Anästhesie, Intensivtherapie, Notfallmedizin
-
Anasth Intensivther Notfallmed · Jan 1990
Clinical Trial Controlled Clinical Trial[The modification of injection pain and the incidence of thrombophlebitis following etomidate].
A prospective study with 161 patients was performed to investigate the effects of intravenous local anaesthetics on the pain of injection following etomidate injection. After placebo injection 56.6% of the patients reported on pain after etomidate, but only 29% after 20 mg lidocaine i.v. ⋯ The rate of postoperative thrombophlebitis was lowest in the group with combined lidocaine with venous congestives at 7.4%, in opposition to a rate of 18% in the remaining groups. In comparison to a second contralateral venous cannula without applied etomidate the venous sequelae did not increase significantly.
-
Anasth Intensivther Notfallmed · Jan 1990
[Cricothyreotomy using the Quicktrach coniotomy instrument set].
Percutaneous cricothyroidotomy may be a lifesaving procedure for airway obstruction, which cannot be relieved by endotracheal intubation and can be performed with specially designed instruments. A new device, the "Quicktrach", was evaluated by an anatomical preparation, flow and resistance measurements, and puncture of the cricothyroid membrane in 55 corpses. The size of the parts of the instrument (needle, plastic cannula, depth gauge) in relation to the size of the larynx is adequate, thus there is little likelihood of perforation of the posterior wall of the larynx. ⋯ The "Quicktrach" is easy to apply even by inexperienced persons. The incidence of damage to the larynx (lesions including fractures of the thyroid, cricoid and 1. tracheal cartilage in 18%; soft tissue injury in 9%) is relatively high, however considering the live saving character of the procedure these numbers appear to be acceptable. Technical problems which occur with the use of the device are discussed and suggestions for improvement are made.
-
Anasth Intensivther Notfallmed · Dec 1989
[Fiber bronchoscopy as an aid in placing and monitoring double lumen tubes in thoracic anesthesia].
100 thoracic surgery patients were intubated by means of a left-hand Broncho-Cath PVC Double-Lumen Tube (DLT) and 10 further patients with a right-hand tube. In 76 of the 100 left-hand DLT's safe conventional placement of the tube was successful, oriented exclusively by auscultation findings and positive pressure respiration. However, fibre-optic control showed that only 44 of these tubes were correctly positioned (57.1%). 25 DLT's were too high and 24 too low, whereas the right main bronchus had been intubated in 6 cases. 1 DLT was endoscopically correctly placed although the positioning of the tube had been considered unsatisfactory during conventional examination. ⋯ Recurrent tube dislocations occurred both after lateral repositioning of the patients (so that they were now lying sideways) (27.3% of all patients) and intraoperatively (24.6% of all patients). Besides, intraoperative obstructions of the tube/bronchus lumen due to blood/coagulates (49.1% of the patients) and/or secretion (46.4% of the patients) could be demonstrated and eliminated by endoscopy. Fibre bronchoscopy proved to be a decisive help to reduce the possibilities of complications associated with the use of the Broncho-Cath PVC-DLT in thoracic surgery.
-
Anasth Intensivther Notfallmed · Dec 1989
Randomized Controlled Trial Comparative Study Clinical Trial[Effects of low molecular weight hydroxyethyl starch (HES 40) in comparison with Ringer solution on oxygen tension in skeletal muscles of infected patients].
Volume expansion for the establishment of normal to slightly hyperdynamic systemic circulation has become part of a standard concept in the treatment of septicemic patients. The goal is an improvement of microcirculation with beneficial effects on tissue oxygen supply. This study investigates the effect of hydroxyethyl starch solution (HES 6%: mean molecular weight = 40,000) versus ringer's solution on tissue oxygen tensions in human skeletal muscle during periods of septicemia in 10 mechanically ventilated ICU-patients. ⋯ In both groups no linear correlation between hematocrit and pO2-tensions could be established. It remains unclear if pO2-tensions during and after HES infusion can be correlated to an improved capillary perfusion. However, as was clearly demonstrated, different types of solutions used for volume expansion may exert different effects on pO2-tissue tension in septic patients.
-
Anasth Intensivther Notfallmed · Dec 1989
[Pulse oximetry monitoring of single lung anesthesia in non-cardiac thoracic surgery].
The pulse oximeter provides continuous and non-invasive measurement of the arterial oxygen saturation. Pulse oximetry contributes to safer patient management because of the immediate availability of oxygen saturation values. ⋯ Pulse oximetry is as important as ECG monitoring and invasive blood pressure monitoring and should therefore be a standard monitoring technique in thoracic surgery. With a pulse oximeter it is possible to efficiently monitor anaesthesia during one lung ventilation thereby avoid hypoxia with its life-threatening complications.