Praktische Anasthesie, Wiederbelebung und Intensivtherapie最新文献

The preoperative selective blood cell separation followed by the postoperative platelet autoransfusion could prevent the exhaustion of platelet function by operations with extracorporal circulation. The postoperative blood loss could be reduced by about 57%. This method can be recommended specially in cases of increased platelet traumatization after long time perfusion. Partial disturbances of platelet function after operations with ECC can also be favourably influenced by infusion of homologous phospholipid (Fibraccel). The postoperative blood loss could be reduced by about one third. This method is beneficial in open heart surgery with short perfusion times due to its little technical expenses.

An aerosol of an aqueous solution still changes its size from development up to alveoli; therefore only conclusions can be made about possible sizes of particle spectrum. Volatilisation, condensation, coagulation and sedimentation are the important interfering factors. To characterize an aerosol one should know the aerosolvolume, the quantity of nebulised substance and the relative size distribution. A method for measurement of size distribution -- a radioactive aerosol was deposited in a spiral centrifuge -- is described and the aerosol of two ultrasonic nebulizers were compared. Because of their physical properties aerosols of ultrasonic nebulizers play a main part in prophylaxis and therapy of functional lesion of bronchopulmonary affections.

A case of a transnasal, paraoesophageally placed sump tube is reported with consecutive skin emphysema. This complication was caused by certain circumstances: 1. unnoticed perforation of oesophagus, 2. open tube, 3. inspiration against resistance, 4. tube tip placed in slack connective tissue.

Experience gained in 3500 supraclavicular innominate vein punctures for catheterization of the superior vena cava with the indirect technique is explained and discussed. The innominate vein is easily accessible in every state of blood circulation, even intraoperatively when the patient is covered by drapes. The thrombosis risk is reduced because of the wide lumen and the straight course of the vessel (vena anonyma dextra). The special advantages of the indirect technique are the small puncture trauma and absence of false positions. The only important complication observed during an average infusion time of 8 days was pneumothorax at a rate of 1.4%.

At low financial and material costs conventional Engström-respirators (Types ER 200, 300) can be converted to make Intermittent Mandatory Ventilation (IMV) possible. These so converted respirators were examined when a group of patients in a surgical intensive care unit who had undergone mechanical ventilation for a longer period of time was weaned from the respirator. It could be shown that during the step-by-step weaning of these patients no significant changes appeared in the results of the blood gas analyses, which means that the patients' pulmonary function took over again gradually. Doubtlessly, the convertability of the Engström-respirator for IMV will help promote the weaning of patients with respiratory complications by this method.

In 1960 direct laryngoscopy in combination with general anaesthesia with relaxation and intermittent positive negative pressure ventilation via a smallbore blocker tube was introduced. When, in 1965, microlaryngoscopy was developed it was exclusively performed with this technique. Since 1960, 44, 464 ear, nose or throat operations were carried out. 3,305 (7.4%) were endolaryngeal operations. 943 of them were performed in surface analgesia. 2,363 microlaryngoscopic operations were done under general anaesthesia. 22.5 per cent of the patients were women and 77.5 per cent were men. Their age varied between 6 weeks and 86 years. 2.4 per cent were children under 6 years of age and 33 per cent were aged over 60 years. The main advantages of this method over "open laryngeal surgery" are: 1. it provides a large measure of safety for the patient since even old and obese persons with a rigid rib cage can be adequately ventilated; the cuff prevents aspiration; there is no danger of the patient waking up during relaxation since he is being kept ventilated with a mixture of nitrous oxide-oxygen and halothane. Ventilation via the blocker tube begins immediately after intubation and not, as in open jet ventilation, after insertion of the laryngoscope. 2. The surgeon and his team are not exposed to the risk of infection since, in contrast to the "open larynx" methods, the closed system effectively prevents the escape of pathogenic micro-organisms.

The German Society of Anaesthesia and Resuscitation was founded in 1953. The change of name to "German Society of Anaesthesia and Intensive Care" in 1977 reflects the development that this specialty has undergone since 1953; it is also an indication of the claim of anaesthesia to play a part in the care of the critically ill surgical patient. To the questions: what is the basis for this claim, what can anaesthesia contribute towards the care of these cases, where is the dividing line between anaesthesia and the other disciplines concerned in intensive care, what effect has intensive care work on the training of the anaesthetist, the answers are as follows: the concern of the anaesthetist is the care of the patient whose vital functions are impaired by surgery, anaesthesia or disease; he has therefore acquired techniques and means to maintain and assist these vital functions. His work in the intensive care ward is thus often no more than a continuation of the work he is doing in the operating theatre. This does not mean that he should replace the clinician of the traditional specialties working in the intensive care unit; rather that he should function as a co-ordinator as regards the type and course of treatment and nursing. For the anaesthetist there is the advantage that he can enlarge and consolidate the skill and knowledge acquired in the operating theatre, deepen his understanding of pathophysiological conditions and gain experience and assurance in evaluation of a variety of clinical situations. By becoming competent in diverse fields (at a time when the general trend is for ever more specialization) he will contribute towards raising the status of the anaesthetist who is still apt to be regarded as merely a technician.

Psychosomatic medicine in intensive care units is essentially characterized by problems arising from the emotional involvement of the intensive care unit team. That is why the functions of a psychosomaticist are not only the diagnostics of psychosyndromes and the psychotherapy of dangerously ill patients, but especially the study of psychological interrelations within the unit team. Hypochondriac depressive psychosyndromes caused by the experience of dread, confusion, exhaustion and communication problems, as well as psychosyndromes characterized by a reduction of consciousness and orientation are discussed. Anaclitic psychotherapy, i.e. supporting and encouraging care, and emergency psychotherapy actually required in precarious situations, are described. The specific interrelations within and between the individual groups of the intensive care unit team (physicians, female and male nurses), which are important to the working conditions in the unit, and the possibilities of their psychological activation (e. g. in Balint groups) are outlined. The status and responsibility of a psychosomaticist within the unit team is critically reflected. Finally, the permanent confrontation of the team with death and dying is emphasized, and the psychological aspect of discontinuing intensive care is discussed.

A case of severe multiple trauma sustained in a road accident is reported. The aim of the report is to show the determing role played by diagnostic and surgical methods and therapeutic possibilities available in the intensive care unit (shock treatment, controlled respiration, parenteral feeding, haemodialysis) in winning the five-months' battle for the life of the patient. Early haemodyalisis as supporting therapy in respiratory failure and conservation treatment of intestinal fistulae are important. Post-traumatic pancreatitis which is a not infrequent complicating feature of severe multiple trauma may present diagnostic difficulties.