0000000000005662
AUTHOR
H. W. Gervais
Initiation of high-frequency oscillatory ventilation and its effects upon cerebral circulation in pigs: an experimental study
BACKGROUND: Current practice at high-frequency oscillatory ventilation (HFOV) initiation is a stepwise increase of the constant applied airway pressure to achieve lung recruitment. We hypothesized that HFOV would lead to more adverse cerebral haemodynamics than does pressure controlled ventilation (PCV) in the presence of experimental intracranial hypertension (IH) and acute lung injury (ALI) in pigs with similar mean airway pressure settings. METHODS: In 12 anesthetized pigs (24-27 kg) with IH and ALI, mean airway pressure (P(mean)) was increased (to 20, 25, 30 cm H(2)O every 30 min), either with HFOV or with PCV. The order of the two ventilatory modes (cross-over) was randomized. Mean art…
High dose naloxone does not improve cerebral or myocardial blood flow during cardiopulmonary resuscitation in pigs
In a prospective, randomized, placebo-controlled, double-blind trial we tested the hypothesis that naloxone given during cardiopulmonary resuscitation (CPR) enhances cerebral and myocardial blood flow. Twenty-one anesthetized, normoventilated pigs were instrumented for measurements of right atrial and aortic pressures, and regional organ blood flow (radiolabeled microspheres). After 5 min of untreated fibrillatory arrest, CPR was commenced using a pneumatic chest compressor/ventilator. With onset of CPR, an i.v. bolus of 40 micrograms/kg b.w. of epinephrine was given, followed by an infusion of 0.4 micrograms/kg per min. After 5 min of CPR, either naloxone, 10 mg/kg b.w. (group N, n = 11) o…
Intubationsbedingungen nach Rocuronium und Succinylcholin
OBJECTIVE Rocuronium is a new non-depolarising steroidal muscle relaxant with a short onset time. The present study was undertaken to compare intubating conditions as well as onset and clinical duration of a single dose of 0.6 mg/kg (2 x ED95) with a single dose of 1 mg/kg suxamethonium (3 x ED95). METHODS After obtaining informed consent and approval of the Ethics Committee, 40 adult patients (ASA I-III) participated in this study. After premedication with oxazepam, anaesthesia was induced with fentanyl and propofol and maintained with propofol, N2O and supplements of fentanyl as needed. Muscular relaxation was assessed by EMG recording of adductor pollicis muscle after supramaximal single…
Pr�hospitale CPR-Studien
Insgesamt 111 relevante Studien zur praklinischen kardiopulmonalen Reanimation (die uberwiegende Mehrzahl bei Erwachsenen) wurden zwischen 1990 und 2001 in der internationalen Fachliteratur publiziert. Dabei fallt auf, dass zum Zeitpunkt der Vorbereitung und Erarbeitung der neuen internationalen Guidelines (“Guidelines 2000”) in den Jahren 1999 und 2000 besonders viele Humanuntersuchungen veroffentlicht wurden. Ein Grosteil der Arbeiten beschaftigte sich mit mechanischen Hilfsmitteln zur Verbesserung der Hamodynamik wahrend der kardiopulmonalen Reanimation (CPR) und mit Vasopressoren. Gesetzliche Bestimmungen der jungsten Zeit (“Dritte Deklaration von Helsinki”; Erlasse des europaischen Par…
Postshock rhythm after first defibrillation of out-of-hospital cardiac arrest patients in ventricular fibrillation: An early outcome predictor
Cardiopulmonary resuscitation in babies and children: New algorithms
Notfallsituationen bei Sauglingen und Kleinkindern, die zur kardiopulmonalen Reanimation (CPR) fuhren, stellen fur den Notarzt im Vergleich zur Reanimation beim Erwachsenen eine besondere Herausforderung dar. Neben der erheblichen psychischen Belastung, die jeder padiatrische Notfall insbesondere fur denjenigen Arzt darstellt, der nicht taglich mit kleinen Patienten konfrontiert ist, gilt in der Reanimationssituation ganz besonders der haufig zitierte und mindestens genauso haufig ignorierte Lehrsatz, dass (Klein)kinder eben keine kleinen Erwachsenen sind. Zur Erleichterung des Vorgehens haben die im International Liaison Committee on Resuscitation (ILCOR) zusammengeschlossenen masgeblichen…
Die Wirkung des Alters auf Anschlagszeit und Erholung nach Atracurium, Rocuronium und Vecuronium
Bei alten Patienten kann die Wirkung von Muskelrelaxanzien verandert sein. Wir untersuchten diesen Zusammenhang an 108 Patienten dreier Altersgruppen, die randomisiert klinisch ubliche Intubationsdosen von Atracurium, Rocuronium und Vecuronium erhielten. Anschlagszeit und Erholung von der neuromuskularen Blockade wurden mit dem evozierten EMG des M. adductor pollicis nach Stimulation des N. ulnaris (Einzelreizung, 0,1 Hz) ermittelt. Die Anschlagszeiten sind in allen drei Altersgruppen vergleichbar, die Erholungszeiten bei den alten Patienten nach allen drei Relaxanzien verlangert. Die verlangerte Erholungszeit fur Rocuronium korreliert mit erhohten Werten der berechneten Kreatinin-Clearance…
Zum Einflu� der pr�isch�mischen Blutzuckerkonzentration auf H�modynamik und regionale Organdurchblutung w�hrend und nach kardiopulmonaler Reanimation (CPR) beim Schwein
Gegenstand der vorliegenden Untersuchung im Schweinemodell ist der Einflus einer pra-ischamischen Normo-, Hyper- oder Hypoglykamie auf Hamodynamik, regionale Organdurchblutung und Reanimierbarkeit nach 3minuti-gem unbehandelten Herz-Kreislauf-Stillstand und anschliesender kardiopulmonalen Reanimation (CPR). Hypoglykamie (Blutzuckerkonzentration von 34±2 mg/dl) war bereits vor der Reanimation mit einer deutlichen Beeintrachtigung hamodynamischer Parameter assoziiert. Keines der hypoglykamischen Tiere konnte erfolgreich reanimiert werden, im Gegensatz zu den hyper- (Blutzucker 319±13 mg/dl) bzw. normoglykamischen Tieren, die keinen Unterschied hinsichtlich der Erfolgsrate der Reanimation aufw…
The Hemodynamic Effects of Ephedrine on the Onset Time of Rocuronium in Pigs
Several studies have found a correlation between the onset time of muscle relaxants, cardiac index, and muscle blood flow. Ephedrine increases these hemodynamic variables and shortens onset time of rocuronium in humans. Our aim in this animal study was to determine the effect of ephedrine on the onset time of rocuronium, cardiac index, and muscle blood flow after administration of thiopental. At predefined measuring points, mean arterial blood pressure and cardiac index were measured invasively and onset time was determined mechanomyographically. Twenty-four pigs were randomly assigned to three groups. Group I received etomidate and subsequently rocuronium (2 x 95% effective dose). Instead …
Effect of chest compressions only during experimental basic life support on alveolar collapse and recruitment
Summary Aim The importance of ventilatory support during cardiac arrest and basic life support is controversial. This experimental study used dynamic computed tomography (CT) to assess the effects of chest compressions only during cardiopulmonary resuscitation (CCO-CPR) on alveolar recruitment and haemodynamic parameters in porcine model of ventricular fibrillation. Materials and methods Twelve anaesthetized pigs (26±1kg) were randomly assigned to one of the following groups: (1) intermittent positive pressure ventilation (IPPV) both during basic life support and advanced cardiac life support, or (2) CCO during basic life support and IPPV during advanced cardiac life support. Measurements w…
Was ist neu in der kardiopulmonalen Reanimation?
A strong consensus was reached for several changes in the guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC) in the 1992 conference on CPR and ECC held by the Emergency Cardiac Care Committee of the American Heart Association. These new recommendations, together with differing recommendations of the European Resuscitation Council, are described. An unresponsive person with spontaneous respirations should be placed in the recovery position if no cervical trauma is suspected. Compared with endotracheal intubation, other airway-protecting devices such as combination esophageal-tracheal tubes are of minor acceptance. During ventilation, the time for filling the …
The objective was to study the effects of a lung recruitment procedure by stepwise increases of mean airway pressure upon organ blood flow and hemodynamics during high-frequency oscillatory ventilation (HFOV) versus pressure-controlled ventilation (PCV) in experimental lung injury. Lung damage was induced by repeated lung lavages in seven anesthetized pigs (23–26 kg). In randomized order, HFOV and PCV were performed with a fixed sequence of mean airway pressure increases (20, 25, and 30 mbar every 30 minutes). The transpulmonary pressure, systemic hemodynamics, intracranial pressure, cerebral perfusion pressure, organ blood flow (fluorescent microspheres), arterial and mixed venous blood ga…
Zusammenfassung der Diskussion: „Die Aufrechterhaltung der Narkose auf intravenösem Wege“
Pharmacokinetics and pharmacodynamics of hydroxyethyl starch in hypovolemic pigs; a comparison of peripheral and intraosseous infusion.
Intraosseous (i.o.) infusion is considered a useful technique for the administration of medications and fluids in emergency situations when peripheral intravascular access is not possible. This study investigated the effectiveness of i.o. versus intravenous (i.v.) infusion of hydroxyethyl starch (HES 200/0.5) in hypovolemic pigs. Twenty-three pigs (8- to 9-week-old) were anaesthesized, instrumented and blood was withdrawn (25-30 ml/kg) to50 mmHg mean arterial pressure (MAP). The animals were left untreated in haemorrhage for 30 min. Relevant haemodynamic parameters were monitored and blood samples were collected for blood gas and HES concentration analysis. Infusion of HES via i.v. or i.o. …
Puffertherapie w�hrend CPR
Bislang gibt es keine eindeutigen Daten, die belegen wurden, dass Puffertherapie wahrend CPR das Outcome verbessert. Die Guide-lines 2000 betonen ausdrucklich, dass die Verabreichung von Natriumbikarbonat wegen der damit verbundenen Kohlendioxidproduktion ungunstig sein kann. Das gebildete Kohlendioxid kann unter Low-flow-Bedingungen nicht in der Lunge durch Ventilation eliminiert werden und verstarkt somit die intrazellulare Azidose. Nicht CO2-produzierende Pufferalternativen zu Natriumbikarbonat sind kommerziell verfugbar. Allerdings konnte auch durch Einsatz dieser Alternativpuffer wahrend der Reanimation keine bessere Uberlebensrate von Patienten nachgewiesen werden.
Dynamic computed tomography: a novel technique to study lung aeration and atelectasis formation during experimental CPR
Objective: To develop an image based technique to study the effect of different ventilatory strategies on lung ventilation and alveolar recruitment during cardiopulmonary resuscitation (CPR). Design: (1) Technical development of the following components: (a) construction of an external chest compression device, which does not interfere with CT imaging, and (b) development of a software tool to detect lung parenchyma automatically and to calculate radiological density parameters. (2) Feasibility studies: three strategies of CPR ventilation were performed and imaged in one animal each (pigs, 25 kg): volume-constant ventilation (VCV), no ventilation, or continuous airway pressure (CPAP). One m…
Weniger ist nicht immer mehr! CPR ohne Beatmung?
Synkope und Krampfanfall
Eine subtile Erhebung der Eigen- und Fremdanamnese, verbunden mit einfachen klinischen und apparativen Untersuchungsverfahren, kann wichtige Hinweise zur Atiologie geben und vermag zwischen einer kardiovaskularen und einer nicht-kardiovaskularen Synkope zu differenzieren. Dieser Unterscheidung kommt aus prognostischen Grunden grose Bedeutung zu (Abb. 1, 2).
Plasma concentration following oral and intramuscular atropine in children and their clinical effects.
In a paediatric population, we compared i.m. v oral atropine premedication to a control group without atropine and determined atropine plasma concentrations (APC). Forty-five children were randomly assigned to one of three groups. Group I received atropine, 20 micrograms.kg-1 i.m., 15 min prior to induction. Group II received atropine, 30 micrograms.kg-1 orally, group III received no atropine. APC (expressed as percent of muscarine-2 receptor subtype occupancy), heart rate, rectal temperature, and salivation were determined before atropine, and 15, 25, 45, 60, 90, 120 (no APC), and 150 min following atropine. Only 10-20% of the M2-cholinoceptors were occupied after oral atropine with a peak…
Is cell salvage safe in liver resection? A pilot study
Abstract Study Objective To investigate the quality of cell salvaged (CS) blood in patients undergoing hemihepatectomy (study group) and compare it with CS-blood from aortic surgery (control group). Design Observational study. Setting Operating room in a university hospital. Measurements 6 patients undergoing hemihepatectomy or aortobifemoral bypass with intraoperative blood loss of more than 800 mL. Samples were drawn from the central venous catheter, from the reservoir of a CS recovery system, and from the processed blood in each patient to determine interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF), complement C3a, and the terminal complement complex C5b-9. Microbiological ana…
Anesthesiological Particularities in Bariatric Surgery
Morbid obesity has become a global pandemic in recent years: 5% of the adult population of the USA are considered morbidly obese, i.e., have a BMI that exceeds 40. Every 90 seconds a US American dies of obesity and its consequences – making 1,000 people every day and 400,000 a year. This explains the dramatic rise of interest in bariatric procedures and with it in suitable anesthesiological methods.
Microbial contamination of anesthetic syringes in relation to different handling habits.
This single-center study prospectively assessed the microbial contamination of anesthetic syringes handled perioperatively under different conditions. We documented high rates of bacterial contamination, with strong but statistically nonsignificant differences between handling groups. Our results identify skin contact as the main source of contamination, and thus we emphasize the impact of proper hand hygiene.