsatility index were studied in 20 patients scheduled for minor elective surgery. Transcranial Doppler sonography (TCD) was used to measure systolic (Vsyst) and mean flow velocity (Vmean) and the pulsatility index (PI). Heart rate (HR), mean arterial blood pressure (MAP), end-tidal CO2(PetCO2) and TCD parameters were recorded at control (PEEP = O) and following PEEP of 5 cm H2O, 10 cm H2O and 15 cm H2O for a period of 5 minutes for each PEEP level. ⋯ PI increased stepwise in response to each PEEP level. MAP decreased with PEEP 10 and 15 while HR and PetCO2 remained constant over time. These data suggest that PEEP-induced decreases in MCA blood flow velocity may represent decreases in CBF due to impairment of the intracranial venous flow if the diameter of the insonated vascular segment remains constant.
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Anasth Intensivther Notfallmed · Oct 1990
Comparative Study Clinical Trial Controlled Clinical Trial[The recovery period following total intravenous anesthesia using propofol and alfentanil versus inhalation anesthesia using nitrous oxide and enflurane at 1.3 MAC].
Recovery of motor and mental functions were investigated in two groups with 20 young patients each. One group received total intravenous anaesthesia (TIVA) with propofol and alfentanil for urological surgery and the other group received nitrous oxide-oxygen anaesthesia in combination with 1.3 MAC of enflurane for lumbar nucleotomy. The following parameters were investigated before and up to 100 minutes after extubation: simple and discriminating motor activities, vigilance and short and long term memory. --Simple and in discriminating motor actions show a significantly faster recovery was seen in the TIVA group during the first 20 minutes after extubation compared to the enflurane-treated patients. ⋯ However the large dosages of alfentanil may be a problem with regard to post-anaesthetic respiratory depression. Further studies with larger numbers of patients will be necessary to evaluate the potential side effects of continuous propofol/alfentanil infusion. Presently, safety demands require, at least a sixty-minute post anaesthesia monitoring for patients receiving this new anaesthesia method.
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Anasth Intensivther Notfallmed · Oct 1990
[The efficiency of prehospital cardiopulmonary resuscitation. Which factors determine the outcome?].
Survival rates following cardiopulmonary resuscitation differ widely with regard to the diverse rescue systems where the investigations were performed, and also with regard to the different patient populations. From 1981 to 1986, 1037 patients with out-of-hospital cardiac arrest were investigated in the city of Bonn. It was the purpose of this study to differentiate between various patient populations and to analyze factors which are responsible for CPR success. ⋯ The worst results were seen in these patients where CPR was initiated following trauma (8%) or in paediatric patients (8%). Factors which significantly determine survival following CPR are: initial ECG finding, therapeutic delay with regard to bystander-initiated basic life support, as well as advanced life support by emergency physicians. In addition, well standardized therapeutical strategies are of importance with early defibrillation, rapid endotracheal intubation and swift epinephrine application mostly by endobronchial administration.