Praktische Anasthesie, Wiederbelebung und Intensivtherapie最新文献

In 10 healthy persons (group I) and in 10 patients with left heart failure the haemodynamic response to reduction of the arterial blood pressure with sodium nitroprusside (SNP) is studied. The systolic arterial pressure (SAP) is reduced in two stages first to 100 mm Hg and than to 90 mm Hg. The SAP was then allowed to reach 100 mm Hg by reduction of the SNP dose. At this SAP a constant amount of SNP and 500 ml Dextran 60 were infused. In group I the cardiac index (CI) decreases from 3,6 +/- 0,4 1/minXm2 at a SAP of 136 +/- 11 mm Hg to 3,2 +/- 0,2 1/minXm2 (p less than 0,05) at a SAP of 101 +/- 2 mm Hg. At a SAP of 89 +/- 3 mm Hg the CI is 3,0 +/- 0,3 1/minXm2 (p less than 0,05). The right atrial pressure (RAP) and the pulmonary capillary wedge pressure (PCWP) are significantly reduced (p less than 0,01). After infusion of 500 ml Dextran 60 the CI increases to 3,9 +/- 0,3 1/minXm2 (p less than 0,05). In group II at a SAP of 132 +/- 8 mm Hg the CI is 2,7 +/- 0,2 1/minXm2, at a SAP of 99 +/- 3 mm Hg the CI is 3,0 +/- 0,3 1/minxm2 (p less than 0,05) and at a SAP of 91 +/- 2 mm Hg decreases to 2,7 +/- 0,2 1/minXm2. RAP and PCWP are significantly reduced (p less than 0,01). After infusion of 500 ml Dextran 60 the CI increases to 3.3 +/- 0,2 1/minxm2 (p less than 0,05). These results show, that SNP-Infusion in patients with left heart failure can improve cardiac performance. In patients without cardiac disease the CI decreases after SNP-Infusion due to the low preload of the heart. In both groups preload restoration with Dextran 60 can increase the cardiac index.

Sodium Nitroprusside (Nipride) was administered by infusion pump intravenously in 27 neurosurgical patients for intraoperative, postoperative and posttraumatic blood pressure lowering. This was accomplished with intension to reduce the risk of hemorrhage during operation on highly vascularized tumors or aneurysms and to combat hypertensive crisis after surgery and brain injury. The effect was documented by direct arterial blood pressure registration and the drug proved to be fast acting, potent and readily reversible. Dosage varied between 1 and 10 microgram/kg/min with systolic pressure decreasing about 6 to 60% of the initial value. There was ill correlation between infusion rate and blood pressure drop which demanded particular caution at the beginning and the end of infusion. A decrease in pulse pressure and a moderate tachycardia were generally observed, however no complications were seen due to a Sodium Nitroprusside administration over less than 12 hours duration in our series.

Before, during and after gynaecological operations performed either in electroacupuncture or enflurane anaesthesia plasma-cortisol levels were determined and compared to each other. During stimulation and operation plasma-cortisol increased continuously, indicating elevated sympathetic tone, whereas with enflurane anaesthesia plasma-cortisol levels were markedly lower. Postoperatively after electroacupuncture cortisol levels decreased, and rose again with the onset of pain. After enflurane anaesthesia cortisol levels increased continuously for a period of more than 90 min. Because of the strong correlation between degree of stress and plasma-cortisol level, our results demonstrate surgery under electroacupuncture analgesia to cause a stress greater than that during enflurane anaesthesia. The changes in cortisol levels were observed during stabilized cardiovascular conditions. Conditions varying plasma-cortisol levels too, are discussed.

The effect of Etomidate on central sympathetic activity, respiration and circulation were studied in animals at rest and under asphyctic conditions. The doses used were 0.15, 0.3 and 0.6 milligrams/kilogram bodyweight. Injection of the drug into animals at rest caused excitation lasting for about 10 seconds and then lowering of sympathetic activity by about 15-30 per cent. With doses of 0.6 mg the depression lasted for about 15 minutes. Central stimulation by asphyxia often a more pronounced dose-dependent depression of sympathetic activity by about 15-40% of the original level was observed. Activity of the phrenic nerve was affected only with doses of 0.6 mg; the reduction by about 30% lasted for up to 15 min. Injection of 0.6 mg was followed within one minute by a short-lasting fall in blood pressure by about 10%. The heart rate remained unchanged at rest but during asphyctic conditions the heart rate was less slowed down than would normally occur with vagal stimulation. Etomidate apparently also depressed the vagal centres. Similarities and differences in action between Etomidate and propanidid are discussed.

In Switzerland the amount of blood donations is determined by the demands for plasma; as a result there is a surplus of erythrocyte concentrates for which more uses should be found. Trials in a regional general hospital proved that these concentrates can be advantageously employed in the field of surgery and anasthesia: due to close cooperation between the clinical department and the blood donor sevice the demand for erythrocyte concentrates rose from 5 per cent to 80 per cent within 5 years.

A technique for continuous block of the brachial plexus is described using an indwelling teflon cannula positioned according to the anatomical dictates of the supraclavicular and interscalene spaces. The anatomy is presented as key to consistent results. Advantages of a continuous block are an extension of normal block duration, block placement independent of operating times and a possible application to intensive care patients.

Acute haemorrhages in the upper intestinal tract derive mainly from smaller low-pressure vessels. Bleeding is generally protracted and is often clinically occult. The clinical signs are a more reliable indicator of the severity of the haemorrhage than are measurements of the central venous pressure, shock index and cardiac output. The considerable tolerance of man to blood loss is probably attributable to the erect standing position. It has the advantage that it provides a large measure of counter-regulatory possibilities; but has the disadvantage that there is only a very narrow margin of safety as regards the development of irreversible shock. Close and consistent co-ordination of diagnosis and therapy is essential in all cases of gastro-intestinal haemorrhage.

In diagnosing electrocerebral silence (isoelectric tracing) the investigator must be sure to exclude the possibility of an artefact. With the methods available up to now for testing the proper functioning of electroencephalographic equipment it has not been possible entirely to avoid errors. A new method is described for the rapid and quantitatively exact testing of EEG equipment including electrodes and cables and the correct recording of isoelectric tracings.

95 506 patients who received general anesthesia during the period of 1964--1977 were studied. The account of all actual or possible life threatening complications during the anesthesia is given: oedema of the glottis, air embolism, accidental injection of the wrong drug, respiratory insufficiency, hypoxia, pulmonary oedema, airway occlusion by the cuff, vomiting and aspiration, anaphylactoid reaction, death within 24 hours, death on the table. Deaths not attributable to anaesthesia are listed separately. We have found that in one of every 139 anaesthetics given there was a life threatening complication to the patient. In every 197th anaesthetic there was a clear connection with the anaesthetic technique used. In contrast with the great number of near fatal complications the rate of irreversible damage or mortality connected with general anaesthesia was low.

A case of subtotal circumferential rupture of the aorta is described which involved a woman who had sustained multiple injuries in a traffic accident. The rupture was discovered only during autopsy. As this type of injury is generally not diagnosed until after death, knowledge of some of the characteristics signs of rupture of the aorta is important, especially to the physician in charge of an intensive care unit. If there are suspicious signs aortography is essential. The only treatment likely to succeed is surgery, but postoperative mortality is still as high as 20--40 per cent.