Anästhesie, Intensivtherapie, Notfallmedizin 

About: Anästhesie, Intensivtherapie, Notfallmedizin is an academic journal. The journal publishes majorly in the area(s): Intensive care & Blood pressure. It has an ISSN identifier of 0174-1837. Over the lifetime, 319 publications have been published receiving 1050 citations.

Acute renal failure in abdominal infection. Comparison of hemodialysis and continuous arteriovenous hemofiltration

Abstract: 58 patients with peritonitis and acute renal failure (ARF) were treated either by haemodialysis (HD, n = 22), continuous arteriovenous haemofiltration (CAVH, n = 9), or continuous pump-driven haemofiltration (CPDHF, n = 27). In contrast to HD, which led to severe hypotension in 31.9% of procedures and to cardiac arrest in 3 cases, CPDHF caused neither haemodynamic nor metabolic alterations. Control of uraemia was most effective in the CPDHF group, too. Mean daily BUN and creatinine values fell significantly (p less than 0.005) and remained at 60 mg % and 2.0 mg %, respectively, whereas during HD no significant changes were found. During CAVH serum creatinine showed an insignificant decline, whereas BUN even increased. Despite higher costs CPDHF seems to be a promising alternative to HD or CAVH for treatment of ARF in septic patients, as mortality was lower in the CPDHF group and recovery of renal function occurred in 48.2%, whereas during HD only 27.3% recovered from ARF.

[The central nervous system arousing effects of ketamine are decreased by addition of midazolam. A post-anesthesia study of patients following maxillary surgery with spontaneous respiration].

Abstract: The present study was done in order to investigate the central nervous activity in patients (n = 15) after maxillo-facial surgery, 5 and 90 minutes post ketamine-midazolam-anesthesia. The combination of a benzodiazepine with ketamine was thought to be beneficial to reduce the usual excitatory effects after ketamine postoperatively. In order to demonstrate these benefits EEG-power spectra as well somatosensory-evoked potentials were derived (Neurotrac). Additionally, the central nervous effects were correlated with blood pressure changes. 5 minutes post ketamine-midazolam-anesthesia EEG-power spectra showed a marked depression in the alpha, theta and delta power band when compared to the control-awake situation. However, power in the beta domain (13-30 Hz) was significantly elevated. 90 minutes post anesthesia the high power values returned back to control. In no instance were there any signs of theta-paroxysms which can be taken as an index for central excitation. In the evoked potential a significant increase in amplitude of the early N20 and late N50 peak was evident. This correlated with an increase in systolic blood pressure. 90 minutes post anesthesia only the late N50 peak still remained elevated suggesting some residual excitatory effects in the thalamo-cortical projection area to be present. The latter may reflect an increase in activity in the associative cortical areas of the cerebral cortex. In general however, the additional administration of midazolam resulted in a marked reduction in excitatory central nervous effects when compared to the well known excitation after sole ketamine injection. Thus, the beneficial venture of the two separate classes of anesthetics is advocated for clinical practice.

[Long-term result and quality of life following preclinical cardiopulmonary resuscitation].

Abstract: The value of successful cardiopulmonary resuscitation (CPR) must be considered in the light of late outcome of survivors, including the neurological situation as well as the subsequent quality of life. We followed up the fates of 168 patients (pts) primary successfully resuscitated by rescue helicopter and mobile intensive care unit of the rescue centre at the military hospital of Hamburg and admitted to emergency hospitals after heart action became stabilised. 130 pts died during hospitalisation and 38 pts (7.9% of 480 resuscitation attempts total) were discharged from hospital. 32 of them had no essential neurologic damage. Within the next 3 years after discharge from hospital 15 of the 38 survivors died (3-year-survival rate: 4.8% of all attempts of CPR or 60% of survivors). 4 of the 6 survivors with persistent cerebral damage died within 6 months after discharge from hospital. Interviews (n = 28) with survivors or their relatives provided information on social situation, physical and psychical condition after CPR as well as recollection of CPR. 29% (n = 8) became incapacitated for work after CPR. 68% considered meaning of life unchanged, 25% as limited and for 7% the incident had a positive effect concerning their outlook on life. 18% (n = 5) suffered from depressions after CPR. Reductions of physical efficiency (64%), of memory (68%) and of concentration capacity (61%) were realised. The majority of survivors did not remember anything, neither experiences of intubation nor of external cardiac massage. Only one patient thought he remembered the incident and reported about "blows on the chest". 89% considered resuscitation to be a sensible and important provision.(ABSTRACT TRUNCATED AT 250 WORDS)

Endobronchial administration of adrenaline in preclinical cardiopulmonary resuscitation

Abstract: The present clinical study was designed to investigate the effectiveness of epinephrine when administered endobronchially (e. b.) in patients undergoing out-of-hospital cardiopulmonary resucitation (CPR). Plasma catecholamine measurements during and following CPR in 30 patients revealed plasma levels of epinephrine and norepinephrine with tremendous variations and elevated, sometimes, for nearly 1,000 fold when compared to normal resting levels. In patients with ventricular fibrillation (VF) native epinephrine concentrations (23.5 +/- 20.4 ng/ml) were significantly different from asystolic victims (2.1 +/- 1.2 ng/ml). This finding once more supports the importance of early defibrillation as main therapeutical step in VF. When epinephrine (2-3 mg) was instilled endobronchially shortly after endotracheal intubation therapeutic concentrations of more than 10 ng/ml of epinephrine were measured when the first venous access was achieved. In 7 patients with successful CPR e. b. epinephrine was the only pharmacological therapy provided to support the cardiovascular system. Under these circumstances plasma epinephrine levels remained within the therapeutic range of 10-20 ng/ml for about 30 minutes. By these clinical findings it becomes clear that e. b. epinephrine (2-3 mg in 5-10 ml of NaCl 0.9%) instilled deeply by a catheter following intubation is the pharmacological therapy of choice in asystolic patients.

Clonidine supplemented analgesia and sedation in prevention of postoperative delirium

Abstract: In an open prospective study we investigated the efficacy of the supplementation of analgosedation by clonidine. 40 patients with oesophagus malignancy and definite alcohol abuse were on respiration therapy postoperatively after having been treated with oesophago-gastro anastomoses. With regard to manifestation intensity and development of withdrawal symptoms we found that during basic medication with piritramid-diazepam continuously i.v. administered clonidine can eliminate haemodynamic and psychovegetative symptoms related to alcohol withdrawal. The clonidine group required less analgosedation. The measurement of the urinary catecholamine output showed a normalised endogenous output. As a finding of importance the gastrovolume was reduced, and the haemodynamically firm, stable and less sedated patients of the clonidine group required fewer days of respiration therapy. Hence, the hazard of aspiration pneumonia and insufficienty anastomosis was lower. Risk of bradycardia of high potential danger did not occur with a median daily dosage of 1.09 mg/d clonidine. We consider clonidine to be a potent supplement to analgosedation for the surgical patient who is at high risk of alcohol withdrawal.