Praktische Anästhesie, Wiederbelebung und Intensivtherapie
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Comparative Study
[Efficacy of plasma substitutes of different molecular weight in acute haemorrhagic shock in dogs (author's transl)].
Dogs were bled into haemorrhagic shock. They were then given isovolaemic infusions of dextran 60 and 40 and of hydroxyethyl starch with an average molecular weight of 200,000 and 40,000 respectively with a view of assessing the haemodynamic efficacy of these plasma substitutes. ⋯ HES 40 (molecular weight 40,000) was retained for about 3-4 hours as measured by cardiac output. For normalizing a relative hypovolaemia, e.g. during anaesthesia or in some emergencies, colloidal plasma substitutes which will be retained for only a short time are entirely satisfactory.
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Comparative Study
[Interpretation of chest roentgenograms of intensive care patients. A comparison of pathoanatomical and roentgenographic findings (author's transl)].
Chest roentgenograms made within 24 hours of death were compared to the autopsy findings. Out of 150 unselected autopsy records of the years 1973/74 and 1976/77 50 and 91 cases respectively were suitable for evaluation. ⋯ The success of these measures is reflected in the greater diagnostic accuracy in respect of the case material for the 1976/77 period. Comparison of the findings in cases of pulmonary embolism exposed the limitation of diagnostic radiology.
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A laryngoscope blade with an integrated suction tube is described. Suction and laryngoscope can be handled simultaneously by one hand. The suction guarantees a free sight during intubation in cases of bleeding in the nasopharyngeal region and may also prevent the aspiration of acid gastric contents.
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A method of spinal anaesthesia with Dixidextracaine-70 (a mixture of xylocaine 40.0 mg + percaine, 10.0 mg+ Dextran-70, 60,0 mg+ distiled water ad 2.0 ml) with continuous epidural block has been tested in 150 patients. The advantages of this association are: the possibility of obtaining a high quality conduction anaesthesia, virtually unlimited in time, the ability to extend over several anatomical regions the surgical field, minimal toxicity, the absence of postoperative pulmonary complications, and the economy. Drawbacks are: the need for two vertebral punctures, the longer induction time of anaesthesia and some difficulty in finding the subarachnoid space after catheterisation of the epidural space. The indications of the method include subdiaphragmatic surgery, interventions on more than one anatomical region, surgery in aging patients, patients with full stomach, and those with anaesthetic and surgical risk, as well as socioeconomic factors which may prevent application of a differentiated and safe narcosis. ⋯ those of subarachnoid and epidural block. The incidents and accidents are minimal and specific to both techniques. The fear of producing total subarachnoid anaesthesia by injection of the anaesthetic solution in the epidural space after puncture of the subarachnoid space is virtually unfounded.
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Clinical Trial Controlled Clinical Trial
[The influence of sedation with diazepam and flunitrazepam during regional anaesthesia upon postoperative pulmonary performance (author's transl)].
In 32 patients between 53 and 86 years of age, undergoing transurethral prostatectomy, the influence of intraoperative sedation with Diazepam (5-10 mg) and Flunitrazepam (0,4-0,8 mg) on postoperative forced vital capacity, forced exspiratory volume (1 sec.) and peakflow, were measured, compared to placebo. We could not find a depression of these ventilatory parameters, in the three groups except peak-flow after sedation with Flunitrazepam in the evening after operation (p less than or equal to 0,05). We conclude that sedation during regional anesthesia does not impair the most important advantage of local anesthesia, the minor effect on ventilation, compared with general anesthesia.