Anästhesie, Intensivtherapie, Notfallmedizin
-
Anasth Intensivther Notfallmed · Dec 1990
Review Comparative Study[Epidural conduction anesthesia versus general anesthesia. A critical evaluation of outcome studies using as examples cesarean section and patients with hip fractures].
In the field of anaesthesiology, outcome studies are undertaken to investigate the influence of different anaesthetic techniques on the intra- and postoperative course of patients in special clinical situations. The design of these studies should follow high methodological standards. ⋯ Up to now, results do not clearly indicate the use of certain techniques in concrete clinical situations. Decisions must be made in accordance with clinical aspects, individual experience and in cooperation with the patient and the surgeon.
-
Anasth Intensivther Notfallmed · Oct 1989
Review[Personal experiences with extracorporeal CO2 elimination in patients with severe ARDS--a current review].
The method of extracorporeal CO2 elimination (ECCO2-R) as described by Luiciano Gattinoni and Theodor Kolobow is compared with earlier extra corporeal methods such as extracorporeal membrane oxygenation. The physiological fundamentals of the method, as well as indications and contraindications are explained. - The results of more than 100 patients treated worldwide are discussed together with the present problems of the method. In cases of severe ARDS stage IV, ECCO2-R definitely reduces mortality.
-
In recent years progress in anaesthesia and surgery has led to improvements in care for traumatized patients. This progress not only affects emergency treatment, but also critical care. Although today a failure of one organ system can be successfully treated in most cases, the problem of multiple organ failure is still unsolved. ⋯ Among the special problems are disturbances of the patients immune system, nosocomial infections with the development of sepsis and its impact on organ functions, hypermetabolism and metabolic failure. The improved insight into the cellular and humoral pathophysiology has led to changes in diagnostic and therapeutic procedures in these patients. Only an aggressive, combined effort of many medical specialties from the beginning and an early recognition and treatment of complications and organ dysfunctions can lead to optimal results.
-
Anasth Intensivther Notfallmed · Feb 1989
Review[Current possibilities and limits of transcranial Doppler sonography as a cerebral monitoring procedure].
Transcranial Doppler Sonography (TCD) can meet some requirements for an ideal measuring device of the cerebral circulation. TCD can measure non-invasively and repeatably blood flow velocities of basal cerebral arteries. Under the assumption of constant vessel diameters can altered flow velocities reflect alterations of cerebral blood flow. ⋯ Furthermore TCD has been applied in cerebrovascular diseases, during operations with extracorporal circulation and in patients with increased intracranial pressure. Unchanged diameters of basal cerebral arteries have been proven only for carbon dioxide variations and some drugs; this cannot be presupposed during alterations of mean arterial or intracranial pressure. If conditions as ventilation, hemodynamics and drug therapy are kept constant, TCD may be valuable for short-term-trend-detection of cerebral blood flow and intracranial pressure.
-
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.