Praktische Anasthesie, Wiederbelebung und Intensivtherapie最新文献

In 12 patients before and after vaginal hysterectomy the plasma amino acid levels were determined. Without parenteral feeding the changes in plasma amino acid patterns can be explained by effects of operation and anaesthesia alone. The branched-chain amino acids decreased after operation. The following rise was never exceeding the control level. Even without substitution the concentrations of phenylalanine, methionine, and glutamic acid were increased. Tyrosine concentration remained within normal levels while cystine fell significantly.

A complete knot of a central venous catheter is a rare complication of subclavian vein catheterization. The knot was pulled tight and minimised, because it was impossible to untie the catheter by the "guidewire-technique" (9). After that, the catheter was removed without damage to the venous wall.

The influence of four different types of anaesthesia -- halothane and enflurane inhalation anaestheis, neurolept analgesia and epidural analgesia with single shot technique -- on the serum levels of GOT, GPT, GLDH, LDH, AP, LAP, gamma-GT, total protein and bilirubin was examined in 104 comparable cases undergoing gynaecological surgery. A significant increase in GOT, GPT, GLDH, AP, and gamma-GT levels was observed between the 6th and 9th postoperative day with all types of anaesthesia. The serum levels remained elevated until the 15th postoperative day. There was no significant difference between the four types of anaesthesia as regarded their effects on the serum constituents investigated. The same applied to the serum CHE activity which reached a minimum on the 3rd postoperative day followed by a steady rise. The results indicate that the postoperative changes of the liver enzyme pattern are not related to the type of anaesthesia used. Bilirubin was elevated on the first postoperative day, then dropped rapidly and stayed below the pre-operative values until the 12th postoperative day. There was no difference between the four types of anaesthesia. Glucuronisation of bilirubin may be inhibited initially by the anaesthetic agents. The subsequent rapid fall of the bilirubin levels may be the result of enzyme induction.

Twelve metabolically healthy patients, who had to undergo cholecystectomy or gastric resection, were fed intermittently by the parenteral route (via veins of the upper limbs) post-operatively up to and including the 2nd post-operative day with a combined maltose-glucose solution in parallel with an 8% mixture of crystalline L-aminoacids. At an administration rate of 150 g maltose/day and 250 g glucose/day with the simultaneous administration of 80 g aminoacids, the mean carbohydrate utilisation was 82,5%. The glucose and maltose levels in the blood fluctuated in accordance with the infusion periods and the free fatty acids levels measured were their mirror image. On the whole free fatty acids were lowered significantly, which indicates adequate carbohydrate supply with consequent inhibition of lipolysis. The degree of tolerance was determined objectively by measurement of the acid-base parameter, gamma-GT, alkaline phosphatase, GOT, bilirubin, uric acid, creatinine and serum electrolytes. No changes were found which could be attributed to the administration of the infusion solution.

In 13 autopsy cases after catheterization of the superior caval vein a surprisingly high rate of incorrect positions of the catheter tip within the right atrium was seen. This had resulted in wide spreaded lesions of the endocardium and in voluminous thrombosis around the catheter tip. In one case a pericardial serous effusion with letal cardiac tamponade was found because of such malpositioning of a caval catheter. The mechanical stress to the endothelium by the catheter tip is held responsible for the intima lesions in the right atrium. The need for X-ray-control of the catheter position and its fixation at the site of entry through the skin is stressed.

A study was made of the extent and type of contact which patients of an intensive care unit established with each other. The information was obtained by interviewing 92 patients in 4 different types of intensive care units. In evaluating and interpreting the results special attention was paid to the possible influence of 10 patient-specific and disease-specific parameters. 81 per cent of the interviewed persons had established contact, mostly of a verbal nature, with their fellow patients. The majority appreciated the companionship and attached a positive value to the contacts made: communication with the other patients relieved the mental stress arising from their condition and detracted from their anxiety and tendency to brooding; on the other hand, they were also, to some extent, worried that too much excitement might adversely affect their condition. Encouraging talks by the medical team greatly helped towards reducing stress. Even severely ill persons who could no longer actively communicate felt happier in a multi-bed ward: they felt less isolated and more involved and therefore, psychically supported. The fact that the great majority of patients preferred multi-bed units to single rooms suggests that the former have a stabilizing effect, both physically and psychically - an aspect of intensive care that has so far been ignored.

We present a case of hydrothorax, which occured in a young man following unrecognized vein perforation by a left internal jugular vein catheter two days after cannulation. The mechanism of this complication and methods for its prevention are discussed.

Under parenteral and following oral nutrition in ten metabolically healthy patients the plasma amino acids were determined before and after vaginal hysterectomy. Starting from normal preoperative values there is a fall in the plasma concentration of most amino acids. The branched-chain amino acids decreased significantly, but under oral feeding they rose above the initial values. With increased plasma phenylalanine and methionine levels the concentration of cystine and tyrosine remained nearly unchanged. Glycine showed no increased levels while serine concentration was decreased even under substitution.