Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Jun 1984
Case Reports[Successful therapy of accidental deep hypothermia].
A case of extreme accidental hypothermia to 23,5 degrees rectal temperature in a 79 years old female with a skull-brain-trauma is reported. Under continuous monitoring and maintenance of vital functions, we succeeded by means of slow surface rewarming in prevention of noxious side effects on the circulatory system. The favourable course during the rewarming process probably was due to elimination of thermoregulation in brain trauma. The patient had a good longterm out-come.
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Twenty patients with combined mitral valve disease were studied to evaluate whether the mode of cardiac pacing can influence myocardial performance after cardiopulmonary bypass. All patients underwent the same surgical procedure (mitral-valve-replacement) under standardized anaesthetic procedure. After weaning from extracorporeal circulation the following haemodynamic measurements were performed either under ventricular pacing or under sequential ("physiological") pacing: blood-pressure (radial artery), central venous pressure (CVP, jugular vein), cardiac output (as cardiac index, C. ⋯ The data indicate that there is some influence on cardiac work by the mode of pacing. Physiological pacing compared to ventricular pacing seems to lead to a marked improvement in cardiac performance. Particularly patients with severe dysrhythmia following cardiopulmonary bypass should be treated by physiological (sequential) pacing.
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Anasth Intensivther Notfallmed · Jun 1984
[Monitoring neuromuscular function in the operating theater].
The advantages of monitoring neuromuscular blockade during anaesthesia and intensive care by electromyography or mechanomyography are reviewed. Correlations between clinical symptoms, monitoring parameters and percentage of receptor occupation are established. ⋯ It is pointed out, that neuromuscular transmission can be considered to be unimpaired, if single twitch responses equal 100% of preblock values and train of four ratios achieve 0.7. Especially under conditions of hypothermia, acid-base disturbances or side effects of drugs other than muscle relaxants monitoring of neuromuscular transmission is superior to simple clinical judgment.
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Anasth Intensivther Notfallmed · Jun 1984
[Adjustment of synchronized intermittent ventilation with the Drager Company's SIMV Pulmolog].
When choosing an IMV frequency in a respirator, the aim should be to guarantee a minimum of ventilation. With most respirators the "time-window" for the synchronisation of the mandatory stroke volume is within the ventilatory cycle. ⋯ This difference is most important for daily clinical practice, as the minimum IMV frequency may be below the adjusted one. The manufacturer has reacted by changing the data on the manufacturer's label.
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Anasth Intensivther Notfallmed · Apr 1984
[Results of therapy of severe metabolic alkalosis using hydrochloric acid infusions].
Severe metabolic alkalosis is often treated by infusion of arginine-HCl. Since we know that this substance leads to a supplemental increase of intracellular pH and fails to reduce intracellular bicarbonate concentration we use HCl for correction of this disturbance of acid-base equilibrium. 18 intensive-care patients with severe metabolic alkalosis were treated with an infusion of 0.2 m HCl. ⋯ Arterial plasma pH, potassium, Hb, Hk, pCO2, pO2, and SO2 remained unchanged. Instructions for preparing different HCl solutions and advice on dosage are given.