Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Dec 1988
[The equilibrium of nitrogen, potassium and phosphate and renal excretion of creatinine and creatinine over the course of 3 weeks following severe trauma].
In 19 patients after accidental trauma and with intact renal function during an observation time of 21 days we found a cumulated negative balance of nitrogen (N), phosphate (P) and potassium (K) amounting to a mean of 214g, 357 and 447 mmol, respectively. Median daily potassium balance was positive on day 2 to 5 and this was interpreted as an increased extrarenal potassium deposition due to increased levels of circulating catecholamines. Median renal creatinine excretion was about 120% of predicted normal till day 10 and continuously decreased thereafter to values lower than predicted normal. ⋯ During the phase of creatinuria, however, the negative balance of N, K and P seems to be mainly due to muscle wasting. Hypophosphatemia was prominent during the first 5 days after trauma and obviously was caused by a decrease in renal phosphate threshold (TmPO4/GFR). The underlying mechanism of this primary change in renal function after severe trauma could not yet be identified.
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Anasth Intensivther Notfallmed · Oct 1988
Randomized Controlled Trial Comparative Study Clinical Trial[The effect of atropine, fentanyl and alfentanyl on cardiocirculatory parameters and thoracic rigidity in the induction phase of intubation anesthesia].
Fentanyl and alfentanil may cause bradycardia if used in combination with succinylcholine during induction of anaesthesia. We therefore studied the influence of atropine, fentanyl and alfentanil on the haemodynamics of 90 urological patients (ASA I, II), who were allocated at random to six groups containing 15 patients each. Induction of anaesthesia was carried out using atropine 0.01 mg/kg-1, fentanyl 0.15 mg or alfentanil 1.5 mg depending on the assigned group: I atropine + fentanyl, II: atropine + alfentanil, III: fentanyl, IV: alfentanil, V: control (no atropine, no analgetic), VI: atropine. ⋯ Arrhythmias occurred in the groups with atropine in 4 out of 45 cases, while a chest wall rigidity was not influenced by atropine. Bradycardia occurred after fentanyl or alfentanil with atropine in the same frequency as without atropine. According to our results the routine use of atropine for induction of anaesthesia with thiopentone/fentanyl or alfentanil even in combination with succinylcholine is not required in ASA I or II patients.
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Anasth Intensivther Notfallmed · Oct 1988
Biography Historical Article[Joseph O'Dwyer--a pioneer in endotracheal intubation and pressure respiration].
The oro- and nasotracheal intubation has been developed into one of the most important techniques in anaesthesiology. Originally, intubations were carried out for overcoming acute diphteric airway obstruction in children. As late as the end of the 19 century, the only life saving chance was to perform tracheotomy. ⋯ Working together with the surgeon George Fell, O'Dwyer designed an apparatus, for artificial respiration. As Fell-O'Dwyer Apparatus it was widely used in cases of asphyxia, - even in those caused by overdosage of anaesthetics. Further developments of the apparatus permitted positive pressure ventilation and the combination with a funnel for narcotics increased the repertory of anaesthesiological possibilities.
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Anasth Intensivther Notfallmed · Oct 1988
[Alarms of medical-technical equipment in the surgical intensive care unit. A prospective study].
To test the need for a graded system of alarms on ICU we examined this aspect of present management by recording the number of devices and alarm-releasing facilities, the interpretation of alarms and type of response of the nursing staff. The data were recorded on multiphase basis at the operative ICU of a university hospital. ⋯ In more than 50 per cent the first reaction of the staff was alarm-related. We conclude that the number of alarm signals should be reduced and unique signals used for each group of medical devices.
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Anasth Intensivther Notfallmed · Oct 1988
[Continuous intrathecal opiate therapy with a portable drug pump in cancer pain].
Terminal cancer patients report substantial pain frequently. Pain control can be achieved in many patients with conventional methods and analgesics. However, significant numbers of patients remain in pain. ⋯ No serious complications like meningitis or other infections were observed. Postmortem examination also could not detect changes of the cord or signs of arachnoiditis due to intrathecal narcotics or the implanted catheter. We conclude, that continuous intrathecal narcotic infusion by means of small portable pump is a very efficient method to control terminal cancer pain and enables treatment on an outpatient basis until death.