Praktische Anasthesie, Wiederbelebung und Intensivtherapie最新文献

The influence of general anaesthesia for operations devoid of substantial tissue traumas on the postoperative pattern of hepatic enzymes was studied in 40 patients undergoing ophthalmologic surgery. 20 had neurolept analgesia, 20 had halothane anaesthesia. The duration of anaesthesia, age of the patients and their previous history corresponded fairly closely to those of a group of patients who had gynaecological operations and were the subject of a previous study. In contrast to the latter group total protein, cholinesterase, GOT, GPT, LDH, GLDH, AP, LAP and gamma-GT remained normal up to 12 days after the operation. The exception were changes in the total bilirubin levels which were similar to those observed in the gynaecological cases. Possible causes are discussed.

In a retrospective study a comparison was made of the doses of Fentanyl used by anaesthetists to induce and maintain neurolept analgesia for a variety of surgical operations (158 cases). Dosages differed widely both for different surgical procedures and for different anaesthetists. A method, based on pharmacokinetic considerations, was developed for calculating Fentanyl requirements during any stage of anaesthesia. The dose/time relation, as represented by y = At + B (1--e-kt) makes it possible to calculate the required doses of Fentanyl; this enables the anaesthetist to maintain a stable level of anaesthesia and makes antagonization of Fentanyl unnecessary. Methods for determining the coefficients of the dose-time equation are described. Simulation by an analogue computer showed that by using the suggested procedure substantial variations of Fentanyl concentration in the brain and other body compartments can be avoided.

Antipollution-devices in T-piece-systems are as far useless as they convert the system. A new device for the Jackson-Rees system is described, which does not disturb its function and which may be used in fresh-air-climatisated rooms.

An electronic spirometer is described which, by means of a device for automatic drift compensation, allows the pulmonary function of artificially ventilated persons to be analysed continuously. The results obtained with the apparatus in artifically ventilated premature births, newborns and infants are discussed.

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. Solutions of high molecular weight hydroxyethyl starch (HES 400) were retained in the circulation for about the same length of time as was dextran 60. 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.

Changes of plasma amino acids in animal studies were observed after administration of different narcotic drugs. In a randomised study the effects of neuroleptic anaesthesia and general anaesthesia with halothane on free plasma amino acids in respect to liver toxicity were investigated in patients during microsurgery of the middle ear. 24 hours postoperatively in both groups a significant increase of branched chain amino acids and of phenylalanine as metabolic sign of stress was found. Typical changes of amino acids as shown in hepatic failure could not be seen in both groups. The study showed that none of the narcotics used had a toxic effect on liver function as measured by the levels of free plasma amino acids and that for disagrees with the results of animal studies.

It is reported about the evaluation of resistances and deadspaces of endotracheal tubes. The results show that the resistances of the tubes are similar to the resistances in the patient lungs. The deadspaces are small as compared to the physiological values. It is suggested that a patient with a endotracheal tube has a smaller deadspace than one without a tube.