Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Sep 1982
Comparative Study[Lung function in pregnant patients and its significance for anesthetic ventilation in cesarean section].
Spirometry was conducted preoperatively in a group of 10 women subjected to cesarean section. The measured minute ventilation served as basis for ventilation under anaesthesia. ⋯ The maternal carbon dioxide level assumes the significance of a guiding value for the choice of the ventilation parameters. If the spirometric initial data and the actual pCO2 value under anaesthesia are not known, it is recommended to employ a minute ventilation of 11.5 l/min.
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The goal of any anaesthesiologist delivering anaesthesia to patients with pre-existing lung disease has to be the prevention of intra- and postoperative complications. Changes in gas exchange imposed by anaesthesia and surgery can cause dangerous disturbances in oxygen transport and in acid-base balance. Uptake and elimination of volatile and gaseous anaesthetics depend upon normal respiratory function. Any marked impairment can considerably modify the kinetics of these processes.
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Anasth Intensivther Notfallmed · Jun 1982
Case Reports[Malignant hyperthermia. Current aspects of dantrolene treatment of 2 cases of hyperthermia maligna incipiens].
During induction with volatile anaesthetic agents and succinylcholine (suxamethonium) both children showed a singular clinical symptom: trismus. In the first case(1) narcosis had been interrupted followed by clinically controlled recovery. One week later, after treatment with oral dantrolen (Dantamacrin), anaesthesia with triggerfree agents was performed without complications. ⋯ Both children showed significant increases of Creatin-Kinase-activities over 5000 U/l after the interrupted narcosis (1) and postoperatively as being typical biochemical parameters for incipient hyperthermia maligna. All other parameters were normal. A review is given on the use of dantrolene-sodium, its development and its use in our department as lifesaving agent in malignant hyperthermia.
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Anasth Intensivther Notfallmed · Jun 1982
[Tube change in nasotracheally intubated intensive care patients using injector ventilation: a method for the prevention of hypoxic complications].
Conventional methods for the replacement of nasotracheal tubes are often dangerous. The interruption of respiration while replacing the nasotracheal airway may cause severe hypoxia. We developed a technique which shortens the time of apnoe to a few seconds. ⋯ Now the new endotracheal tube is guided into the trachea by the nasogastic tube while jet ventilation is continued. We used this technique 19 times without any complications. We found the method safe and simple, giving sufficient ventilation in all patients, provided that contraindications and precautions are observed.
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Anasth Intensivther Notfallmed · Jun 1982
Clinical Trial Controlled Clinical Trial[Pain treatment by sub or epidural opiate administration].
Morphine and opiate analogues for pain relief were applied epidurally or intrathecally. Synthetic opioids, eg. pethidine, pentazocine or piritramide proved unsuitable with both modes of administration. Only morphine in doses as low as 2 mg reliably produced analgesia lasting from 16-24 hours. ⋯ Conversely this very side effect may advantageously be employed in patients on ventilator treatment as a method for analgesia and sedation. Lumbar epidural administration of single doses of morphine 2 mg at present is the most effective treatment both for pain following thoracotomy, laparotomy, surgery on the vertebral column, gynecological and urological procedures and pain due to trauma to the chest wall or pelvis, provided supervision in an intensive care ward guards against possible side effects. Epidural or intrathecal opiate is not suitable for the treatment of chronic or functional pain.