Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Aug 1985
Case Reports[Celiac plexus block. Modeling study using images of computerized tomography].
To determine possible risks of the blind approach to the coeliac plexus, a method for simulating Bridenbaugh's "blind" coeliac plexus block by CT slices and scoutviews was employed. This mathematical simulation of the blind approach to the coeliac plexus was applied to CT images of 50 patients suspected of upper abdominal tumours. ⋯ The importance of the coeliac plexus block in patients with chronic pain is stressed. Literature studies and the results of the present study indicate that CT-guided or ultrasound-guided techniques should be preferred in coeliac plexus block whenever the facilities are available.
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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.
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Anasth Intensivther Notfallmed · Apr 1985
Randomized Controlled Trial Comparative Study Clinical Trial[Circulatory effects of vecuronium as well as pancuronium under different conditions of anesthesia].
The cardiovascular effects of equipotent doses (1,25 X ED95) of vecuronium (70 micrograms/kg iv) and pancuronium (80 micrograms/kg iv) were studied in 16 patients scheduled for elective coronary artery bypass surgery during steady-state conditions of isoflurane (0,4-0,5 vol% end-tidal)-nitrous oxide anaesthesia. All patients were chronically treated with oral beta receptor-blocking agents. Vecuronium did not cause any significant cardiovascular changes whereas pancuronium produced increases in heart rate (13%), cardiac index (15%) and mean arterial pressure (4%) while systemic vascular resistance decreased (8%). ⋯ The administration of pancuronium (80 micrograms/kg) caused the greatest percentage increases in HR (20%), CI (22%), MAP (8%) and RPP (31%) in this group of patients. In contrast, patients (n = 8) anaesthetized with isoflurane-nitrous oxide who were not on preoperative beta-receptor blocker medication, demonstrated higher haemodynamic control values and less increases in HR (10%), CI (10%) and RPP (15%), MAP did not change. The clinical significance of these findings is discussed.
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Up to now there are almost no investigations on the situation of relatives of ICU patients. Therefore a study was designed into the impressions left on relatives by intensive care treatment in their next of kin. A questionnaire including 46 items was developed which mainly refers to the following topics: first contact with the ICU, experience with the situation in the ICU, information given on the patient's state, psychosocial assistance, evaluation of experiences made in the ICU. ⋯ The relation to the medical and nursing staff is described as positive, especially by relatives of surviving patients. In retrospect the relatives--like the former ICU patients--hold a positive view of the intensive care unit. The reasons are discussed.