Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Feb 1984
[Indications for tracheotomy in long-term ventilated critically ill patients].
In order to evaluate the frequency and indication of tracheotomy in long-term ventilated critically ill patients we analysed retrospectively patients requiring artificial ventilation for periods of more than 7 days. During 1974-75 30 out of 55 of these patients were tracheotomised. In accordance with common practice, early tracheotomy (14 patients) was performed when ventilatory support was expected to exceed 8 to 10 days. ⋯ No late laryngeal sequelae after prolonged tracheal intubation were observed. The risks have been reduced by the use of recently introduced tube materials. Prolonged tracheal intubation has become a safe alternative to tracheotomy.
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Anasth Intensivther Notfallmed · Dec 1983
Comparative Study Clinical Trial Controlled Clinical Trial[Comparative circulatory studies during implantation of total endoprostheses using methylmethacrylate and BDF cement].
In every ten patients undergoing elective surgery for total hip prosthesis methylmethacrylate and BDF cement respectively were used for the implantation of the prosthesis. The results of the haemodynamic investigation demonstrate that improvement of the surgical procedure may reduce the incidence of haemodynamic parameters: After implantation of methylmethacrylate into the femoral shaft the arterial pressure decreased from 95.9 +/- 13 to 86 +/- 11 torr (P less than 0.05); the left ventricular stroke work index dropped from 49.9 +/- 5 to 42.1 +/- 7 g.m/m2 (P less than 0.01). ⋯ The determination of the serum concentration of the cement monomer did not yield any measurable serum concentrations. Heat production by polymerisation of BDF cement (maximum 45.8 +/- 6.5 Centigrade) was much less compared with the temperature which developed during the polymerisation of methylmethacrylate (maximum 63 +/- 16.4 Centigrade); therefore, the safety of clinical application seems to be greater with the new BDF cement.
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Anasth Intensivther Notfallmed · Oct 1983
Case Reports[Malignant hyperthermia - therapy results with dantrolene. A case report].
A 5-year-old previously healthy girl, received general anaesthesia for performing an appendectomy. After administration of succinyl choline (20 mg, twice repeated) and halothane (increasing to 2 per cent by volume), the following symptoms of malignant hyperthermia became manifest during anaesthesia: rigor, tachycardia, cardiac dysrhythmia, temperature increase to 42.6 degrees C; anaesthesia was effected with 2 litres O2/min, 4 litres N2O/min, halothane 1.5-2 per cent by volume, using the Kuhn system. ⋯ The pattern of symptoms and therapy are critically reviewed. Basing on the cases described in literature, as known to the authors, the value of dantrolene in respect of treatment of malignant hypothermia in man is reviewed.
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Anasth Intensivther Notfallmed · Oct 1983
[Experiences with high-frequency jet ventilation in operations of the larynx and trachea].
60 ENT patients were ventilated with the high frequency jet ventilation method, using endotracheal catheters during 50 cases of laryngeal and 10 cases of tracheal surgery. Ventilation was carried out with equipment of type MK 800 (Acutronic Ltd.) using the following parameters; rate: 150/min, insufflation time: 30-40%, pressure: 0.7-2.1 bar, and flow minute volume (FMV) 7-23 1. Anaesthesia was carried out with flunitrazepam or diazepam, fentanyl and succinylcholine. ⋯ Hypoventilation occurred when the FMV was less than 250 ml/kg in patients with decreased lung function, when the tip of the catheter was inserted into a mainstem bronchus or near to the tracheostoma, or when gas escape was obstructed. Unhampered gas escape must be present at all times, because otherwise intratracheal pressure rises and ventilation becomes insufficient. If the pressure increase is marked under these circumstances it can even lead to a pneumothorax.
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Anasth Intensivther Notfallmed · Aug 1983
Review[Effect of high-frequency ventilation on the pulmonary clearance system].
Four types of ventilation with high frequencies offer new therapeutical possibilities of treating severe pulmonary diseases. The first aim in using these techniques is to normalize or to maintain a stable gas exchange. Secondly, the improvement of mucociliary transport function and the counterpulsation effect on the capillaries and lymph vessels may have an interesting influence on pulmonary secretion clearance. These methods will represent essential progress in mechanical ventilation and respiratory physiotherapy, if they gain clinical perfection.