Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Aug 1986
[Airway pressure and transcutaneous O2 and CO2 partial pressure as monitoring measurements for high-frequency jet ventilation?].
Two different methods of measuring airway pressures (n = 7), and the usefulness of transcutaneous pO2 and pCO2 measurement (n = 9) in monitoring High Frequency Jet Ventilation (HFJV), were investigated in critically ill patients. Airway pressures obtained by tip manometer from different points within trachea and mainstem bronchi during HFJV (f = 100/min, inspiratory time 40%, FIO2 0,4, minute volume 25.6 +/- 5.2 l) were nearly identical with pressures obtained from the integrated pressure line of HI-LO-JET endotracheal tubes (R = 0.9638). ⋯ There was sufficient correlation between transcutaneous and arterial pO2 (R = 0.7573) and poor correlation between transcutaneous and arterial pCO2 (R = 0.4987). paO2 values were 51.1% above, paCO2 values 33.4% below transcutaneous values. Transcutaneous measurement of pO2 and pCO2 is only an additional method in monitoring HFJV which can reveal rough trends but cannot replace blood gas analysis.
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Anasth Intensivther Notfallmed · Aug 1986
[Course of central body temperature in the laminar airflow operating room in various anesthesia procedures].
The oesophageal body temperature of 130 patients was measured pre- and intraoperatively. 92% (n = 116) of the operations (implantation or replacement of hip prostheses) were performed in an operating room having a laminar air flow system with horizontal air flow. 9% (n = 14) of the operations (laparotomies) were performed in a room of identical design without an air circulation system. Three different forms of anesthesia were investigated with regard to their influence on interior body temperature: 1) general anesthesia with a volatile anesthetic (INH); 2) peridural anesthesia with additional general anesthesia (KPDA+ITN); and 3) neuroleptic anesthesia (NLA). A drop in temperature during the operation was found in all patients. ⋯ In the operating room with laminar air flow the INH-patients sustained the greatest decrease in temperature; the mean value in the first hour was 1.1 degrees C/h, and up to 4.6 degrees C/3 h toward the end of the operation. There was a comparable drop in temperature in the first hour in patients anesthetized with KPDA+ITN, but the rate slowed down toward the end of the investigation (2.2 degrees C/3 h). NLA caused a characteristic temperature behavior, with an initial fall in temperature, plateau phase, and subsequent rise (total: -1.0 degrees C/3 h) Temperature regulation was influenced least by NLA in the operating room with laminar air flow; thus, in this context, NLA proved to be a favourable form of anesthesia.
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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)
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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)
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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.