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[ { "id": "DerAnaesthesist.60450240.eng.abstr-passage-0", "type": "abstract", "text": [ "The right ventricle is more jeopardized by a cardiopulmonary bypass than the left one . Impaired right ventricular performance may profit from an afterload reduction . A selective reduction in pulmonary artery pressure ( PAP ) or pulmonary vascular resistance ( PVR ) without impairment of the systemic circulation seems to be possible by inhalation of nitric oxide ( NO ) . Therefore in the present study we looked for influences of NO inhalation on PAP , PVR and right heart parameters immediately after weaning from the bypass . The dependence of endothelial function on age , preoperative heart function and extracorporeal circulation is well established . The relevance of such parameters on NO inhalation was also investigated ." ], "offsets": [ [ 0, 734 ] ] } ]

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[ { "id": "DerAnaesthesist.60450249.eng.abstr-passage-0", "type": "abstract", "text": [ "Eltanolone is a new steroid anaesthetic agent that is a 5- reduced derivative of progesterone . In the present study we investigated the haemodynamic effects of eltanolone or thiopentone in patients scheduled for coronary artery bypass grafting ." ], "offsets": [ [ 0, 246 ] ] } ]

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[ { "id": "DerAnaesthesist.60450255.eng.abstr-passage-0", "type": "abstract", "text": [ "2-Agonists are being used increasingly in anaesthesia and intensive care medicine because of their antihypertensive , analgesic and sedative properties . Platelets bear 2-receptors on the cell surface . Stimulation of these receptors by agonists induces platelet aggregation . The present study examined whether in vitro incubation of blood with the 2-agonists clonidine and dexmedetomidine decreases 2-receptor density and hereby influences platelet aggregation ." ], "offsets": [ [ 0, 464 ] ] } ]

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[ { "id": "DerAnaesthesist.60450271.eng.abstr-passage-0", "type": "abstract", "text": [ "Over a period of 10 years various orthopaedic-paediatric operations were performed under hyperbaric spinal anaesthsia ." ], "offsets": [ [ 0, 119 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.60450278.eng.abstr-passage-0", "type": "abstract", "text": [ "Laryngeal obstruction is a challenging complication during anaesthesia with a face mask or laryngeal mask and is due to insufficient analgesia in most cases . However , with a laryngeal mask in place it must be differentiated whether the airway obstruction is caused by the laryngeal mask itself or by other factors . Knowledge of the pathophysiology of the laryngeal closure and experience with the use of the laryngeal mask are essential for adequate treatment . Not the removal of a correctly inserted laryngeal mask which initially provided a satisfying airway , but the relaxation of laryngeal muscle activity by adequate anaesthesia is the first mandatory treatment if intraoperative airway obstruction occurs ." ], "offsets": [ [ 0, 717 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.60450312.eng.abstr-passage-0", "type": "abstract", "text": [ "Clinical manifestations of sepsis , such as systemic inflammatory response and multiple organ dysfunction syndrome , are considered to be the results of a decompensated host defense response . If tissue injury is sufficiently severe to overwhelm local defense mechanisms , systemic activation of these essentially protective mechanisms may lead to autodestructive \" host defense failure disease . \" This is not always caused by invading bacteria ; sterile inflammation such as results from multiple trauma or pancreatitis can initiate a similar response . Evidence suggests that the activation of the macrophage/monocyte system that underlies the systemic inflammatory response may reflect one facet of a more generalized dysregulation of intercellular communication , as well as a dysfunction of such subcellular processes as signal transduction or stress gene expression . Alterations in signal transduction or stress gene expression can affect the host defense response to subsequent stressful events in either a negative or a positive sense . In particular , the sequential induction of acute phase and heat shock response may initiate programmed cell death , reflecting a potential molecular mechanism for the development of multiple organ dysfunction syndrome . The development of anti-inflammatory treatment strategies seems to be hampered by the discrepancy between locally protective and systemically deterimental properties of the host defense response ." ], "offsets": [ [ 0, 1464 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.60450323.eng.abstr-passage-0", "type": "abstract", "text": [ "Numerous basic drugs are extensively bound to 1-acid glycoprotein . Fentanyl , with a pKa value of 8.43 , is also a basic drug . Protein binding studies have yielded contradictory results concerning binding of fentanyl to 1-acid glycoprotein . In this study we investigated time courses of serum protein concentrations and serum protein binding of fentanyl during postoperative acute phase reaction , assuming that an increase of 1-acid glycoprotein is accompanied by an increase of serum protein binding , if fentanyl is extensively bound to 1-acid glycoprotein . Fentanyl protein binding measurements using equilibrium dialysis can be affected by volume shifts and pH changes . Therefore , volume shifts from buffer to serum and the influence of various phosphate buffers on increasing pH due to loss of CO2 were also evaluated . Methods . Thirteen patients with no history of renal or hepatic disease undergoing an operation with a significant acute phase reaction were studied . Preoperatively and on the first 3 postoperative days serum concentrations of 1-acid glycoprotein , albumin , total protein and apolipoprotein A and B were determined by rocket immunoeolectrophoresis , biuret method and laser nephelometry , respectively . Corresponding serum protein binding of fentanyl was measured by adding 40 ng of fentanyl to 1 ml serum followed by equilibrium dialysis at 37 ° C for 4 h . A 0.167 M phosphate buffer ( pH 7.27 ) , which gave a final pH of 7.40 , was used . Volume shifts from buffer to serum were measured . Fentanyl concentration in serum before dialysis ( FS ) was determined by gas chromatography , and fentanyl concentration in buffer after dialysis ( FB ) was determined by radioimmunoassay . Serum protein binding ( SPB ) was calculated by the formula : SPB=(FS-FB-FB*c)/(FS-FB) where c is a correction factor . Ten randomly selected patient sera were dialyzed against four phosphate buffers of different pH values and molarities , and the serum pH at the end of equilibrium dialysis was measured . Results . Postoperatively , the serum concentration of 1-acid glycoprotein rose to 151% of the control value . In contrast , serum protein binding of fentanyl did not change significantly , with a slight decrease to 96% of control value . There was a significant decrease in serum concentrations of albumin ( 3rd postoperative day ) , total protein ( 2nd postoperative day ) and apolipoprotein B ( 1st-3rd postoperative day ) to 85% , 90% and 75% of control values , respectively . Changes in apolipoprotein A concentration were not significant . Protein binding of fentanyl did not correlate with 1-acid glycoprotein and apolipoprotein A , but there was a positive linear relationship between protein binding of fentanyl and albumin , total protein and apolipoprotein B. At the end of equilibrium dialysis the mean volumes of the serum and buffer compartments were 1114 +/- 72 and 834 +/- 68 µl, respectively . The two phosphate buffers , with pH 7.30 ( 0.15 M ) and pH 7.27 ( 0.167 M ) , gave final serum pH of 7.42 and 7.40 , respectively . Conclusions . Present findings suggest that in contrast to other basic drugs , fentanyl binding to 1-acid glycoprotein is of minor importance . In agreement with the findings of former studies , protein binding of fentanyl depended on albumin , total protein and apolipoprotein B concentrations . Due to unspecific binding of fentanyl by hydrophobic interactions , a major role of albumin , which amounts to about 60% of total protein , seems to be evident . Determining fentanyl protein binding by equilibrium dialysis , volume shifts must be taken into account if calculation is based on fentanyl concentrations in plasma ( serum ) and buffer after dialysis , and an appropriate buffer must be used ." ], "offsets": [ [ 0, 3772 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.60450330.eng.abstr-passage-0", "type": "abstract", "text": [ "Extracorporeal shock-wave lithotripsy ( ESWL ) is the method of choice for the treatment of solitary stones in the kidney or ureter . Early lithotripters required prolonged immobility of the patient and caused considerable pain , necessitating general or epidural anaesthesia during the procedure . Modern lithotripters are quicker , but still require analgesia . Intravenous opioids are currently the drugs in favour . The opioids most commonly used are fentanyl and its shorter-acting analogue , alfentanil . The latter has a more rapid onset and , because of its reduced lipid solubility , is less cumulative . Sufentanil is a new opioid that is also of the phenylpiperidone group and has been recently licensed and introduced in Germany . Its pharmacokinetic and pharmacodynamic properties suggest an intermediate duration of action , high analgesic potency , and cardiovascular stability with diminished respiratory depression . In this prospective double-blind study , the effects of alfentanil and sufentanil on cardiovascular and respiratory parameters , the quality of analgesia , degree of sedation and the number and type of side-effects were compared ." ], "offsets": [ [ 0, 1164 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.60450337.eng.abstr-passage-0", "type": "abstract", "text": [ "Acute respiratory failure is characterised by mismatch of ventilation with perfusion ( V. A/Q . ) . The multiple inert gas elimination technique ( MIGET ) is a complex method which allows the description of a virtually continuous distribution of V. A/Q . ratios . We investigated V. A/Q . relationships in patients admitted to the intensive care unit due to acute respiratory failure and thus requiring for mechanical ventilation . Method . Eight patients ( mean APACHE II=22 +/- 4 ) who suffered from acute pneumonia ( n=4), traumatic lung contusion ( 2 ) , toxic lung failure ( 1 ) or massive bilateral atelectasis ( 1 ) were investigated by MIGET within 3 days after the begin of mechanical ventilation . A mixture of six inert gases , dissolved in isotonic saline , was infused continuously . Arterial and mixed venous blood samples and expired gas samples were obtained and analysed by gas chromatography . Blood-gas partition coefficients were determined , and the ratios of retention and excretion were calculated . The data were transformed in a 50-compartment model of blood flow and ventilation against V. A/Q . ratio . We assessed the amount of intrapulmonary shunt ( V. A/Q . =0 ) , low V. A/Q . regions ( V. A/Q . =0 . 005-0 . 1 ) , normal V. A/Q . regions ( V. A/Q . =0 . 11-10 ) , high V. A/Q . regions ( V. A/Q . =11-100 ) and dead space ventilation ( V. A/Q . > 100 ) . Furthermore , we calculated the logarithmic standard deviation of pulmonary perfusion distribution ( logSDQ . ) . Results . In all patients we found moderate to severe intrapulmonary shunt and V. A/Q . mismatching . The data are expressed as median values and ranges . Inert-gas-measured shunt was 21% ( 3-45 . 5% ) , whereas low V. A/Q . regions were little affected . Normal V. A/Q . regions ranged from 41.5% to 96.0% ( median 76.8% ) . The amount of alveolar dead space ventilation was 28% ( 19.7-41.8%). Median logSDQ . ( normal range 0.3-0.6) was calculated to be 0.855 ( 0.540-1.490). In patients presenting with moderate lung injury ( Murray score 3 ) , a moderate increase in shunt and a moderate V. A/Q . mismatch were observed . In contrast , patients with severe lung failure and critically decreased oxygenation ( Murray score > 3 ) were characterised by massive shunting and V. A/Q . mismatching . Additionally , low V. A/Q . and high V. A/Q . compartments and an increase in dead space ventilation was found in these patients . Conclusions . The impairment of oxygenation in patients with acute respiratory failure is due to several pathophysiological mechanisms : increase in intrapulmonary shunt , V. A/Q . -mismatching and dead space ventilation , according to the severity of lung failure . We conclude from our results that the prevention and/or reduction of non-ventilated lung areas ( atelectasis ) is an outstanding therapeutic strategy in the treatment of patients with acute respiratory failure . From this point of view , several techniques of systemic changes in body position should be integrated as supportive therapeutic strategies ." ], "offsets": [ [ 0, 3050 ] ] } ]

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[ { "id": "DerAnaesthesist.60450343.eng.abstr-passage-0", "type": "abstract", "text": [ "Hyperoxic ventilation , used to prevent hypoxia during potential periods of hypoventilation , has been reported to paradoxically decrease whole-body oxygen consumption ( VO2). Reduction in nutritive blood flow due to oxygen radical production is one possible mechanism . We investigated whether pretreatment with the sulfhydryl group donor and O2 radical scavenger N-acetylcysteine ( NAC ) would preserve VO2 and other clinical indicators of tissue oxygenation in cardiac risk patients . Methods . Thirty patients , requiring hemodynamic monitoring ( radial and pulmonary artery catheters ) because of cardiac risk factors , were included in this randomized investigation . All patients exhibited stable clinical conditions ( hemodynamics , body temperature , hemoglobin , FIO2 0.5 ) . Cardiac output was determined by thermodilution and VO2 by cardiovascular Fick . After baseline measurements , patients randomly received either 150 mg kg-1 NAC ( n=15) or placebo ( n=15) in 250 ml 5% dextrose i.v. over a period of 30 min . Measurements were repeated 30 min after starting NAC or placebo infusion , 30 min after starting hyperoxia ( FIO2=1.0), and 30 min after resetting the original FIO2. Results . There were no significant differences between groups in any of the measurements before treatment and after the return to baseline FIO2 at the end of the study , respectively . NAC , but not placebo infusion , caused a slight but not significant increase in cardiac index ( CI ) , left ventricular stroke work index ( LVSWI ) and a decrease in systemic vascular resistance . Significant differences between groups during hyperoxia were : VO2 ( NAC : 108 +/- 38 ml min-1m-2 vs placebo : 79 +/- 22 ml min-1m-2; P =0 . 05 ) , CI ( NAC : 4.6 +/- 1.0 vs placebo : 3.7 +/- 1.11 min-1m-2; P =0 . 05 ) and LVSWI ( NAC : 47 +/- 12 vs placebo : 38 +/- 9 ; P =0 . 05 ) . The mean decrease of VO2 was 22% in the NAC group vs 47% in the placebo group ( P =0 . 05 ) and the mean difference between groups in venoarterial carbon dioxide gradient ( PvaCO2 ) was 14% ( P =0 . 05 ) . ST segment depression ( > 0.2 mV ) was significantly less marked in the NAC group ( NAC : -0 . 02 +/- 0.17 vs placebo : -0 . 23 +/- 0.15 ; P =0 . 05 ) . Conclusions . NAC helped preserve VO2, oxygen delivery , CI , LVSWI and PvaCO2 during brief hyperoxia in cardiac risk patients . Clinical signs of myocardial ischemia did not occur such as ST-depression if patients were prophylactically treated with NAC . This suggests that pretreatment with NAC could be considered to attenuate impaired tissue oxygenation and to preserve myocardial performance better in cardiac risk patients during hyperoxia ." ], "offsets": [ [ 0, 2668 ] ] } ]

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[ { "id": "DerAnaesthesist.60450351.eng.abstr-passage-0", "type": "abstract", "text": [ "Acute renal failure ( ARF ) is a serious complication following liver transplantation . Many therapeutic regimens have been used so far but with limited success . Urodilatin ( URO ) is a new member of the atrial natriuretic peptide ( ANP ) family . When administered intravenously , URO induces strong diuresis and natriuresis with tolerable hemodynamic side effects . Preliminary non-controlled clinical studies demonstrate beneficial effects using URO as a therapeutic agent in patients suffering from ARF following heart and liver transplantation ( HTx , LTx ) . These results prompted us to initiate this first controlled clinical trial to investigate whether URO infusion can improve renal function in patients with emerging ARF following LTx ." ], "offsets": [ [ 0, 749 ] ] } ]

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[ { "id": "DerAnaesthesist.60450359.eng.abstr-passage-0", "type": "abstract", "text": [ "Experimental studies have shown that in traffic accidents with frontal impact the new airbag system can significantly reduce the incidence of severe injuries and fatal outcome . The question of whether the airbag itself induces specific patterns of injury needs further investigation . Two cases of traffic accidents with airbag protection are presented here . The first case report clearly shows the life-saving and injury-reducing effect of the airbag system in a traffic accident with frontal impact at 100 km/h . In the second case only minor injuries of the face were diagnosed initially . Hemodynamic instability occurred after 3 h of hospitalization due to rupture of the azygos vein . Analysis of the presented cases shows that , besides the well-known benefits , there are certain injury patterns that seem to be related to the use of airbags . These have not been described before . It is concluded that patients who were involved in traffic accidents with airbag deployment have to be hospitalized and followed up carefully over time , even though they are initially stable , as potentially fatal sequelae of deceleration trauma can occur later . In our opinion it is not possible to estimate the severity of airbag-associated injuries with conventional methods ." ], "offsets": [ [ 0, 1274 ] ] } ]

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[ { "id": "DerAnaesthesist.60450413.eng.abstr-passage-0", "type": "abstract", "text": [ "Prerequisites for experimental study designs are extremely difficult to realise under prehospital emergency conditions . Results obtained in animal experiments always need validation with prehospital or inhospital patient studies . Investigations related to emergency medicine are , however , an ethical obligation on behalf of the patient . A retrospective analysis of the available literature should be considered a prerequisite for prospective randomised and controlled studies . Frequently , a pilot study or feasibility trial needs to precede the actual study . Informed consent must be obtained for all patient studies . However , under emergency conditions informed consent cannot always be obtained due to unconsciousness , etc. Nevertheless , the following principles should be observed : ( a ) randomised studies are essential , even in emergency medicine ; ( b ) they are ethically acceptable if the treatment provided for the study group is at least equivalent to the therapy for the control group ; ( c ) only these preconditions guarantee that the patient always receives treatment in accordance with the standard of treatment . If the patient is unconscious or otherwise unable to give informed consent , the principle of deferred consent is acceptable . The deferred consent principle should be carefully documented . A prospective randomized study represents the gold standard for an investigation , even under emergency conditions . There are different principles of randomization : telephone or telefax randomisation , etc. Emergency medicine investigations need to be completed within a reasonable time frame which should , as a rule , not exceed 2 years . Otherwise , too many items might change without being noted . Curative treatment and the intention to treat are terms employed by ethics committees . If an investigation does not bear in itself additional risk factors , it does not necessarily have to be brought before the ethics committee . If , however , for example , the effect of obtaining blood samples is investigated separately for research purposes , the patient needs to be informed and sign the respective agreement . In Germany the ethics committees have agreed to accept their respective decisions . For multicentre and multinational studies , however , the ethics committees also need to accept decisions made by non-German ethics committees . Not all therapeutic principles can serve as the basis of prospective randomized studies because they need to be considered the present standard of care ( e.g. , endotracheal intubation , etc. ) . Nevertheless , the feasibility of a study should be assessed according to the 1-3 rating proposed by the American Heart Association . In principle , the overall emergency physician protocol does not fulfill scientific requirements . For all studies , particularly in the prehospital setting , an independent observer should be involved for documentation purposes . Scores can be of importance for investigating different treatment regimens . Biases in emergency medicine studies focus on the variability of EMS , personnel qualifications , etc. This is in part why it is extremely difficult to prove efficacy and efficiency in emergency medicine . The results of emergency medicine investigations should be published in suitable journals , i.e. , journals with a reasonable rating ." ], "offsets": [ [ 0, 3364 ] ] } ]

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[ { "id": "DerAnaesthesist.60450420.eng.abstr-passage-0", "type": "abstract", "text": [ "According to a literature search , it seems most unlikely based on pathophysiological requirements and physiological aspects that traumatized children benefit from preoperative waiting times aimed at achieving a 6-h fast . Irrespective of fasting , traumatized children are at risk of requiring aspiration . Many generally recommended measures for the avoidance of aspiration are neither reasonable nor effective in traumatized children . The physical and psychological benefits that can be derived from shorter preoperative waiting times can more than override the organizational difficulties caused by waiting longer ." ], "offsets": [ [ 0, 620 ] ] } ]

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[ { "id": "DerAnaesthesist.60450428.eng.abstr-passage-0", "type": "abstract", "text": [ "A combination of epidural opioids with local anaesthetics has been used to improve pain relief during labor and to reduce side effects , such as muscle weakness , usually seen when local anaesthetics are used alone . The addition of epidural fentanyl ( F ) produces highly effective analgesia , the only side effect being mild itching . Initial trials investigated the improvement in analgesia after a single administration of F during first- but not during second-stage labor . Even though pain perception during second-stage labor under epidural analgesia with local anaesthetics can be severe , the addition of opioids was avoided for fear of neonatal or maternal depression . A recent report found maternal and umbilical plasma concentrations following injection of 100 µg F to be safe and the investigators speculated that repeated addition of epidural/F to injections of local anaesthetic may prove beneficial for the parturient without exposing the mother or fetus to risk . We therefore studied maternal analgesia , maternal and umbilical plasma levels and associated side effects following repeated addition of 100 µg F to bupivacaine epidural analgesia during labor . Methods . Following institutional and governmental approval 53 parturients were randomly assigned to receive either 8 ml bupivacaine 0.25%+0.1 mg fentanyl ( B+F group ; n=28) or 8 ml bupivacaine 0.25%+2 ml saline ( BUP group ; n=25) in an epidural catheter at L2/3. The same dose was reinjected upon the patients ' request regardless of the degree of cervical dilatation . Blood pressure , heart rate , respiratory rate and the incidence of side effects were recorded before and following each epidural injection . Pain relief was determined at each injection and following cord clamping using the visual analogue pain scale ( VAS ; 0-100 mm ) . Maternal venous blood samples were collected to measure plasma F concentrations before and 20 and 40 min after each injection and at birth when umbilical venous and arterial blood was obtained . After centrifugation the samples were maintained at -20 ° C and then analyzed by radioimmunoassay . At delivery , Apgar scores and umbilical venous and arterial blood gas values were determined . Results . Both groups were comparable for age , weight , height , gestational age and parity . A total of 48 epidural injections were evaluated in the B+F group , 43 in the BUP group . No statistically significant group difference was found between the frequency of injections per delivery ( B+F : 2.2 ; BUP : 1.8 ) ; regarding the time between the initial and the first top-up dose ( B+F : 144 min ; BUP : 140 min ) or regarding the interval between the last injection and birth ( B+F : 94 min ; BUP ; 90 min ) . However , the quality of pain relief during labor and particularly at birth was significantly improved by F ( mean VAS in B+F group : 6 mm ; mean VAS in BUP group : 42 mm ) . Mild itching was observed in 43% of patients receiving F , moderate shivering in 13% versus 40% in patients not receiving F. At control mean maternal F plasma levels were not zero but 0.25 ng/ml . After the initial injection and following the first and second top-up dose mean maximum maternal F plasma concentrations were 0.54 ng/ml ( +/- 0.32 ; +/- SD ) , 0.88 ng/ml ( +/- 0.62 ) and 1.06 ng/ml ( +/- 0.4 ) ( range 0.18-2.76 ng/ml ) , respectively . The increase in maternal F concentrations with increasing injection frequency was statistically significant ( P 0.02 ) . Mean umbilical venous and arterial F concentrations at birth were 0.72 ng/ml ( +/- 1.16 ) and 0.62 ng/ml ( +/- 0.52 ) . No significant group differences were found regarding Apgar scores or umbilical blood gas analyses . In one newborn , radioimmunoassay resulted in unexplainably high umbilical F concentrations without any clinical signs of sedation , depressed vigilance and without any sequellae ." ], "offsets": [ [ 0, 3878 ] ] } ]

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[ { "id": "DerAnaesthesist.60450437.eng.abstr-passage-0", "type": "abstract", "text": [ "Mortality of severe acute respiratory distress syndrome ( ARDS ) in Germany is about 60% . Respiratory therapy can make the lung injury worse by high positive airway pressures , high tidal volumes and high inspiratory oxygen concentrations . Extracorporeal membrane oxygenation ( ECMO ) was employed to reduce aggressive mechanical ventilation , but it has not been proved to be superior to conventional ventilation . However , encouraged by recently developed improvements in the technique and concept of ECMO , we introduced this therapy into our program for the treatment of ARDS . Patients and methods . All patients with severe ARDS ( lung injury score > 2.5 ) admitted to our multidisciplinary intensive care unit from March 1992 to March 1995 were evaluated prospectively . After admission , the patients first underwent a conventional therapeutic approach , including pressure-controlled inverse-ratio ventilation , permissive hypercapnia , changes in body position ( in particular , the prone position ) , negative fluid balance , antibiotics , and low-dose hydrocortisone infusion . ECMO via a covalently heparin-coated , venovenous bypass-system with a vortex pump and two membrane lungs was performed if ARDS did not improve after 24-96 h of conventional therapy and if two of three of the slow-entry criteria for ECMO were fulfilled : ( 1 ) PaO2/FiO2 150 mmHg at PEEP > 5 mbar ; ( 2 ) semistatic compliance 30 ml/mbar ; ( 3 ) right-left shunt > 30% . Only in cases of life-threatening hypoxemia ( PaO2 50 mmHg at FiO2 1.0 and PEEP > 5 mbar for > 2 h ( fast-entry criteria ) was ECMO instituted immediately . Results . Sixty patients fulfilled the entry criteria for our study . Thirty-nine patients were treated with a conventional protocol , 37 after improvement of ARDS and 2 who had not improved but in whom there were contraindications to the use of ECMO . ECMO was performed in 10 patients who had not improved , but who fulfilled the slow-entry criteria and in 11 primarily hypoxemic patients who fulfilled the fast-entry criteria . The survival rate was 30/39 ( 77% ) for the conventional therapy group , 6/10 ( 60% ) for the slow-entry group , and 11/11 ( 100% ) for the fast-entry group . The onset of ECMO allowed a significant decrease in peak and mean airway pressures , tidal volume , ventilatory rate , minute volume and inspiratory oxygen concentration . Sufficient gas exchange was provided , and pulmonary artery pressures significantly decreased on bypass . The most frequent complications on bypass were pneumothorax ( 15/21 patients ) and bleeding ( 7/21 patients ) . Conclusion . In comparison with the historical results at our own institution , the present study demonstrates an improvement in the survival rate from 56% to 78% since ECMO has become available . We conclude that venovenous ECMO with a heparin-bonded bypass circuit is an effective additional option for the treatment of patients with severe ARDS ." ], "offsets": [ [ 0, 2950 ] ] } ]

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[ { "id": "DerAnaesthesist.60450449.eng.abstr-passage-0", "type": "abstract", "text": [ "Administration of highly concentrated , highly potent , and therefore highly dangerous drugs with syringe pumps is common in modern anaesthesia as well as in intensive care and emergency medicine . Because of their exact flow rates down to 1 ml/h , these pumps are predestined for delivery of drugs with short half-lives , such as catecholamines and vasodilators . But intravenous application of drugs with syringe pumps is not without problems . While it is well known that syringes not fixed correctly into the pump can empty themselves by the influence of gravity , it seems not to be known that hydrostatic pressure can influence the flow rate of a correctly connected system even during continuous infusion . In this situation a change of height of the syringe pump in relation to the patient's position can have tremedous effects on hemodynamics due to unintended acceleration or deceleration of the flow rate . This case report demonstrates that the elevation of a connected epinephrine pump while moving a cardiac surgery patient after ACB operation from the operation table into his bed led to critical increases of heart rate , blood pressure and left atrial pressure . In order to quantify the problem we repeated the situation experimentally . It could be demonstrated that the elevation of the syringe pump by 80-100 cm delivers an additional bolus of 4-5 drops as the central venous catheter outlet . Lowering the pump consecutively leads to the opposite effect . In the case reported , the accidentally administered bolus of epinephrine was 12-15 µg ( we use a concentration of 60 µg/ml epinephrine for continuous infusion with syringe pumps ) . From this accidental observation the following conclusion can be drawn : The change of height , in relation to the patient's position , of a running syringe pump during continuous infusion of highly concentrated cardiovascular drugs may cause considerable , even life-threatening hemodynamic disorders . Even in a closed infusion system ( syringe-extension-central venous catheter ) , hydrostatic pressure influences infusion rate . Elevation of the pump leads to unintended bolus administration , and lowering of the pump is followed by an interruption of the infusion . In the knowledge of this phenomenon , unexpected hemodynamic reactions during transport of critically ill patients cannot always be interpreted as a result of inadequate anesthesia or volume load , but may be a consequence of incorrect handling of the syringe pumps as described in this report ." ], "offsets": [ [ 0, 2528 ] ] } ]

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[ { "id": "DerAnaesthesist.60450453.eng.abstr-passage-0", "type": "abstract", "text": [ "Using the PTB simulator , which emits real signals from patients , we examined the precision of the oscillometric blood pressure measurement with the Dinamap 1846 ( Critikon ) and the HP M-1008B ( Hewlett Packard ) . For this purpose we simultaneously registered invasive arterial pulsewave , cuff pressure and cuff pressure oscillations of 20 patients from our intensive care unit and stored them in the database of the simulator . The invasive reference blood pressure values were determined following the recommendations given by the Association for the Advancement of Medical Instrumentation . The invasive system showed a cut-off frequency of 35 Hz ; the damping constant was 0.21. With 49 record signals from patients we carried out 15 simulated measurements each . From a total of 49 bio-signals from patients the Dinamap 1846 was able to process 41 signals and the HP M-1008B 47 signals . The mean error of the oscillometric blood pressure measurement of the systolic , diastolic and mean arterial pressure amounted to -2 . 50 mmHg , 3.35 mmHg ( P 0.05 ) and 1.51 mmHg with the Dinamap 1846 and to -8 . 5 mmHg ( P 0.001 ) , -5 . 15 mmHg ( P 0.001 ) and -5 . 58 mmHg ( P 0.001 ) for the HP M-1008B. The 95% confidence limit for the systolic , diastolic and the mean arterial pressure amounts to 56 mmHg , 30 mmHg and 35 mmHg for the Dinamap 1846 and 50 mmHg , 38 mmHg and 35 mmHg for the HP M-1008B. The differences between that two instruments could be caused by the different algorithms for the calculation of blood pressure values and different artefact detection and elimination techniques . The results of the performance tests we achieved with the PTB simulator correspond to the results of other clinical examinations . The American Association for the Advanecement of Medical Instrumentation recommends a maximum mean error of 5 +/- 8 mmHg . None of the examined instruments lay within these limits . Due to the systematic and stochastic errors , we think that the Dinamap 1846 ( Critikon ) and the HP M-1008B ( Hewlett Packard ) do not achieve performance levels that are adequate for measuring critically ill patients ." ], "offsets": [ [ 0, 2136 ] ] } ]

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[ { "id": "DerAnaesthesist.60450460.eng.abstr-passage-0", "type": "abstract", "text": [ "Postoperatively , after an uncomplicated vaginal hysterectomy , a 58-year-old female patient developed the signs of disseminated intravascular coagulation and fever , which progressed to a septic shock . She received two units of autologous blood , one during and one after the operation . A blood culture from the patient and one unit of the autologous blood showed abundant growth of Pseudomonas cepacia and Serratia marcescens within 24 h and culture of this blood bag also showed slight growth of Staphylococcus epidermidis within 48 h . Culture of the second blood unit showed slight growth of Propionibacterium acnes . The source of bacterial contamination could not be identified . Autologous blood products thus also include a risk of infection that shouldn ' t be underestimated , and a strict medical indication to retransfusion is indispensable ." ], "offsets": [ [ 0, 857 ] ] } ]

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"DerAnaesthesist.60450460.eng.abstr-s5-t1", "type": "umlsterm", "text": [ "bacterial" ], "offsets": [ [ 639, 648 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0521009" } ] }, { "id": "DerAnaesthesist.60450460.eng.abstr-s6-t1", "type": "umlsterm", "text": [ "blood" ], "offsets": [ [ 700, 705 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005767" }, { "db_name": "UMLS", "db_id": "C0005768" }, { "db_name": "UMLS", "db_id": "C0005835" } ] }, { "id": "DerAnaesthesist.60450460.eng.abstr-s6-t2", "type": "umlsterm", "text": [ "risk" ], "offsets": [ [ 735, 739 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0035647" } ] }, { "id": "DerAnaesthesist.60450460.eng.abstr-s6-t3", "type": "umlsterm", "text": [ "infection" ], "offsets": [ [ 743, 752 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021311" } ] }, { "id": "DerAnaesthesist.60450460.eng.abstr-s6-t4", "type": "umlsterm", "text": [ "risk of" ], "offsets": [ [ 735, 742 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0035647" } ] } ]

[]

[]

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[ { "id": "DerAnaesthesist.60450495.eng.abstr-passage-0", "type": "abstract", "text": [ "The treatment of cancer pain with opioids is well accepted . However , the use of opioids for the treatment of non-cancer pain is still a matter of controversy . The main matters of concern are physical dependence and opioid abuse . Another argument against opioids is the lack of efficacy . Experiences with opioids in non-cancer pain have been published on about 850 patients , the longest therapy lasting almost 14 years . 85% of the patients treated with opioids had beneficial effects . In a number of investigations evaluating the opioid sensibility of pain by PCA and intravenous infusions , 67-80% of the patients with neuropathic pain responded to opioids . The efficacy of opioids in the treatment of non-cancer pain was proven in 3 placebo controlled studies . In 2 studies pain reduction in neuropathic pain was similar to that in nociceptive pain . When opioids are used , the administration has to be performed according to well defined standards . The indication for opioids must be made by a specialist in pain management . The diagnosis must clearly reveal an organic origin of the pain . Before the start of therapy the duration as well as the criteria for discontinuation must be set up . The treatment must be controlled by a specialist team and frequent regular follow up investigations must be performed . These must include proper documentation of the pain level , changes in patients ' function and in social activities . The reliable intake of prescribed medication must be assured if necessary by laboratory screening . The treatment of non-cancer pain with opioids may be an alternative for those patients , who didn ' t gain sufficient reduction of pain by other therapies . Standards for this therapy are an absolute necessity and are to be followed closely ." ], "offsets": [ [ 0, 1788 ] ] } ]

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[ { "id": "DerAnaesthesist.60450512.eng.abstr-passage-0", "type": "abstract", "text": [ "Prompted by the ongoing discussion of the pros and cons of using succinylcholine , this study was conducted to compare the responses to bolus injections of atracurium or vecuronium with those after sequential injection of these drugs ( priming principle ) . We evaluated the earliest possible intubation times , intubating conditions , and the onset times ( i.e. times from the end of injection to the maximum blockade ) under conditions approaching real use as closely as possible . Methods . The randomized and double-blind study was carried out with 80 ASA risk class 1 and 2 patients . Approval of the institutional ethics committee was obtained , and each patient gave informed consent . Patients were randomly allocated to four study groups of 20 patients each . Isotonic saline was administered to those patients assigned to the atracurium or vecuronium bolus groups , whereas the patients assigned to the other two groups received a priming injection of either atracurium ( 0.05 mg/kg ) or vecuronium ( 0.01 mg/kg ) . We observed the patients for signs of incipient muscular weakness before the induction of anaesthesia . Anaesthesia was induced with thiopental 3.5 min after the first injection ( 5 mg/kg and 50-100 mg before intubation ) . After a further 1 min during which adequate mask ventilatin with oxygen was assured , corresponding to a priming interval of 4.5 min , 0.5 mg/kg of atracurium or 0.1 mg/kg of vecuronium was administered to the patients in the bolus groups and 0.45 mg/kg of atracurium or 0.09 mg/kg of vecuronium as intubating doses to those in the priming groups . Intubation was attempted at 90 , 120 , 150 and 180 s thereafter . Intubating conditions were evaluated on the basis of laryngoscopy , vocal cord movement and coughing or bucking of the patients . Neuromuscular function was monitored via accelerometry at the adductor pollicis muscle ( TOF stimulation of the ulnar nerve every 15 s ) . Results . The priming doses did not diminish the elicited twitches of the adductor pollicis muscle , but led to heavy eyelids and double vision in 35% of the atracurium patients and 47% of the vecuronium patients ; these symptoms were well tolerated by the patients . At the time of intubation the adductor pollicis muscle was relaxed to approximately the same degree in all groups ( mean +/- SD for the TOF ratios in the bolus groups was 0.46 +/- 0.37 for atracurium , 0.45 +/- 0.4 for vecuronium ; in the priming groups 0.52 +/- 0.39 for atracurium , 0.53 +/- 0.36 for vecuronium ) . The administration of the relaxants in divided doses significantly shortened the intubating time after atracurium ( 100 vs 124 s ) and improved the intubating conditions of vecuronium ( good vs tolerable ) , but had no effect on the time course of the neuromuscular blockade ( onset times in the bolus groups 224 +/- 84 s for atracurium and 209 +/- 64 s for vecuronium ; in the priming groups 249 +/- 112 s for atracurium and 205 +/- 52 s for vecuronium ) . Conclusions . The priming technique presented here is clinically superior to the bolus method and therefore should be preferred in all elective cases and in those patients in whom succinylcholine is contraindicated ." ], "offsets": [ [ 0, 3194 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.60450526.eng.abstr-passage-0", "type": "abstract", "text": [ "As it is the driving force in the development of a multiorgan dysfunction syndrome ( MODS ) , the gastro-intestinal region is at the centre of current discussion . Recently , hepatovenous oximetry has been used increasingly to monitor the relationship between oxygen supply and consumption in the splanchnic system . In the present paper we report an exclusively oximetrically controlled catheterisation procedure that can be carried out at the bedside without the use of imaging procedures . In the inferior vena cava a typical venous oxygen saturation profile can be expected . Near the opening of renal veins there is a peak in venous saturation due to the large extent to which the kidneys partake in the cardiac output and their relatively low oxygen consumption . Correspondingly there is a significant drop in saturation in the area around the opening of the hepatic veins . At the right atrium the oxygen saturation increases again due to admixing of more highly saturated blood from the superior vena cava . Taking these physiological facts into consideration it was attempted to find the opening of the hepatic veins into the inferior vena cava using only continuous in vivo oximetry and to insert a hepatovenous catheter ." ], "offsets": [ [ 0, 1233 ] ] } ]

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[ { "id": "DerAnaesthesist.60450533.eng.abstr-passage-0", "type": "abstract", "text": [ "The action of local anaesthetics on isolated nerves is enhanced by high stimulation frequencies . The aim of our study was to investigate whether high-frequency stimulation enhances regional anaesthesia in man ." ], "offsets": [ [ 0, 211 ] ] } ]

[ { "id": "DerAnaesthesist.60450533.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "anaesthetics" ], "offsets": [ [ 20, 32 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002932" } ] }, { "id": "DerAnaesthesist.60450533.eng.abstr-s1-t2", "type": "umlsterm", "text": [ "nerves" ], "offsets": [ [ 45, 51 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027769" } ] }, { "id": "DerAnaesthesist.60450533.eng.abstr-s1-t3", "type": "umlsterm", "text": [ "frequencies" ], "offsets": [ [ 84, 95 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0376249" } ] }, { "id": "DerAnaesthesist.60450533.eng.abstr-s1-t4", "type": "umlsterm", "text": [ "local anaesthetics" ], "offsets": [ [ 14, 32 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002934" }, { "db_name": "UMLS", "db_id": "C0002921" } ] }, { "id": "DerAnaesthesist.60450533.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "aim" ], "offsets": [ [ 102, 105 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0108800" } ] }, { "id": "DerAnaesthesist.60450533.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "man" ], "offsets": [ [ 206, 209 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0025266" }, { "db_name": "UMLS", "db_id": "C0024554" } ] }, { "id": "DerAnaesthesist.60450533.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "regional anaesthesia" ], "offsets": [ [ 182, 202 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002911" } ] } ]

[]

[]

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[ { "id": "DerAnaesthesist.60450538.eng.abstr-passage-0", "type": "abstract", "text": [ "Even today , adequate postoperative analgesia is still a great problem . Based on positive results of former studies using a continuous infusion of tramadol for postoperative pain relief [ 2 , 15 ] , we aimed to improve this regimen . In order to investigate the effectiveness of preventive analgesia , one group of patients was given 100 mg tramadol ( Tramal ) at the time of extubation , followed by a maintenance infusion . The other group was treated with single boluses of tramadol on demand , thus representing common pain treatment ." ], "offsets": [ [ 0, 540 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.60450545.eng.abstr-passage-0", "type": "abstract", "text": [ "The number of patients with congenital cyanotic heart disease who reach child-bearing age is increasing . This is partly a consquence of the high long-term survival and the haemodynamic benefits resulting from the Fontan procedure , which is used for the definitive palliation of such cyanotic heart disease as tricuspid atresia and single ventricle . However , so far little experience has been recorded with pregnant patients who have undergone right ventricular exclusion procedures . The particular physiology of a univentricular heart and a passive , non-pulsatile blood flow through the lungs has significant implications for the anaesthetic obstetric management of these patients . We report a case of successful pregnancy and caesarean delivery after a modified Fontan procedure ." ], "offsets": [ [ 0, 788 ] ] } ]

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"DerAnaesthesist.60450545.eng.abstr-s1-t6", "type": "umlsterm", "text": [ "heart disease" ], "offsets": [ [ 48, 61 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018799" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "survival" ], "offsets": [ [ 156, 164 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0220921" }, { "db_name": "UMLS", "db_id": "C0038952" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "haemodynamic" ], "offsets": [ [ 173, 185 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0019010" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "procedure" ], "offsets": [ [ 221, 230 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0184661" }, { "db_name": "UMLS", "db_id": "C0025664" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "heart" ], "offsets": [ [ 294, 299 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018787" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "disease" ], "offsets": [ [ 300, 307 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012634" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s2-t6", "type": "umlsterm", "text": [ "atresia" ], "offsets": [ [ 321, 328 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0243066" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s2-t7", "type": "umlsterm", "text": [ "single" ], "offsets": [ [ 333, 339 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0087136" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s2-t8", "type": "umlsterm", "text": [ "ventricle" ], "offsets": [ [ 340, 349 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018827" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s2-t9", "type": "umlsterm", "text": [ "Fontan procedure" ], "offsets": [ [ 214, 230 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0190010" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s2-t10", "type": "umlsterm", "text": [ "heart disease" ], "offsets": [ [ 294, 307 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018799" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s2-t11", "type": "umlsterm", "text": [ "tricuspid atresia" ], "offsets": [ [ 311, 328 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0243002" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 419, 427 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "procedures" ], "offsets": [ [ 475, 485 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0184661" }, { "db_name": "UMLS", "db_id": "C0025664" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s4-t1", "type": "umlsterm", "text": [ "physiology" ], "offsets": [ [ 503, 513 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0031842" }, { "db_name": "UMLS", "db_id": "C0031843" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s4-t2", "type": "umlsterm", "text": [ "heart" ], "offsets": [ [ 534, 539 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018787" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s4-t3", "type": "umlsterm", "text": [ "blood" ], "offsets": [ [ 570, 575 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005767" }, { "db_name": "UMLS", "db_id": "C0005768" }, { "db_name": "UMLS", "db_id": "C0005835" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s4-t4", "type": "umlsterm", "text": [ "lungs" ], "offsets": [ [ 593, 598 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0024109" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s4-t5", "type": "umlsterm", "text": [ "anaesthetic" ], "offsets": [ [ 636, 647 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002932" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s4-t6", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 678, 686 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s5-t1", "type": "umlsterm", "text": [ "pregnancy" ], "offsets": [ [ 720, 729 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0032961" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s5-t2", "type": "umlsterm", "text": [ "delivery" ], "offsets": [ [ 744, 752 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0011209" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s5-t3", "type": "umlsterm", "text": [ "procedure" ], "offsets": [ [ 777, 786 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0184661" }, { "db_name": "UMLS", "db_id": "C0025664" } ] }, { "id": "DerAnaesthesist.60450545.eng.abstr-s5-t4", "type": "umlsterm", "text": [ "Fontan procedure" ], "offsets": [ [ 770, 786 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0190010" } ] } ]

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[ { "id": "DerAnaesthesist.60450550.eng.abstr-passage-0", "type": "abstract", "text": [ "Selecting a route for drug administration during CPR requires consideration of the speed with which access can be obtained , the technical difficulties involved in performing the procedure , the associated risk of complications , delays in drug delivery to the central circulation , and the duration of effective drug levels following injection . The peripheral venous route is the safest method , and drug delivery can be enhanced by a fluid bolus after injection of the medication . The circulation time is shortest after central venous injection , but there is some risk of complications . The femoral route is associated with a high incidence of unsuccessful catherization . The endotracheal tube provides an accessible route for administration of most drugs , but peak concentrations are lower than those obtained by other routes . While the results are almost the same as an intravenous injection , the intraosseous route is currently underrepresented in clinical practice . This method must not only be considered in pediatric patients , but in adult patients as well ." ], "offsets": [ [ 0, 1076 ] ] } ]

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[ { "id": "DerAnaesthesist.60450587.eng.abstr-passage-0", "type": "abstract", "text": [ "Immediate-type hypersensitivity due to natural rubber ( latex ) products is an increasing problem for the anaesthetist , because a major part of products used for anaesthesia contains natural rubber . If the patient has a positive history of allergic symptoms after contact to natural rubber like urticaria , bronchospasm or anaphylaxis , preoperative skin tests , in vitro-tests , and if necessary even latex-glove wearing-test should be performed . If preoperative diagnosis of natural latex allergy is established , latex free anaesthesia is strictly recommended , otherwise life-threatening complications may ensue . Accordingly , we report on a patient who developed intraoperative anaphylactic shock following exposure to natural latex . In addition to the treatment with drugs , latex-containing products should be immediately replaced by latex free ones , in particular all persons should put on latexfree gloves . For prevention of anaphylactic episodes in sensitized patients the reader is provided an examplary list of latexfree products for anaesthesia . Because the incidence of immediate-type reactions to latex is still increasing , intraoperative occurence of an anaphylactic reaction to an unknown agent is likely to be due to allergy to natural rubber ." ], "offsets": [ [ 0, 1271 ] ] } ]

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[ { "id": "DerAnaesthesist.60450597.eng.abstr-passage-0", "type": "abstract", "text": [ "Increased perception of the risks of homologous blood transfusion has focused substantial interest on autologous blood transfusion ( ABT ) . To evaluate the role of ABT in the Federal Republic of Germany ( FRG ) , we conducted postal surveys of German hospitals in 1989 and 1993. In the present study , the responses of 143 hospitals in the \" old \" federal states ( former West Germany ) that replied to both of our surveys were analysed . The objective was to examine trends in ABT practice in the FRG from 1989 to 1993. The study was restricted to the \" old \" federal states because data for the \" new \" federal states ( former German Democratic Republic ) were not available for that period . Methods . Data presented in this study were obtained by postal surveys of German hospitals in 1989 and 1993. Because of German reunification ( 3 October 1990 ) , only hospitals in the \" old \" federal states were surveyed in 1989 , while hospitals in both the \" old \" and \" new \" states were included in 1993. Four hundred randomly selected hospitals in the \" old \" federal states were included in both surveys , 143 of which responded to both . The completed questionaires of these 143 hospitals were analysed . In addition , to estimate the magnitude of positive selection bias , the data provided by these 143 hospitals were compared with data provided by another set of 162 hospitals in the \" old \" federal states that replied to the 1993 but not to the 1989 survey . Results . There were no significant changes from 1989 to 1993 in the 143 hospitals with respect to hospital size by number of beds and spectrum of surgical specialties . The proportion of hospitals that performed preoperative autologous blood donation grew by 20% ( from 74% to 89% ) and the proportion that used this technique regularly ( \" frequently \" and \" mostly \" ) rose by 80% ( from 25% to 45% ) . The percentage of hospitals that performed preoperative plasmapheresis had more than doubled ( from 8% to 19% ) . The proportion that used acute isovolaemic haemodilution grew by 32% ( from 62% to 82% ) , while those doing so regularly ( \" frequently \" and \" mostly \" ) increased by only 17% ( from 23% to 27% ) . The fraction of hospitals equipped with cell-washing devices grew by 29% ( from 35% to 45% ) . General transfusion practice , as measured by acceptance of postoperative haemoglobin levels of less than 10.0g/dl, had changed but little . Conclusions . Although the 143 hospitals are not representative on a national level , the findings of our study allow some conclusions on general trends in the \" old \" states of the FRG . The potential for ABT has substantially grown in the \" old \" states from 1989 to 1993 , although more consistent advantage of this potential could be taken ." ], "offsets": [ [ 0, 2768 ] ] } ]

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[ { "id": "DerAnaesthesist.60450614.eng.abstr-passage-0", "type": "abstract", "text": [ "Recently , professional anaesthesiologists organizations , have set up recommendations for intraoperative monitoring . These recommendations are based upon the assumption that anaesthesia-related deaths are largely preventable and that extensive monitoring will reduce mortality . Hypoxaemia appears to be an important pathophysiological mechanism , and this is why oxygen monitoring is given a high priority in safety standards in anaesthesia . However , no reduction in mortality has been definitively shown to follow the use of any monitoring device in randomized , controlled trials . Four techniques of oxygen monitoring are discussed and evaluated . Oxygen monitoring during inspiration can be recommended , although its implementation will probably prevent only a few anaesthesia-related deaths . Pulse oximetry is certainly highly recommended , but also has some deficiencies which are not sufficiently well known considering the popularity of this technique . Transcutaneous PO2 is considered mainly for historical reasons . Near infrared spectrometry is a new technique offering noninvasive and continuous monitoring of intracerebral oxygenation ." ], "offsets": [ [ 0, 1157 ] ] } ]

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[ { "id": "DerAnaesthesist.60450626.eng.abstr-passage-0", "type": "abstract", "text": [ "A commercially available C1 inhibitor ( C1-INH) concentrate was used for short-term prophylaxis before surgery in two patients with hereditary angioneurotic oedema . The patients suffered from recurrent subcutaneous and submucosal oedema of the face , extremities , and gastrointestinal tract as the result of a hereditary C1-INH deficiency . Both patients were receiving tranexamic acid or danazol therapy as oral long-term prophylaxis . Over the years the patients underwent several operations in regional and general anaesthesia , with mask ventilation or intubation . The C1-INH plasma concentrations measured preoperatively were always very low ( 0.02-0.06 g/l , normal range 0.15-0.35 g/l ) , despite the oral long-term prophylaxis . Substitution treatment with 500-1000 U C1-INH was performed 1 h before surgery . No side effects were seen following the concentrate infusions . With this substitution treatment no specific symptoms of hereditary angioneurotic oedema were recognized in either case . The measurement of C1-INH plasma concentration 2 h or 4 h after C1-INH substitution showed a marked rise in both patients , though normal values were not reached in either . We suggest that infusion of C1 concentrate is an appropriate form of preoperative substitution treatment in patients with hereditary angioneurotic oedema , in view of the lower risk of infection than with infusion of fresh-frozen plasma and the observed effectiveness ." ], "offsets": [ [ 0, 1450 ] ] } ]

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[ { "id": "DerAnaesthesist.60450635.eng.abstr-passage-0", "type": "abstract", "text": [ "Epidural anaesthesia for elective caesarean section can have advantages over general anaesthesia . The anaesthesiologist can avoid endotracheal intubation as well as fetal depression following placental transfer of systemic anaesthetics . However , despite reaching an effective blockade preoperatively , intraoperative discomfort and pain may occur during epidural anaesthesia with local anaesthetics alone , necessitating supplemental systemic analgesics or even conversion to general anaesthesia [ 21 ] . Addition of epidural fentanyl has been shown to improve onset and quality of perioperative analgesia without evident side effects for mother or newborn [ 24 ] . Nevertheless , administration of epidural opioids before cord clamping is still hotly debated , some fearing maternal and or neonatal depression [ 6 , 26 ] . The aim of the present study was to investigate the quality of analgesia , associated side effects and the resulting maternal and neonatal plasma opiate concentrations after a single preoperative addition of 0.1 mg fentanyl to epidural bupivacaine analgesia in comparison to epidural bupivacaine analgesia alone ." ], "offsets": [ [ 0, 1140 ] ] } ]

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[ { "id": "DerAnaesthesist.60450643.eng.abstr-passage-0", "type": "abstract", "text": [ "Hypoxic pulmonary vasoconstriction ( HPV ) was first described by von Euler and Liljestrand in 1946 and is still the only known vascular feedback control mechanism in the lung . This technique results in a redistribution of blood flow away from poorly ventilated areas into better ventilated regions , thus reducing shunt . HPV functions as a local mechanism that acts in response to alveolar hypoxia but in the smallest areas of the lung , making it an important mechanism in all situations where ventilation perfusion mismatch occurs . To be effective , HPV needs normal pulmonary areas into which blood flow can be diverted . This explains why the efficacy of the treatment depends on the area that is vasoconstricted . The effect on PaO2 is maximal when the amount of the hypoxic lung ist 30-70% . If the area in vasoconstriction is small , the influence on PaO2 is negligible . On the other hand , when most of the lung is hypoxic , there is no significant normoxic region to which the hypoxic region can divert flow . In that case it does not matter , in terms of PaO2, whether the hypoxic region has active hypoxic pulmonary vasoconstriction or not . In this situation HPV becomes a rather detrimental mechanism , because it causes an increase in pulmonary arterial pressure . At some stage a turning point , where the gain in PaO2 is lost due to an increase in right ventricular afterload , inducing a decrease in CO . The reaction is diminished by exogenous manipulations , drugs ( inhalation anesthetics , direct vasodilators ) , endotoxin , very low PaO2 values , vasodilating mediators and changes in the acid-base balance . Acidosis and alcalosis inhibit HPV . Factors like spontaneous or mechanical ventilation , PEEP , open or closed chest , and the type of hypoxia ( atelectasis or nitrogen ) have no influence on HPV . The small arteries , those less than 500 µm in diameter , were identified as the location of the hypoxic constriction . Pulmonary vascular smooth muscle cells in pure culture undergo reversible and repeated hypoxic constriction . Examination of a histological lung section emphasizes that the small arteries are closely surrounded by alveoli gas on the outside and by mixed venous blood on the inside . Thus , the response is believed to be accounted for by each smooth muscle cell in the pulmonary arterial wall responding proportionally to the local oxygen tension in its vicinity and depending on alveolar as well as mixed venous oxygen pressure . The biochemical intracellular mechanism remains unknown ." ], "offsets": [ [ 0, 2544 ] ] } ]

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[ { "id": "DerAnaesthesist.60450674.eng.abstr-passage-0", "type": "abstract", "text": [ "Recently , two new halogenated volatile anaesthetics , sevoflurane and desflurane , have been approved for clinical use in Germany . Their low solubility in blood is the most important common property , and this represents the most obvious difference from the inhalational anaesthetics currently used . Extensive clinical and experimental evaluations have confirmed the superior pharmacokinetic properties predicted . Both sevoflurane and desflurane provide more rapid emergence from anaesthesia , permit easier titration of the anaesthetic dose during maintenance and offer more rapid recovery from anaesthesia . For sevoflurane , there are additional advantages : a pleasant odor , negligible airway irritation , and excellent pharmacodynamic characteristics that even provide cardiovascular stability comparable to isoflurane . A certain disadvantage and source of potential nephrotoxicity result from the metabolism of sevoflurane ( 2-5% ) to anorganic fluoride and degradation to compound A in carbon dioxide absorbents . The extensive clinical data reported to date have revealed no evidence that sevoflurane has adverse renal effects . New insight into the pathomechanism of nephrotoxicity associated with either production of fluoride or compound A may well support clinical experience . Desflurane strongly resists in vivo metabolism and because of this it appears to be devoid of toxicity . Nevertheless , potential side-effects may result from degradation in dry absorbents and subsequent release of CO , from its extreme pungency and irritating airway effects . Thus , desflurane is not recommended for induction of anaesthesia , especially in children . The tendency for desflurane transiently to stimulate sympathetic activity , especially at concentrations above 1.0 MAC , limits its application in patients with cardiac disease ." ], "offsets": [ [ 0, 1845 ] ] } ]

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[ { "id": "DerAnaesthesist.60450694.eng.abstr-passage-0", "type": "abstract", "text": [ "The separation of whole blood into components is the state-of-the-art in transfusion of allogeneic blood . The main reasons are the negative effects of the buffy coat and the need for FFP . Nevertheless , especially in Germany whole blood is being rejected more and more even as autologous blood . However , most of the negative effects of the buffy coat do not apply to autologous blood . Additionally , these patients usually do not develop coagulation disorders and therefore do not need plasma as a hemostatic component . On the other hand , separation into components of autologous blood leads to an increase of costs and to logistic problems that restrict autologous blood predeposit to a few institutions . Therefore , we have reviewed the literature in order to find a scientific basis for this . Methods . We analysed all articles listed by MEDLINE during the last 12 years that dealt with the quality of whole blood or red cell concentrates . In addition , all references were included that contributed relevant information to the topic . A total of 135 original articles , abstracts , reviews , letters or editorials were analysed that referred to standard preparations and storage media . In 48 papers the in vivo red cell survival was studied . 28 of which fulfilled the prerequisites to be included into a meta-analysis . The following in vitro parameters were also evaluated : pH , potassium load of the units , ATP and DPG concentration of the red cells . Results and discussion . Whole blood ( resuspended in CPDA-1) and red cell units ( stabilized in CPDA-1 or additive solutions ) with a different buffy coat or leucocyte content have comparable pH values and red cell 2,3-DPG and ATP concentrations at the end of the approved storage time . The potassium load of a whole blood unit appears to be higher than red cell concentrates , but this is to some extent caused by the higher plasma content of whole blood and is not thought to be a clinically relevant problem for patients receiving only a few units . A number of studies demonstrate that dependent upon the leucocyte content of a red cell unit , leucocyte metabolites and enzymes are released and accumulate during storage . A detrimental influence on the integrity of the red cell membrane was found in several in vitro studies . Nevertheless , a significant improvement in red cell survival by leucocyte reduction was detected by only one group . Undoubtedly , non-hemolytic febrile transfusion reactions ( NHFTR ) are generally caused by an antibody-antigen interaction due to the transfusion of allogeneic buffy coat . On the other hand , there is some evidence that non-specific immunological mechanisms such as the release of histamine or cytokines are also capable of causing NHFTR . Thus , these reactions are expected to occur in autologous blood transfusion . However , so far , there are no data about the frequency and severity of these reactions and whether they are more likely to emerge after transfusion of blood units with a particular preparation . Blood transfusions can cause septic complications due to bacterial contamination of the transfused units . These fatal but rare complications may be reduced by pre-storage filtration of blood , but there is no indication that buffy coat reduction is effective . Three cases with septic complications have been reported after autologous transfusion , in two of which red cell concentrates ( at least one was free of buffy coat ) had been used . Thus , there is no justification for the conclusion that the risk of septic complications is increased by transfusion of whole blood . After all , whole blood and red cell concentrates exhibit only minor differences in relevant in vitro parameters . Hence , a higher incidence of adverse effects following the transfusion of autologous whole blood compared to autologous red cell concentrations is unlikely . Therefore , the 24 h in vivo recovery is considered to be the most valid criterion to assess the quality of red cell preparations ." ], "offsets": [ [ 0, 4027 ] ] } ]

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[ { "id": "DerAnaesthesist.60450708.eng.abstr-passage-0", "type": "abstract", "text": [ "Several methods have been developed to quantify central anaesthetic effects and monitor awareness during general anaesthesia . The most important of these are the PRST score , calculated from changes in blood pressure , heart rate , sweating , and tear production , the isolated forearm technique , where the patient is allowed to move during surgery , the processed electroencephalogram ( EEG ) and the derived parameters median frequency ( MF ) and spectral-edge frequency ( SEF ) , and midlatency auditory evoked potentials ( MLAEP ) . In clinical practice , the application of individual doses of anaesthetics is generally guided by autonomic vegetative clinical signs such as changes in blood pressure , heart rate , sweating , and tear production , quantified as the PRST score . Unfortunately , these parameters are not very reliable with regard to predicting the suppression of consciousness and awareness , especially when high-dose opioids are used in patients with cardiovascular medications and a variety of accompanying diseases . The PRST score probably indicates mainly the autonomic responses to painful stimuli , and seems to be useful in guiding the individual use of analgesics . The isolated forearm technique is a useful test of the patient's responsiveness during general anaesthesia , and thus an instrument for investigating the incidence of awareness during different anaesthetic regimens and when muscle relaxants are imployed . A disadvantage is that it can only be used for 20 to 30 min because of pressure-induced nerve blocks or lesions . It can not be employed when long-term relaxation is necessary and consciousness and awareness are to be monitored continuously . The processed EEG and the derived parameters MF and SEF are important scientific tools to quantify central effects of many anaesthetics and opioid analgesics that allow the development of pharmacodynamic-pharmacokinetic models of anaesthetic action . MF has proven to be useful in monitoring closed-loop feedback of intravenous drug administration . Unfortunately , until now there have been no clinical studies that document the usefulness of MF or SEF with regard to predicting intraoperative arousal or awareness . To the contrary , some experimental data failed to predict imminent arousal and response to surgical incision or verbal commands by MF or SEF . Therefore , the EEG seems to be of limited value for monitoring awareness , consciousness , or memory formation during anaesthesia . MLAEP are suppressed in a dose-dependent fashion by many general anaesthetics and correlate with wakefulness , awareness , and explicit and implicit memory during anaesthesia and seem to be a promising method of monitoring awareness during anaesthesia . Nevertheless , future studies will have to determine threshold values for the different MLAEP parameters for intraoperative awareness and explicit and implicit recall of intraoperatively presented information for the different commonly used anaesthetics . Only then will it be possible to determine the usefulness of the method in clinical practice ." ], "offsets": [ [ 0, 3097 ] ] } ]

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[ { "id": "DerAnaesthesist.60450722.eng.abstr-passage-0", "type": "abstract", "text": [ "This study was designed to determine the relationship between the electroencephalogram ( EEG ) and clinical signs of depth of anaesthesia during induction of anaesthesia by slow infusion of propofol ( 18 mg/kg - h ) ." ], "offsets": [ [ 0, 217 ] ] } ]

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[ { "id": "DerAnaesthesist.60450737.eng.abstr-passage-0", "type": "abstract", "text": [ "Several clinical studies have demonstrated the efficacy of ropivacaine in different regional anaesthesia techniques , e.g. , epidural anaesthesia . However , the efficacy of ropivacaine for spinal anaesthesia has only been demonstrated in animal experiments up to now . The objective of this study was the investigation of the efficacy and appropriate dosage of isobaric ropivacaine for spinal anaesthesia in humans ." ], "offsets": [ [ 0, 417 ] ] } ]

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[ { "id": "DerAnaesthesist.60450745.eng.abstr-passage-0", "type": "abstract", "text": [ "Erythropoietin , the hematopoietic growth factor , is synthesised in the kidneys and liver and regulates red blood cell production . Within the last few years , recombinant DNA technology has produced synthetic erythropoietin ( rhEPO ) . Some patients , especially Jehova's Witnesses , will not accept blood transfusion . The perioperative administration of rhEPO increases the patients ' hematocrit ( HCt ) to a higher than physiological level ." ], "offsets": [ [ 0, 446 ] ] } ]

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[ { "id": "DerAnaesthesist.60450750.eng.abstr-passage-0", "type": "abstract", "text": [ "Objective . A new portable device for blood gas analyses ( BGA ) has been examined for prehospital application ." ], "offsets": [ [ 0, 112 ] ] } ]

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[ { "id": "DerAnaesthesist.60450789.eng.abstr-passage-0", "type": "abstract", "text": [ "Every action taken by a physician comes under the jurisdiction of the courts . The physician is sentenced when he offends against the duties of care , set down by the respective standard , or when he carries out treatment without having first obtained the patient's consent . Using the examples of many decisions made by the chief justice and the supreme court relating to the field of anaesthesia , this paper sets out to indicate which rules on diligence apply in this area . In the second part , 14 guiding principles on the physician's obligation to obtain informed consent are set out . The burden of proof for fulfillment of this obligation lies with the physician . The final part of the paper is a discussion of the documentational obligations , which are important for litigation on the physician's liability . A description of a variety of topics from a physician's everyday work is also given ." ], "offsets": [ [ 0, 905 ] ] } ]

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[ { "id": "DerAnaesthesist.60450798.eng.abstr-passage-0", "type": "abstract", "text": [ "In the presence of completely dry soda lime volatile anaesthetics will decompose to carbon monoxide ( CO ) . In an in vitro study , the absorbent ( soda lime , ICI ) was dried with a constant gas flow of 1 l/min oxygen for 120 h . The weight loss during the drying was 17.1% . Two vol% of halothane , enflurane or isoflurane in oxygen was administered with a constant flow of 0.5 l/min oxygen through the completely dry absorbent . Concentrations of gases were measured before and after the absorbent using mass spectrometry ( MGA 1100 , Perkin-Elmer ) and an electrochemical NO monitor ( Mini PAC CO , Draeger ) . The temperature inside the soda lime was monitored continuously . Shortly after adding the anaesthetic to the oxygen passing through the absorbent , carbon monoxide appeared in the outlet of the soda lime container . The measured peak concentrations varied around 450 ppm ( halothane ) , 3500 ppm ( enflurane ) and 3800 ppm ( isoflurane ) . The temperature inside the absorbent rose from the ambient temperature ( 19.8 °C) to a maximum of 52.1 °C during CO production and decreased when the CO production lowered after approximately 1 h ( all anaesthetics ) . During CO production no measurable concentration of halothane left the absorber . After passing through the absorbent the concentrations of isoflurane and enflurane were slightly lower than the corresponding concentrations in the fresh gas measured before absorption ." ], "offsets": [ [ 0, 1443 ] ] } ]

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[ { "id": "DerAnaesthesist.60450802.eng.abstr-passage-0", "type": "abstract", "text": [ "The administration of dry anaesthetic gases for ventilation leads to morphological changes of the tracheobronchial epithelium that may cause postoperative pulmonary complications . Therefore , additional humidification with a heat and moisture exchanger ( HME ) is suggested for ventilation during anaesthesia , particularly when using semi-open breathing systems . Recommendations concerning the use of a HME in the semi-closed system are controversial . There are no data in the literature as to whether a HME improves mucociliary transport under these conditions . We therefore studied bronchial mucus transport velocity ( BTV ) with and without the use of a HME in the semi-closed circle system in humans ." ], "offsets": [ [ 0, 710 ] ] } ]

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[ { "id": "DerAnaesthesist.60450807.eng.abstr-passage-0", "type": "abstract", "text": [ "Heated humidifiers ( HH ) as well as heat and moisture exchangers ( HME ) are commonly used in intubated patients as air-conditioning devices to raise the moisture content of the air , thus preventing mucosal damage and heat loss resulting from ventilation with dry inspired gases . In contrary to HME , HH are able to add heat and moisture to the inspired air in surplus , which is often stressed as an advantage in warming hypothermic patients or reducing major heat losses , e.g. , during long operations . The impact of air conditioning on the energy balance of man was calculated comparing HME and HH ." ], "offsets": [ [ 0, 607 ] ] } ]

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[ { "id": "DerAnaesthesist.60450814.eng.abstr-passage-0", "type": "abstract", "text": [ "Two commercially available bacterial filters to be used as part of the mechanical ventilation unit during anaesthesia were tested for hygienic criteria . Manufacturers claim that bacterial breathing filters have a filtration capacity of about 99.995% , so that there would be no need for thermal disinfection of tubing and ventilation circuits after each use . One filter is designed for a single use only , the other can be used up to 24 times after sterilisation . Both filters consist of hydrophobic glass fibres ." ], "offsets": [ [ 0, 517 ] ] } ]

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[ { "id": "DerAnaesthesist.60450826.eng.abstr-passage-0", "type": "abstract", "text": [ "The number of surgical procedures performed as day surgery has significantly increased in recent years . Therefore , a safe and short postoperative recovery period has become increasingly important . The aim of the present study was to investigate perioperative cognitive and physiological function after oral premedication with low-dose midazolam ( 3.75 mg ) , especially during the postoperative period ." ], "offsets": [ [ 0, 406 ] ] } ]

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[]

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[] } ]

[ { "id": "DerAnaesthesist.60450834.eng.abstr-passage-0", "type": "abstract", "text": [ "Intraoperative autotransfusion is contraindicated in cancer surgery because of the possible risk of systemic tumor spread . The aim of the present study was to investigate whether a cell saver in combination with a white blood cell depletion filter can remove osteosarcoma cells ." ], "offsets": [ [ 0, 280 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.60450839.eng.abstr-passage-0", "type": "abstract", "text": [ "Impaired pulmonary gas exchange can result from lung parenchymal failure inducing oxygenation deficiency and fatigue of the respiratory muscles , which is characterized by hyercapnia or a combination of both mechanisms . Contractility of and coordination between the diaphragm and the thoracoabdominal respiratory muscles predominantly determine the efficiency of spontaneous breathing . Sepsis , cardiac failure , malnutrition or acute changes of the load conditions may induce fatigue of the respiratory muscles . Augmentation of spontaneous breathing is not only achieved by the application of different technical principles or devices ; it also has to improve perfusion , metabolism , load conditions and contractility of the respiratory muscles . Intermittent mandatory ventilation ( IMV ) allows spontaneous breathing of the patient and augments alveolar ventilation by periodically applying positive airway pressure tidal volumes , which are generated by the respirator . Potential advantages include lower mean airway pressure ( PAW ) , as compared with controlled mechanical ventilation , and improved haemodynamics . Suboptimal IMV systems may impose increased work and oxygen cost of breathing , fatigue of the respiratory muscles and CO2 retention . During pressure support ventilation ( PSV ) , inspiratory alterations of PAW or gas flow ( trigger ) are detected by the respirator , which delivers a gas flow to maintain PAW at a fixed value ( usually 5-20 cm H2O) during inspiration . PSV may be combined with other modalities of respiratory therapy such as IMV or CPAP . Claimed advantages of PSV include decreased effort of breathing , reduced systemic and respiratory muscle consumption of oxygen , prophylaxis of diaphragmatic fatigue and an improved extubation rate after prolonged periods of mechanical ventilation . Minimum alveolar ventilation is not guaranteed during PSV ; thus , close observation of the patient is mandatory to avoid serious respiratory complications . Continuous positive airway pressure breathing ( CPAP ) maintains PAW above atmospheric pressure throughout the respiratory cycle , which may increase functional residual capacity and decrease the effort of breathing . CPAP has been conceptually designed for the augmentation of spontaneous breathing and requires the intact central and peripheral regulation of the respiratory system . Airway pressure release ventilation ( APRV ) improves alveolar ventilation by intermittent release of PAW , which is kept above atmospheric pressure by means of a high-flow CPAP system . The opening of an expiratory valve for 1-2 s induces a decreased PAW and lung volume , which increases rapidly to pre-exhalation values after closure of the valve due to the high gas flow within the circuit ( 90-100 l/min ) . APRV may improve haemodynamics and VA/Q distribution as compared with conventional mechnical ventilation . Biphasic positive airway pressure ( BIPAP ) is characterized by the combination of spontaneous breathing and time-regulated , pressure-controlled mechanical ventilation . During the respiratory cycle the ventilator generates two alternating CPAP levels , which can be modified with regard to time and pressure . As with APRV , alveolar ventilation is maintained even if the spontaneous breathing efforts of the patient cease , which improves the safety of both modes of respiratory therapy . The contribution of spontaneous breathing to total minute ventilation may be important , since a decreased shunt and improved VA/Q relationship have been observed in experimental non-cardiogenic lung oedema . These data give support to the concept that spontaneous breathing should be maintained and augmented in the setting of acute respiratory failure ." ], "offsets": [ [ 0, 3748 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.60450856.eng.abstr-passage-0", "type": "abstract", "text": [ "We describe unexpected episodes of paced tachycardia in two patients with rate-responsive pacemakers during anaesthesia . Five months after a heart transplant and implantation of a pacemaker a 43-year-old patient suffered cardiac tamponade as a result of chronic pericarditis . The second case involved embolic occlusion of the femoral artery in a 33-year-old female patient previously operated on for tricuspid valve replacement and implantation of a pacemaker . In both cases induction of anaesthesia was performed with fentanyl , etomidate and vecuronium . Following intubation and mechanical ventilation , the heart rates ( HR ) of the two patients increased to 140 and 130 min-1 respectively . This was interpreted as a sign of inadequate anaesthesia , and therefore additional doses of fentanyl and etomidate were given , with no effect on the tachycardia . After exclusion of other possible reasons for this complication such as hypokalaemia , hypercapnia , hypoxaemia or allergic reactions , unexpected functioning of the rate-responsive pacemakers due to thoracic impedance changes was assumed . Minute ventilation was reduced , lowering paced HR in 3-5 min ." ], "offsets": [ [ 0, 1168 ] ] } ]

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[ { "id": "DerAnaesthesist.60450900.eng.abstr-passage-0", "type": "abstract", "text": [ "Cimetidine is a commonly used H2-receptor antagonist that has been recommended for the prevention of acid aspiration syndrome and has been shown to potentiate vecuronium-induced neuromuscular block . The present study was designed to investigate the influence of a single IV dose of cimetidine on the neuromuscular effects of rocuronium , an analogue of vecuronium with a short onset time ." ], "offsets": [ [ 0, 390 ] ] } ]

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[ { "id": "DerAnaesthesist.60450903.eng.abstr-passage-0", "type": "abstract", "text": [ "Elderly patients may show an age-related decline in physiologic functions , which may be responsible for the prolonged duration of some neuromuscular blocking agents . Previous studies have yielded conflicting results as to the effects of these drugs in the elderly . Methods . After obtaining informed consent and approval of the Ethics Committee , we compared onset and recovery times of single IV doses of atracurium , rocuronium , and vecuronium given to 108 patients divided into three groups according to age ( 18-50 , 51-64 , > =65 years ) . Following oxazepam premedication and fentanyl and thiopentone induction , patients were randomly allocated to receive atracurium , rocuronium or vecuronium ( 0.5 , 0.6 , or 0.1 mg/kg , respectively ) in =0 . 8 vol . % enflurane ( end-tidal ) -nitrous oxide anaesthesia . Muscular relaxation was assessed by electromyographic ( EMG ) recording of the adductor pollicis muscle after supramaximal single-twitch stimulation of the ulnar nerve every 10 s. Onset time and recovery to 25% , 75% and 90% of twitch control values ( DUR25, 75 , 90 ) were recorded . Creatinine clearance predicted from serum creatinine ( Ccr ) was correlated with recovery from neuromuscular block . Results . Onset time was not different among groups or relaxants . The results showed a prolonged duration of action for atracurium ( DUR75, DUR90), rocuronium ( DUR25, DUR75), and vecuronium ( DUR25) in the elderly . A number of patients did not reach DUR75 or DUR90. There was a significant relationship between age and failure to return to control values during recovery from neuromuscular block , especially after atracurium and rocuronium . Ccr showed a negative correlation with age for all relaxants , but a negative significant correlation between Ccr and recovery was found only for rocuronium . Conclusions . This study suggests that onset time for atracurium , rocuronium and vecuronium is not age-dependent . Recovery was prolonged in the elderly for all three relaxants . This effect appears to be secondary to changes in body composition and function accompanying the aging process . Neither atracurium nor vecuronium depends significantly on the kidney for elimination , but the negative correlation between Ccr and rocuronium suggests an appreciable role for the kidney in the elimination of this relaxant . The long recovery times observed in this study could also be related to enflurane anaesthesia . We suggest that failure of EMG responses to return to baseline values during recovery from neuromuscular block may be related to age , especially for atracurium and rocuronium ." ], "offsets": [ [ 0, 2619 ] ] } ]

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[ { "id": "DerAnaesthesist.60450907.eng.abstr-passage-0", "type": "abstract", "text": [ "Laryngoscopy causes temporary postoperative dysfunction of the temporomandibular joint ( TMJ ) : during iatrogenic TMJ manipulation in anaesthetised patients , the TMJs have lost the protection afforded by the tone of the surrounding muscles . Thus far , the exact type and extent of TMJ movements have not been known . The purpose of this study was to develop a method to visualise and assess TMJ movements during intubation by means of electronic axiography , a diagnostic monitor of TMJ movements used in dentistry : registration of the hinge axis ( HA ) as an equivalent of the condylar paths on extra-oral sagittally mounted , parallel plates . The HA is individually defined in each patient by the pure , rotating TMJ movement during initial mouth opening ( no farward gliding of the condyles , incisor distance up to 10 mm ) . The parallel plates are placed in the TMJ region in the skull-mounted plate bow ; both registration tips ( \" drawing \" the HA tracings on the electronic plates ) are connected to the mandible by a face bow , paraocclusally fixed to the teeth . The face bow is individually shaped for each patient to allow mask ventilation and free movement of the laryngoscope during intubation . HA tracings are registered and calculated for both sides independently every 24 ms with the SAM/Klett system and presented on sagittal and frontal projections . In the operating theatre , the active mouth-opening traces ( MOT ) are registered first and the passive endotracheal intubation traces ( EIT ) after induction of anaesthesia ( same head position ) . With informed consent and approval by the ethics committee of the Landesaerztekammer Rheinland-Pfalz , 40 male patients ( ASA I , Mallampati I , limb surgery ) were randomly allocated to four groups ( n=10 each ) . OS : Oral intubation , suxamethonium ( 1.5 mg/kg ) ; OV : Oral intubation , vecuronium ( 0.1 mg/kg ) ; NS : Nasal intubation , suxamethonium ( 1.5 mg/kg ) ; and NV : Nasal intubation , vecuronium ( 0.1 mg/kg ) . Intubation was performed 100 s after injection of the relaxant . Pre- and postoperatively ( every 24 h over 3 days , in case of positive findings longer ) recorded were : active movements of the mandible ( maximal mouth opening/max . laterotrusion ) ; dysfunction of the TMJ ; and pain sensation in the TMJ ( Helkimo rating ) . MOTs and EITs were recorded and analysed with the system described and typical EIT patterns were identified : bland , clinically uneventful intubations ( n=7), massive distraction and laterotrusion of the EIT compared to the MOT ( n=24), and blocked or limited TMJ movements resulting in intubation problems ( n=1). With the method presented , TMJ movements could be visualised during endotracheal intubation for the first time . It can be used to assess techniques , routes , and instruments for intubation as well as to evaluate potential traumatising movements during endotracheal intubation ." ], "offsets": [ [ 0, 2926 ] ] } ]

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"umlsterm", "text": [ "TMJ" ], "offsets": [ [ 115, 118 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039496" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s1-t7", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 149, 157 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s1-t8", "type": "umlsterm", "text": [ "muscles" ], "offsets": [ [ 234, 241 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s1-t9", "type": "umlsterm", "text": [ "temporomandibular joint" ], "offsets": [ [ 63, 86 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039493" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "exact" ], "offsets": [ [ 259, 264 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0059927" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "TMJ" ], "offsets": [ [ 284, 287 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039496" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "movements" ], "offsets": [ [ 288, 297 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026649" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "method" ], "offsets": [ [ 363, 369 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0025663" }, { "db_name": "UMLS", "db_id": "C0025664" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "TMJ" ], "offsets": [ [ 394, 397 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039496" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "movements" ], "offsets": [ [ 398, 407 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026649" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s3-t4", "type": "umlsterm", "text": [ "intubation" ], "offsets": [ [ 415, 425 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021925" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s3-t5", "type": "umlsterm", "text": [ "electronic" ], "offsets": [ [ 438, 448 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013850" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s3-t6", "type": "umlsterm", "text": [ "axiography" ], "offsets": [ [ 449, 459 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0162397" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s3-t7", "type": "umlsterm", "text": [ "diagnostic" ], "offsets": [ [ 464, 474 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0348026" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s3-t8", "type": "umlsterm", "text": [ "monitor" ], "offsets": [ [ 475, 482 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0728873" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s3-t9", "type": "umlsterm", "text": [ "TMJ" ], "offsets": [ [ 486, 489 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039496" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s3-t10", "type": "umlsterm", "text": [ "movements" ], "offsets": [ [ 490, 499 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026649" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s3-t11", "type": "umlsterm", "text": [ "dentistry" ], "offsets": [ [ 508, 517 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0011438" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s3-t12", "type": "umlsterm", "text": [ "axis" ], "offsets": [ [ 546, 550 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004457" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s3-t13", "type": "umlsterm", "text": [ "plates" ], "offsets": [ [ 641, 647 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005971" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s4-t1", "type": "umlsterm", "text": [ "patient" ], "offsets": [ [ 689, 696 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s4-t2", "type": "umlsterm", "text": [ "TMJ" ], "offsets": [ [ 720, 723 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039496" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s4-t3", "type": "umlsterm", "text": [ "movement" ], "offsets": [ [ 724, 732 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026649" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s4-t4", "type": "umlsterm", "text": [ "mouth" ], "offsets": [ [ 748, 753 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0153381" }, { "db_name": "UMLS", "db_id": "C0226896" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s4-t5", "type": "umlsterm", "text": [ "farward" ], "offsets": [ [ 767, 774 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030707" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s4-t6", "type": "umlsterm", "text": [ "incisor" ], "offsets": [ [ 801, 808 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021156" } ] }, { "id": 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] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040426" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s6-t1", "type": "umlsterm", "text": [ "face" ], "offsets": [ [ 1082, 1086 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0015450" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s6-t2", "type": "umlsterm", "text": [ "patient" ], "offsets": [ [ 1123, 1130 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s6-t3", "type": "umlsterm", "text": [ "mask" ], "offsets": [ [ 1140, 1144 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0024861" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s6-t4", "type": "umlsterm", "text": [ "ventilation" ], "offsets": [ [ 1145, 1156 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042491" }, { "db_name": "UMLS", "db_id": "C0035203" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s6-t5", "type": "umlsterm", "text": [ "movement" ], "offsets": [ [ 1166, 1174 ] ], 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] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018670" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s8-t3", "type": "umlsterm", "text": [ "operating theatre" ], "offsets": [ [ 1383, 1400 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0029064" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s8-t4", "type": "umlsterm", "text": [ "endotracheal intubation" ], "offsets": [ [ 1480, 1503 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021932" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s9-t1", "type": "umlsterm", "text": [ "ethics" ], "offsets": [ [ 1617, 1623 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0015000" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s9-t2", "type": "umlsterm", "text": [ "male" ], "offsets": [ [ 1681, 1685 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0024554" }, { "db_name": "UMLS", "db_id": "C0086582" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s9-t3", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 1686, 1694 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s9-t4", "type": "umlsterm", "text": [ "ASA" ], "offsets": [ [ 1697, 1700 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004057" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s9-t5", "type": "umlsterm", "text": [ "Mallampati" ], "offsets": [ [ 1705, 1715 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001465" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s9-t6", "type": "umlsterm", "text": [ "limb" ], "offsets": [ [ 1720, 1724 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0015385" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s9-t7", "type": "umlsterm", "text": [ "surgery" ], "offsets": [ [ 1725, 1732 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038894" }, { "db_name": "UMLS", "db_id": "C0038895" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s9-t8", "type": "umlsterm", "text": [ "ethics committee" ], "offsets": [ [ 1617, 1633 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0085546" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s10-t1", "type": "umlsterm", "text": [ "intubation" ], "offsets": [ [ 1800, 1810 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021925" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s10-t2", "type": "umlsterm", "text": [ "suxamethonium" ], "offsets": [ [ 1813, 1826 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038627" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s10-t3", "type": "umlsterm", "text": [ "intubation" ], "offsets": [ [ 1853, 1863 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021925" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s10-t4", "type": "umlsterm", "text": [ "vecuronium" ], "offsets": [ [ 1866, 1876 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242531" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s10-t5", "type": "umlsterm", "text": [ "intubation" ], "offsets": [ [ 1904, 1914 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021925" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s10-t6", "type": "umlsterm", "text": [ "suxamethonium" ], "offsets": [ [ 1917, 1930 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038627" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s10-t7", "type": "umlsterm", "text": [ "intubation" ], "offsets": [ [ 1962, 1972 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021925" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s10-t8", "type": "umlsterm", "text": [ "vecuronium" ], "offsets": [ [ 1975, 1985 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242531" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s11-t1", "type": "umlsterm", "text": [ "Intubation" ], "offsets": [ [ 2002, 2012 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021925" } ] }, { "id": "DerAnaesthesist.60450907.eng.abstr-s11-t2", "type": "umlsterm", "text": [ "injection" ], "offsets": [ [ 2039, 2048 ] ], "normalized": [ { 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[]

[]

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[ { "id": "DerAnaesthesist.60450923.eng.abstr-passage-0", "type": "abstract", "text": [ "The technique of light-guided intubation is based on the principle that a source of light brought into the trachea results in clearly visible and defined transcutaneous illumination , while no illumination can be observed with the light source in the oesophagus ( Fig . 1-7 ) . The Trachlight is a reintroduced instrument for this alternative intubation technique . The essential developments are : a length-adjustable stylet with a removable internal metal wire , a brighter light source , a stable handle with tight fixation of the endotracheal tube , and a time-dependent warning device to avoid extended intubations . One hundred twenty patients ( Mallampati I , ASA I-III ) were included in the study ( conventional intubation [ group KL , n=60], Trachlight intubation [ group TT , n=60]. The goals of the investigation were to examine the handling , application , problems , limitations , and possible indications of the method . The recorded parameters were : number of intubation attempts : course and duration of intubation ; complications ; and difficulties . In 40 patients ( 20 in each group ) the indication for invasive blood presure measurement was given due to the surgical procedure , and circulatory parameters were recorded at defined moments during the intubation course . In group KL 55 patients were intubated in the attempt , 4 on the second , and 1 on the third ( mean duration 23.6 +/- 10.4 s , range 12-60 s ) . Complications were : unilateral intubation ( 3 patients ) , bradycardia ( 2 ) , asystole ( 1 ) and soft-tissue injury ( 1 ) . Of the 60 patients in group TT , 54 were intubated successfully , the mean time needed being 29.9 +/- 14.8 s ( range : 6-61 s ) . The remaining 6 were then intubated by the conventional method . Positive results in group TT included : easy handling and application , no injury to soft tissues or teeth , and invariably correct placement of the tube . Problems included : sufficient transillumination was achieved only after ( entire ) dimming of the room , insufficient control over the distal end of the tube due to an unfixed metal wire , unintentional switching off of the light while with-drawing the metal wire , difficulties in with-drawing the metal wire ( too strong fixation ) , as well as disturbing effects of the warning device ( blinking of the light 30 s after switching on ) . Reasons for the 6 intubation failures were introduction of the instrument into the oesophagus despite a supposed correct position , impossibility of correct placement in a patient with an extremely large goiter , and insufficiently clear transillumination in 3 extremely obese patients . The cardiovascular parameters showed no changes during laryngeal manipulation ; a clear rise in heart rate and blood pressure was recorded , however , when the tube was inserted into the trachea . The cardiovascular parameters during conventional intubations were similar . The light-guided intubation technique can be regarded as a further alternative for airway management , due to the described improvements of the instrument . The indication for the technique is given in patients in whom no difficulty with intubation is expected , to avoid soft tissue damage and traumatising temporomandibular joint movements . Preclinical use may be limited due to environmental brightness . In patients with expected difficult airway management , fiberoptic intubation will remain the method of choice ." ], "offsets": [ [ 0, 3439 ] ] } ]

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[ { "id": "DerAnaesthesist.60450941.eng.abstr-passage-0", "type": "abstract", "text": [ "Blood glucose alterations prior to cerebral ischaemia are associated with poor neurologic outcome , possibly due to extensive lactic acidosis or energy failure . Cerebral effects of hyper- or hypoglycaemia during cardiopulmonary resuscitation ( CPR ) are less well known . In addition , little information is available concerning cardiac effects of blood glucose alterations . The aim of this study was to evaluate the effects of pre-cardiac-arrest hypo- or hyperglycaemia compared to normoglycaemia upon haemodynamics , cerebral blood flow ( CBF ) and metabolism ( CMRO2), and regional cardiac blood flow during CPR subsequent to 3 min of cardiac and respiratory arrest and after restoration of spontaneous circulation . Methods . After approval by the State Animal Investigation Committee , 29 mechanically ventilated , anaesthetised pigs were instrumented for haemodynamic monitoring and blood flow determination by the radiolabeled microsphere technique . The animals were randomly assigned to one of three groups : in group I ( n=9) blood glucose was not manipulated ; in group II ( n=10) blood glucose was increased by slow infusion of 40% glucose to 319 +/- 13 mg/dl ; in group III ( n=10) blood glucose was lowered by careful titration with insulin to 34 +/- 2 mg/dl . After 3 min of untreated ventricular fibrillation and respiratory arrest , CPR ( chest compressor/ventilator ( Thumper ) and epinephrine infusion ) was commenced and continued for 8 min . Thereafter , defibrillation was attempted , and if successful , the animals were observed for another 240 min . Cerebral perfusion pressure ( CPP ) , CBF , CMRO2, coronary perfusion pressure ( CorPP ) , and regional cardiac blood flow were determined at control , after 3 min of CPR , and at 10 , 30 , and 240 min post-CPR . Results . In group I , 4/9 animals ( 44% ) could be successfully resuscitated ; in group II 4/10 ( 40% ) ; and in group III 0/10 ( 0% ) . Prior to cardiac arrest , mean arterial pressure , CPP , and CorPP in group III were significantly lower compared to groups I and II . In group I , CPP during CPR was 26 +/- 6 mmHg ; CBF 31 +/- 9 ml/min/100 g CMRO2 3.8 +/- 1.2 ml/min/100 g ; CorPP 18 +/- 5 mmHg ; and left ventricular ( LV ) flow 35 +/- 15 ml/min/100 g . In group II : CPP=21 +/- 5 ; CBF 21 +/- 7 ; CMRO2 1.8 +/- 0.8 ; CorPP 16 +/- 6 ; and LV flow 22 +/- 9 ; and in group III : CPP 15 +/- 3 ; CBF 11 +/- 8 ; CMRO2 1.5 +/- 1.1 ; CorPP 4 +/- 2 ; and LV flow 19 +/- 10. During the 240-min post-resuscitation period , there were no differences in CBF , CMRO2, or LV flow between groups I and II . Conclusion . Hypoglycaemia prior to cardiac arrest appears to be predictive for a poor cardiac outcome , whereas hyperglycaemia does not impair resuscitability compared to normoglycaemia . In addition , hyperglycaemia did not affect LV flow , CBF , or CMRO2. However , it has to be kept in mind that haemodynamics and organ blood flow do not permit conclusions with respect to functional neurologic recovery or histopathologic damage to the brain , which is very likely to be associated with hyperglycaemia ." ], "offsets": [ [ 0, 3096 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.60450950.eng.abstr-passage-0", "type": "abstract", "text": [ "The lateral decubitus position is the standard position for nephrectomies . There is a lack of data about the effects of this extreme position upon respiratory mechanics and gas exchange . In 20 patients undergoing surgery in the nephrectomy position , we compared a new closed-loop-controlled ventilation algorithm , adaptive lung ventilation ( ALV ) , which adapts the breathing pattern automatically , to the respiratory mechanics with conventionally controlled mandatory ventilation ( CMV ) . The aims of our study were ( 1 ) to describe positioning effects on respiratory mechanics and gas exchange , ( 2 ) to compary ventilatory parameters selected by the ALV controller with traditional settings of CMV , and ( 3 ) to assess the individual adaptation of the ventilatory parameters by the ALV controller . The respirator used was a modified Amadeus ventilator , which is controlled by an external computer and possesses an integrated lung function analyzer . In a first set of measurements , we compared parameters of respiratory mechanics and gas exchange in the horizontal supine position and 20 min after changing to the nephrectomy position . In a second set of measurements , patients were ventilated with ALV and CMV using a randomized crossover design . The CMV settings were a tidal volume of 10 ml/kg body weight , a respiratory rate of 10 breaths/min , an I : E ratio of 1:1 . 5 , and an end-inspiratory pause of 30% of inspiratory time . With both ventilation modes FiO2 was set to 0.5 and PEEP to 3 cm H2O. During ALV a desired alveolar ventilation of 70 ml/kg KG - min was preset . All other ventilatory parameters were determined by the ALV controller according to the instantaneously measured respiratory parameters . Positioning induced a reduction of compliance from 61.6 to 47.9 ml/cm H2O; the respiratory time constant shortened from 1.2 to 1.08 s , whereas physiological dead space increased from 158.9 to 207.5 ml . On average , the ventilatory parameters selected by the ALV controller resembled very closely those used with CMV . However , an adaptation to individual respiratory mechanics was clearly evident with ALV . In conclusion , we found that the effects of positioning for nephrectomy are minor and may give rise to problems only in patients with restrictive lung disease . The novel ALV controller automatically selects ventilatory parameters that are clinically sound and are better adapted to the respiratory mechanics of ventilated patients than the standardized settings of CMV are ." ], "offsets": [ [ 0, 2526 ] ] } ]

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[ { "id": "DerAnaesthesist.60450957.eng.abstr-passage-0", "type": "abstract", "text": [ "Capnometry , the noninvasive measurement of end-expiratory CO2 concentration ( cCO2, vol%) or calculation of its respective partial pressure ( pCO2; mmHg ) is an established method . However , for prehospital settings , capnometry is still used very restrictively , mainly owing to the respective devices used . The prerequisite for their use is sufficient accuracy ( +/- 2 mmHg ) and easy handling . Two special capnometers ( STAT CAP , Nellcor : mainstream , semiquantitative estimation ; Capnocheck 8200 , BCI : sidestream , quantitative measurement , numeric display ) , developed recently for potential use in emergency medicine , are said to fit these criteria . Therefore , the objective of the present investigation was to assess the accuracy and precision of both devices , comparing methods under standardized in vitro ( reference gases ) and in vivo ( intubated and ventilated patients ) conditions ." ], "offsets": [ [ 0, 911 ] ] } ]

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[ { "id": "DerAnaesthesist.60450965.eng.abstr-passage-0", "type": "abstract", "text": [ "Hypnosis can be an alternative to cerebral sedatives with no side effects for sedation during regional anaesthesia , especially in high-risk and fearful patients . Patients who have experience with relating techniques like Jakobson's progressive muscle relaxation are very good candidates for hypnosis . It is contraindicated in patients with psychotic disorders , major depression , and abuse of hallucinogenic drugs . The authors shows his personal method of hypnosis based on fixation and suggestive techniques like muscle relaxation , temperature sensation , and creation of emotional pictures . Of ten cases , hypnosis was successful in six ( vegetative stress symptoms like tachycardia or shivering stopped immediately after induction of hypnosis ) , not completely successful in two ( interruption of hypnosis after 30 min ) and unsuccessful in two . Four cases where hypnosis was used during spinal anaesthesia for knee and hip surgery or brachial plexus block for open fixation of Colles ' fracture are discussed as examples . As it requires more time ( 15 to 45 min to inform and test the patient ) and special organisational conditions hypnosis will not become a routine procedure , but is still a good alternative for selected cases ." ], "offsets": [ [ 0, 1246 ] ] } ]

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[ { "id": "DerAnaesthesist.60451004.eng.abstr-passage-0", "type": "abstract", "text": [ "Pain is a major , but largely neglected problem in AIDS patients . The aim of this article is to review the etiology of pain manifestations in AIDS patients in different organ systems and to discuss appropriate treatment strategies . The most common pain symptoms in AIDS patients are headache , oral cavity pain , dysphagia and adynophagia , chest pain , abdominal pain and pain related to peripheral neuropathy . Symptomatic pain treatment should be started while diagnostic work-up is still in progress , so that the patient does not suffer . If etiological treatment is possible , specific treatment should be started and symptomatic pain treatment tapered as tolerated . If etiological treatment is not possible , symptomatic pain treatment should be continued . In view of the multiple organs involved in the presentation of AIDS requiring multiple drugs , careful attention to side effects , contraindications and drug interactions is warranted , when administering pain medications . Fear of the complexity of these issues should , however , not prevent effective pain management for these patients , who suffer from a fatal disease . A multidisciplinary approach to painin AIDS patients , similar to the approach in patients with cancer , is desirable ." ], "offsets": [ [ 0, 1262 ] ] } ]

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[ { "id": "DerAnaesthesist.60451024.eng.abstr-passage-0", "type": "abstract", "text": [ "Cisatracurium - one of the ten stereoisomers of atracurium - is an intermediate long-acting non-depolarizing neuromuscular blocking agent . Cardiovascular reactions have been described after administration of cisatracurium or vecuronium in surgical patients . Methods . After approval by our institutional review board , 62 patients ( ASA I-II ) were randomly assigned to three groups to either receive 3xED95 or 5xED95 of cisatracurium or 3xED90 of vecuronium prior to intubation as a bolus . After oral premedication with 2 mg lormetazepam anaesthesia was induced with thiopental ( 4-12 mg/kg ) and maintained with O2/N2O and isoflurane ( 1.5%-2%). Six minutes after administration of thiopental , patients received the muscle relaxant . Six minutes later 0.1-0.2 mg fentanyl was given and the trachea was intubated . Heart rate ( HR ) and blood pressure ( BP ) were monitored every minute . Changes of heart rate or blood pressure > 20% compared to baseline were defined as clinically significant . Results . After application of the study drug , median values of blood pressure and heart rate were stable . For each muscle relaxant , there were several patients who had statistically significant cardiovascular changes . After 3xED95 cisatracurium , 3 of 21 patients exhibited haemodynamic changes > 20% ( 2 exhibited hypotension and 1 tachycardia ) , while in the high-dose cisatracurium group 2 of 21 patients demonstrated a tachycardia that was predetermined to be statistically but not clinically significant . In the vecuronium group , 2 of 20 patients sustained statistically significant hypotension and 1 patient had statistically significant tachycardia . The frequency of all individual cardiovascular changes after the application of the muscle relaxant was not dose-dependent . Conclusion . After the administration of cisatracurium in two different doses ( 3xED95 and 5xED95 ) or vecuronium ( 3xED90 ) only minor cardiovascular changes were observed . Both drugs proved to be safe for use during induction of anaesthesia in patients ASA I-II . With regard to its cardiovascular effects , cisatracurium shares with vecuronium the requirements of an ideal muscle relaxant ." ], "offsets": [ [ 0, 2187 ] ] } ]

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[ { "id": "DerAnaesthesist.60451030.eng.abstr-passage-0", "type": "abstract", "text": [ "In this study cerebral blood flow ( CBF ) was simultaneously measured with the Kety-Schmidt method and the intravenous 133Xe clearance technique . CBF , cerebral metabolic rate of oxygen ( CMRO2), and CO2 reactivity of CBF were compared under fentanyl-midazolam anaesthesia and varying paCO2 levels ." ], "offsets": [ [ 0, 300 ] ] } ]

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[ { "id": "DerAnaesthesist.60451037.eng.abstr-passage-0", "type": "abstract", "text": [ "The cerebral haemodynamic effects of vasodilators are of clinical interest because a decrease in mean arterial pressure ( MAP ) might alter global cerebral blood flow ( CBF ) . Luxury perfusion of the brain , in contrast , might be unfavourable in patients with reduced intracranial compliance . Despite the widespread use of nitroglycerine ( NTG ) , little is known about the cerebral haemodynamic consequences of NTG infusions in humans . This prospective , controlled study was designed : ( 1 ) to investigate the effects of NTG on CBF and cerebrovascular CO2 reactivity ." ], "offsets": [ [ 0, 575 ] ] } ]

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[ { "id": "DerAnaesthesist.60451051.eng.abstr-passage-0", "type": "abstract", "text": [ "During pressure support ventilation ( PSV ) , the timing of the breathing cycle is mainly controlled by the patient . Therefore , the delivered flow pattern during PSV might be better synchronised with the patient's demands than during volume-assisted ventilation . In several modern ventilators , inspiration is terminated when the inspiratory flow decreases to 25% of the initial peak value . However , this timing algorithm might cause premature inspiration termination if the initial peak flow is high . This could result not only in an increased risk of dyssynchronization between the patient and the ventilator , but also in reduced ventilatory support . On the other hand , a decreased peak flow might inappropriately increase the patient's inspiratory effort . The aim of our study was to evaluate the influence of the variation of the initial peak-flow rate during PSV on respiratory pattern and mechanical work of breathing ." ], "offsets": [ [ 0, 935 ] ] } ]

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[ { "id": "DerAnaesthesist.60451059.eng.abstr-passage-0", "type": "abstract", "text": [ "Temperature of the tympanic membrane is recommended as a \" gold standard \" of core-temperature recording . However , use of temperature probes in the auditory canal may lead to damage of tympanic membrane . Temperature measurement in the auditory canal with infrared thermometry does not pose this risk . Furthermore it is easy to perform and not very time-consuming . For this reason infrared thermometry of the auditory canal is becoming increasingly popular in clinical practice . We evaluated two infrared thermometers - the Diatek 9000 Thermoguide and the Diatek 9000 Instatemp - regarding factors influencing agreement with conventional tympanic temperature measurement and other core-temperature recording sites . In addition , we systematically evaluated user dependent factors that influence the agreement with the tympanic temperature ." ], "offsets": [ [ 0, 846 ] ] } ]

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[ { "id": "DerAnaesthesist.60451067.eng.abstr-passage-0", "type": "abstract", "text": [ "Heat loses during surgery occur mainly to the environment and due to infusions and irrigations . Infusions given at room temperature account for a great deal of the total heat deficit during major operations , e.g. , the infusion of 53 ml/kg 20 ° C fluid leads to a loss of 1 ° C in mean body temperature . Hence , heating i.v. fluids will add to the effect of other measures aimed at reducing heat loss to the environment . We investigated the efficacy of different warming methods for i.v. fluids in an experimental model by measuring the temperature at the end of the delivery line . Methods . The following in-line warmers were studied : Hotline HL-90 and System H-250/heat exchanger D-50 ( Level 1 Technologies , Marshfield , USA ) , Astotherm IFT 260 ( Stihler Elektronic GmbH , Stuttgart , Germany ) , RSLB 30 H Gamida ( Productions Hospitalieres Francaises , Eaubonne , France ) , Bair Hugger 241/Modell 500 Prototype ( Augustine Medical , Eden Prairie , USA ) . They were compared with prewarming infusions ( 39 ° C ) only using the Clinitherm S ( Labor Technik Barkey GmbH , Bielefeld , Germany ) and prewarming with \" active insulation \" of the delivery line using the Autotherm/Autoline system ( Labor Technik Barkey GmbH , Bielefeld , Germany ) . We investigated the influence of four variables on the efficacy of warming : ( 1 ) flow rate ( 50-15 , 000 ml/h ) ; ( 2 ) ambient temperature ( 20 ° C and 25 ° C ) ; ( 3 ) infusion bag temperature ( 6 ° C , 20 ° C , and 39 ° C ) ; and ( 4 ) length of infusion system downstream from the heat exchanger . Fluid temperatures were measured using thermistors of 1 mm diameter ( Modell YSI 520 , Yellow Springs Instruments Co. , Yellow Springs , USA ) incorporated into 3-way stopcocks . Temperatures were recorded using Hellige temperature monitors ( Hellige GmbH , Freiburg im Breisgau , Germany ) and the signals were collected at 10 Hz through an AD converter and averaged over 1 min . Flows were calculated by timed collection into calibrated cylinders ; 10 to 12 different flow rates were taken to define one temperature/flow plot . Effective warming was defined as a temperature > 33 ° C at the end of the infusion line . Results . At high flow rates ( > 2,500 ml/h ) using 20 ° C fluids at 20 ° C ambient temperature , the H-250/D-50 system gave the highest temperatures throughout the range and showed effective warming from 1,300 ml/h on over the entire range tested ( 35 ° C at 17,000 ml/h ) compared to the RSLB 30 H Gamida system ( 3,000-18,000 ml/h ) ( Fig . 2 ) . This difference in performance was almost abolished with fluids at 6 ° C ( Fig . 4 ) . Similar efficacy could be reached by using prewarmed infusions that gave effective warming at > 2,000 ml/h and reached 39 ° C at 13,000 ml/h . Prewarmed infusions could be used effectively down to > 80 ml/h applying \" active insulation \" ( Autotherm/Autoline ) to the whole infusion system . The Hotline HL-90 ( 50-4 , 700 ml/h ) appeared to be the most effective in-line warmer in the low ( 250 ml/h ) and middle ( 250-2 , 500 ml/h ) flow range , followed by the Astotherm IFT 260 ( 400-4 , 000 ml/h ) , but only if used with a length of 40 cm down-stream from the heat exchanger ( Fig . 1 ) . Increasing this distance to 145 cm markedly reduced its efficacy below the range of 2,000 ml/min ( 1,200-3,000 ml/h ) ( Fig . 5 ) . The Bair Hugger 241 Prototype showed a narrow effective range ( 700-1 , 300 ml/h ) that could be extended beyond 1,300 ml/h by the use of prewarmed infusions ( Figs . 1 and 3 ) . The performance for 6 ° C solutions and ambient temperatures of 25 ° C are given in Fig . 4 and Table 1. Conclusions . The importance of infusion warming increases with the amount of fluid given . In general , the infusion bag temperature only influenced the efficacy of in-line warmers within the high-flow range , challenging the performance of the heat exchanger . The length of uninsulated i.v. line downstream from the heat exchanger influenced the efficacy within the low- and middle-flow range ." ], "offsets": [ [ 0, 4029 ] ] } ]

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[ { "id": "DerAnaesthesist.60451075.eng.abstr-passage-0", "type": "abstract", "text": [ "Hypothermia ( core temperature 36 ° C ) is common after longer-lasting surgical procedures . Heat loss mainly occurs during anaesthesia and surgery and leads to increased risk , especially in the early recovery period of elderly patients . In the present study we investigated the effects of intraoperative forced-air warming , administered via an upper-body blanked ( \" Warm Touch \" , Mallinckrodt , USA ) , with the specific aims of : ( 1 ) drawing up heat balances ; and ( 2 ) analysing postoperative thermoregulation , oxygen consumption ( VO2) and cardiovascular reactions of mechanically ventilated patients . The general aim of our study was to compare intraoperative forced-air-warming and conventional patient-insulation with cotton blankets . Methods . Twenty four ASA II and III patients sheduled for elective colon surgery were randomly assigned to a control group ( n=12, no warming therapy , upper body covered with a cotton hospital blanket ) or a convective warming group ( n=12). Anaesthesia was administered with etomidate ( 0.2 mg/kg ) , fentanyl ( approximately 10 µg/kg) and vecuronium bromide ( 0.1 mg/kg ) . During surgery the lungs were mechanically ventilated with 70% nitrous oxide in oxygen and enflurane ( end-tidal-concentration max . 0.7% ) using a semiclosed circuit with a fresh gas flow of 3 l/min . A hygrophobe heat and moisture exchanger ( \" Sterivent , \" Darex Corp. , Italy ) was used . At the end of surgery patients were transferred to the ICU , covered with a hospital cotton-quilt and normo-ventilated using a Bennett 7200 a. Patients were sedated/kept free of pain by administering titrated doses of midazolam and/or piritramide . Postoperative oxygen consumption ( VO2) was recorded continuously with a Deltatrac Metabolic Monitor ( Datex Corp. , Finland ) . Pre- , intra- and postoperative measurements included heartrate , invasive blood pressure , core-temperature ( before and after operation : urinary bladder-temperature , during surgery : oesophageal temperature ) and mean-skin-temperature ( according to Ramanathan ) up to 180 min from the end of surgery . Shivering , pharmacological interventions ( e.g. pethidine ) and time of extubation were noted . Data are presented as median , minima and maxima . The results were analysed using the Mann-Whitney U test or Chi-Square test ( shivering ) . Statistical significance was assumed when P 0.05. Results . Both groups were comparable for gender , body weight , height , age , duration of their operations and amount of intraoperative fluids , narcotics and muscle relaxants . Room temperatures in the control group were significantly higher than in the forced air group ( 24 vs 22 ° C ) . Initial setting of the forced-air blower was \" high \" ( 42-46 ° high air flow ) . When the oesophageal-temperature reached 36,5 ° C , the blower temperature was reduced to 36-40 ° C. Reduction was necessary approximately 60 min from start in the operation . At the end of surgery/administration to the ICU core-temperatures of both groups differed significantly ( 35.2/35.4 ° C vs 36.3/36.2 ° C ) . Mean-skin temperatures were higher , too , but no statistical analysis was carried out for the intraoperative period , because warm air influenced skin thermometers located on the upper body . At admission to the ICU patients in the control group had a heat loss of 4.4 kJ/kg ; those in the convective warming group had a heat-gain of 0.8 kJ/kg . Further measurements of postoperative core temperatures did not differ significantly , but the skin-temperatures of patients who received forced-air warming in the theatre remained higher ( P 0.05 ) until 120 min from the end of surgery . Shivering was more frequent and lasted longer in the control group ( 8 patients , 20 min vs 4 patients , 9 min ; P 0.05 ) . Patients in the control group needed more drugs to stop increased cardiovascular reactions ( hypertension , tachycardia ) or shivering ." ], "offsets": [ [ 0, 3937 ] ] } ]

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[ { "id": "DerAnaesthesist.60451082.eng.abstr-passage-0", "type": "abstract", "text": [ "Etomidate has become an important induction agent in high-risk patients because of its cardiovascular stability . Its unwanted side-effects such as pain on injection and thrombophlebitis could be significantly reduced by a new ( medium chain triglyceride and soya bean ) emulsion formulation . Propofol is solved in a mixture of long chain triglyceride and soya bean emulsion . In this double-blind , randomized study we compared the haemodynamic effects , the patients ' sensations , signs of thrombophlebitis and postoperative nausea and vomiting ( PONV ) following injection of both drugs ." ], "offsets": [ [ 0, 593 ] ] } ]

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[ { "id": "DerAnaesthesist.60451085.eng.abstr-passage-0", "type": "abstract", "text": [ "100 ASA I and II children , aged 4 to 14 years , and scheduled for strabismus surgery , were randomly assigned to one of the following groups : group 1 ( n=50): endotracheal tube , group 2 ( n=50): laryngeal mask airway . Apart from airway management , the anaesthesiological procedures were identical in both groups : induction with 2-3 mg/kg propofol , 0.02 mg/kg alfentanil , 0.05 mg/kg vecuronium , and 0.01 mg/kg atropine . After endotracheal intubation or insertion of the laryngeal mask , anaesthesia was continued with 6-15 mg/kg - h propofol and 10-30 µg/kg - h alfentanil . All patients were ventilated with N2O/O2 ( 2:1 ) . No antiemetics were given , gastric contents were not aspirated . Postoperative nausea and vomiting ( PONV ) were recorded by 24 h , the incidence of sore throats was recorded 8 , 12 , and 24 h post-operatively ." ], "offsets": [ [ 0, 847 ] ] } ]

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"DerAnaesthesist.60451085.eng.abstr-s1-t6", "type": "umlsterm", "text": [ "laryngeal mask" ], "offsets": [ [ 198, 212 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0162645" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s1-t7", "type": "umlsterm", "text": [ "laryngeal mask airway" ], "offsets": [ [ 198, 219 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0162645" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "procedures" ], "offsets": [ [ 276, 286 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0184661" }, { "db_name": "UMLS", "db_id": "C0025664" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "propofol" ], "offsets": [ [ 344, 352 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033487" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "alfentanil" ], "offsets": [ [ 366, 376 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002026" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "vecuronium" ], "offsets": [ [ 390, 400 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242531" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "atropine" ], "offsets": [ [ 418, 426 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004259" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "intubation" ], "offsets": [ [ 448, 458 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021925" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "mask" ], "offsets": [ [ 489, 493 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0024861" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "propofol" ], "offsets": [ [ 542, 550 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033487" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s3-t4", "type": "umlsterm", "text": [ "alfentanil" ], "offsets": [ [ 571, 581 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002026" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s3-t5", "type": "umlsterm", "text": [ "endotracheal intubation" ], "offsets": [ [ 435, 458 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021932" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s3-t6", "type": "umlsterm", "text": [ "laryngeal mask" ], "offsets": [ [ 479, 493 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0162645" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s4-t1", "type": "umlsterm", "text": [ "All" ], "offsets": [ [ 584, 587 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0023449" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s4-t2", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 588, 596 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s5-t1", "type": "umlsterm", "text": [ "antiemetics" ], "offsets": [ [ 638, 649 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003297" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s5-t2", "type": "umlsterm", "text": [ "gastric contents" ], "offsets": [ [ 663, 679 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038352" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s6-t1", "type": "umlsterm", "text": [ "Postoperative" ], "offsets": [ [ 701, 714 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0032790" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s6-t2", "type": "umlsterm", "text": [ "nausea" ], "offsets": [ [ 715, 721 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027497" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s6-t3", "type": "umlsterm", "text": [ "vomiting" ], "offsets": [ [ 726, 734 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042963" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s6-t4", "type": "umlsterm", "text": [ "PONV" ], "offsets": [ [ 737, 741 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0520909" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s6-t5", "type": "umlsterm", "text": [ "incidence" ], "offsets": [ [ 772, 781 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0220856" }, { "db_name": "UMLS", "db_id": "C0021149" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s6-t6", "type": "umlsterm", "text": [ "throats" ], "offsets": [ [ 790, 797 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0031354" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s6-t7", "type": "umlsterm", "text": [ "Postoperative nausea" ], "offsets": [ [ 701, 721 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0520904" } ] }, { "id": "DerAnaesthesist.60451085.eng.abstr-s6-t8", "type": "umlsterm", "text": [ "sore throats" ], "offsets": [ [ 785, 797 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242429" } ] } ]

[]

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[ { "id": "DerAnaesthesist.60451093.eng.abstr-passage-0", "type": "abstract", "text": [ "We report the case of a 35-year-old male who was admitted to the intensive care unit because of somnolence due to accidental hypothermia . Initial examination showed a Glasgow coma score of 10 and a rectal temperature of 27.4 ° C. Because of stable circulatory conditions , there was no mandatory indication for rewarming by means of cardiopulmonary bypass . We rewarmed the patient with an extracorporeal veno-venous haemofiltration device combined with a countercurrent fluid warmer . An average increase in body temperature of 1.34 ° Ch-1 could be obtained . We conclude that the described technique represents an effective and well-controllable method for treatment of hypothermia in patients with stable haemodynamic conditions . Because of the availability of the required equipment , this method can also be practised in hospitals without cardiac surgical departments and cardiopulmonary bypass facilities ." ], "offsets": [ [ 0, 914 ] ] } ]

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[ { "id": "DerAnaesthesist.60451097.eng.abstr-passage-0", "type": "abstract", "text": [ "Treatment of pulmonary hypertension is an important issue in intensive care . One therapeutic regimen involves the intravenous administration of prostacyclin ( PGI2). This , however , is accompanied by diminished hypoxic pulmonary vasoconstriction , reduced arterial oxygenation , and systemic vasodilation . Thus , its clinical usefulness is limited . However , the inhalation of vasodilators such as nitric oxide ( NO ) or nebulized PGI2 causes a selective pulmonary vasodilation in ventilated alveoli and improved gas exchange , without any systemic vasodilation . It has therefore gained importance for the treatment of pulmonary failure associated with high shunt fractions . However , the inhalation of vasodilators may have adverse effects : in the case of NO , toxic side effects are predominant ( MetHb , NOx ) , whereas in the case of PGI2, technical problems in terms of dosing and administration safety are of major interest . Furthermore , some patients do not respond to the treatment . In some individuals a reduction in pulmonary hypertension can be seen , while others lack even pulmonary vasodilation . The exact pathophysiological mechanisms remain to be investigated ." ], "offsets": [ [ 0, 1188 ] ] } ]

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[ { "id": "DerAnaesthesist.60451142.eng.abstr-passage-0", "type": "abstract", "text": [ "During the last five years several authors have reported largely satisfactory results , using the steroid intravenous anaesthetic eltanolone ( pregnanolone ) for induction of anaesthesia after administering a bolus dose . Until now , however , no investigations have been undertaken , dealing with the infusion pharmacokinetics of eltanolone after arterial blood sampling and using slow induction to quantify the concentration-effect relationship . Secondary objectives were to assess the haemodynamic and respiratory effects ." ], "offsets": [ [ 0, 527 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.60451151.eng.abstr-passage-0", "type": "abstract", "text": [ "Major abdominal surgery often leads to a marked sympathoadrenal stress response with high concentrations of plasma catecholamines , hypertension , and tachycardia . We compared the effects of sufentanil-propofol with fentanyl-propofol anaesthesia in a controlled , randomised , double-blind study of 18 ASA I-II patients aged 23-64 years undergoing major abdominal surgery . Study parameters were haemodynamics ( heart rate [ HR ] , arterial [ ABP ] , central venous , and pulmonary arterial pressures , cardiac index [ CI ] ) , arterial catecholamine concentrations , and the median frequency of the electroencephalogram ( EEG ) power spectrum ." ], "offsets": [ [ 0, 646 ] ] } ]

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"DerAnaesthesist.60451151.eng.abstr-s1-t6", "type": "umlsterm", "text": [ "hypertension" ], "offsets": [ [ 132, 144 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0020538" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s1-t7", "type": "umlsterm", "text": [ "tachycardia" ], "offsets": [ [ 151, 162 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039231" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "sufentanil-propofol" ], "offsets": [ [ 192, 211 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0143993" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "sufentanil-propofol" ], "offsets": [ [ 192, 211 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033487" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "fentanyl-propofol" ], "offsets": [ [ 217, 234 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0015846" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "fentanyl-propofol" ], "offsets": [ [ 217, 234 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033487" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "ASA" ], "offsets": [ [ 303, 306 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004057" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s2-t6", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 312, 320 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s2-t7", "type": "umlsterm", "text": [ "surgery" ], "offsets": [ [ 365, 372 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038894" }, { "db_name": "UMLS", "db_id": "C0038895" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s2-t8", "type": "umlsterm", "text": [ "double-blind study" ], "offsets": [ [ 278, 296 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013072" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "haemodynamics" ], "offsets": [ [ 397, 410 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0019010" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "heart" ], "offsets": [ [ 413, 418 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018787" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "ABP" ], "offsets": [ [ 444, 447 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001239" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s3-t4", "type": "umlsterm", "text": [ "pressures" ], "offsets": [ [ 492, 501 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033095" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s3-t5", "type": "umlsterm", "text": [ "index" ], "offsets": [ [ 512, 517 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021200" }, { "db_name": "UMLS", "db_id": "C0918012" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s3-t6", "type": "umlsterm", "text": [ "catecholamine" ], "offsets": [ [ 538, 551 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0007412" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s3-t7", "type": "umlsterm", "text": [ "concentrations" ], "offsets": [ [ 552, 566 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0086045" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s3-t8", "type": "umlsterm", "text": [ "frequency" ], "offsets": [ [ 584, 593 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0376249" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s3-t9", "type": "umlsterm", "text": [ "electroencephalogram" ], "offsets": [ [ 601, 621 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0086205" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s3-t10", "type": "umlsterm", "text": [ "EEG" ], "offsets": [ [ 624, 627 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013819" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s3-t11", "type": "umlsterm", "text": [ "power" ], "offsets": [ [ 630, 635 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0032863" } ] }, { "id": "DerAnaesthesist.60451151.eng.abstr-s3-t12", "type": "umlsterm", "text": [ "heart rate" ], "offsets": [ [ 413, 423 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018810" } ] } ]

[]

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[ { "id": "DerAnaesthesist.60451158.eng.abstr-passage-0", "type": "abstract", "text": [ "The purpose of the present study was to compare two sedation regimens with either propofol ( P ) or methohexital ( M ) for elective magnetic resonance imaging ( MRI ) in children with respect to safety , side effects , recovery , and discharge time ." ], "offsets": [ [ 0, 250 ] ] } ]

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[ { "id": "DerAnaesthesist.60451167.eng.abstr-passage-0", "type": "abstract", "text": [ "Pollution of work areas by volatile anaesthetics and nitrous oxide occurs during general anaesthesia . Short anaesthesia procedures are often carried out in operating theatres that are not equipped with air-conditioning systems . Methods of lovering exposure during short procedures , where mask anaesthesia is the usual procedure , are double masks and the laryngeal mask . The aim of our investigation was to determine the possibility of lowering the pollution of the environment to below national and international thresholds in a non-air-conditioned work area and to find out which method of anaesthesia is the most effective in environmental protection , i.e. which has the lowest leakage rate ." ], "offsets": [ [ 0, 700 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.60451171.eng.abstr-passage-0", "type": "abstract", "text": [ "Human recombinant interleukin 2 ( IL-2), alone or in combination with other cytokines , is currently under investigation for the immunotherapy of metastatic tumours . Objective responses of 20%-35% have been reported in patients with disseminated melanoma and renal cell carcinoma who received high-dose intravenous IL-2 in combination with interferon- ( IFN ) . However , treatment with IL-2 is complicated by a syndrome of life-threatening adverse reactions such as disseminated vascular leakage , fluid retention , severe hypotension , and ( reversible ) multiple organ dysfunction ( MODS ) . A systemic inflammatory reaction ( SIRS ) /sepsis sepsis-like haemodynamic pattern has been described in patients after IL-2 bolus application alone . Our purpose was to study the haemodynamic changes in patients treated with high-dose IL-2 administered as a constant infusion and in combination with IFN ." ], "offsets": [ [ 0, 902 ] ] } ]

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[ { "id": "DerAnaesthesist.60451179.eng.abstr-passage-0", "type": "abstract", "text": [ "Although still rare , pregnancy and delivery in women with spinal cord injuries is becoming more frequent ( Table 2 ) . In 85%-90% of patients with lesions above T6 symptoms of autonomic hyperreflexia ( Table 1 ) , especially paroxysmal and excessive increases in arterial blood pressure , may occur . In anaesthesising a 31-year-old paraplegic primigravida with a complete transverse spinal lesion at T4 for an elective caesarean section , no indication of hypertonic cardiovascular dysregulation either intra- or postoperatively was observed after repeated epidural administration of bupivacaine . Distinct intraoperative spasticity of the abdominal wall muscles was , however , not influenced by the dosages selected ." ], "offsets": [ [ 0, 721 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.60451184.eng.abstr-passage-0", "type": "abstract", "text": [ "In a large , multicenter survey in 1994 , the prevalence of nosocomial infections in German hospitals was examined , predominant pathogens were identified , and possible risk factors evaluated . In this paper the results from the intensive care units ( ICUs ) are presented ." ], "offsets": [ [ 0, 275 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.60451196.eng.abstr-passage-0", "type": "abstract", "text": [ "In prehospital emergency treatment , the timely establishment of a secure vascular access , especially in infants and small children , can be difficult or even impossible . An alternative to the puncture of peripheral or central veins is intraosseous ( IO ) puncture [ 6 , 7 ] . However , experience with this method in prehospital emergency medicine within the Federal Republic of Germany is extremely limited at present [ 25 ] . After intensive theoretical and practical training of our trauma anaesthesiologists , IO puncture was introduced in our rescue helicopter program \" Christoph 22 \" as an alternative to peripheral or central venous puncture in the prehospital treatment of patients up to 6 years of age . IO puncture is indicated after a maximum of three failed peripheral venous puncture attempts . The purpose of this study was to collect data and summarise first-hand experience on the prehospital use of the IO method as well as the practicability of our prescribed IO puncture algorithm in order to subject them to critical review and evaluation ." ], "offsets": [ [ 0, 1064 ] ] } ]

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"db_id": "C0087111" }, { "db_name": "UMLS", "db_id": "C0039798" } ] }, { "id": "DerAnaesthesist.60451196.eng.abstr-s4-t8", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 685, 693 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.60451196.eng.abstr-s4-t9", "type": "umlsterm", "text": [ "age" ], "offsets": [ [ 711, 714 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001792" }, { "db_name": "UMLS", "db_id": "C0001811" } ] }, { "id": "DerAnaesthesist.60451196.eng.abstr-s5-t1", "type": "umlsterm", "text": [ "puncture" ], "offsets": [ [ 720, 728 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0034117" } ] }, { "id": "DerAnaesthesist.60451196.eng.abstr-s5-t2", "type": "umlsterm", "text": [ "puncture" ], "offsets": [ [ 792, 800 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0034117" } ] }, { "id": "DerAnaesthesist.60451196.eng.abstr-s6-t1", "type": "umlsterm", "text": [ "use" ], "offsets": [ [ 913, 916 ] ], "normalized": 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[]

[]

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[ { "id": "DerAnaesthesist.60451211.eng.abstr-passage-0", "type": "abstract", "text": [ "The objectives of the present study were to compare in a randomized double-blind crossover study design the concentration-effect relationships of Ro 48-6791 , a new benzodiazepine agonist , and midazolam , following infusion in young and elderly male volunteers . Therefore , linearly increasing plasma concentrations were generated by computer controlled infusion pumps to achieve a deep hypnotic effect . The endpoint of the infusion was defined by loss of response to loud verbal commands and a median frequency of the recorded EEG power spectrum below 4 Hz. Arterial blood samples were collected in regular intervals up to 6 hours after cessation of the infusion . The method of pharmacokinetic-pharmacodynamic modeling was used to quantify the concentration-effect relationship , including age related differences , already in this early phase I study . The total clearance of Ro 48-6791 was found to be 1410 +/- 380 vs. 399 +/- 91 ml min-1 for midazolam ( mean +/- SD ; P 0.005 ) and the central volume of distribution to be 20.5 +/- 7.1 vs. 7.9 +/- 3.0 l , respectively ( P 0.005 ) . The comparison between young and elderly volunteers yielded for Ro 48-6791 a statistically not significant reduction of 16% for clearance with age and a slowed distribution of 47% for midazolam ( P 0.05 ) . The recovery period for Ro 48-6791 was reduced by 66% ( P 0.005 ) in the young and 45% ( P 0.01 ) in the elderly , respectively , in comparison with midazolam . With respect to the total doses administered , Ro 48-6791 appeared to be 2.5 times as potent as midazolam in all volunteers ( P 0.001 ) . Comparing both age groups , the doses necessary to cause similar effects were reduced by one half for both compounds in the elderly ( P 0.001 ) . The major advantages of Ro 48-6791 compared to midazolam were its shorter duration of action as well as the faster recovery and thus the better controllability . Further investigations would have to confirm these results in a greater number of patients . The applied method of pharmacokinetic-pharmacodynamic modeling not only allowed to quantify the efficacy of Ro 48-6791 but also provided data to augment the safety for further investigations ." ], "offsets": [ [ 0, 2190 ] ] } ]

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[ { "id": "DerAnaesthesist.70460003.eng.abstr-passage-0", "type": "abstract", "text": [ "Introduction : Recent developments in both the quantitative evaluation of neuromuscular blockade and new muscle relaxants are reviewed . With respect to nerve stimulation , neuromuscular recording , and definition of parameters , the results of the 1994 Copenhagen International Consensus Conference are highlighted . Future clinical studies should adhere to these standards ." ], "offsets": [ [ 0, 376 ] ] } ]

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[ { "id": "DerAnaesthesist.70460014.eng.abstr-passage-0", "type": "abstract", "text": [ "Rocuronium is a new nondepolarizing muscle relaxant for which a fast onset has been described . The goal of this study was to examine whether the characteristics of rocuronium could make it an appropriate relaxant for the anaesthetic management of operations of intermediate duration such as endoscopic upper airway surgery . These operations , which require the anaesthesiologist and surgeon to \" share \" the patient's airway , require good muscle relaxation for endotracheal intubation and placement of endoscopic instruments . In addition , the time course of neuromuscular blockade and its relation to the quality of intubating conditions were analysed ." ], "offsets": [ [ 0, 658 ] ] } ]

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[ { "id": "DerAnaesthesist.70460021.eng.abstr-passage-0", "type": "abstract", "text": [ "The economic impact of the new German health care laws requires an awareness of cost-effectiveness when using newer drugs . The main goal in patient care , i.e. , effective treatment , must be achieved by the rational use of restricted resources at a maximum degree of effectiveness . Economic aspects of the new inhalational anaesthetics such as sevoflurane are discussed in this article . The cost of inhalational anaesthetic agents accounts for up to 5% of all the running expenses of an anaesthesia department . The consumption and cost of an inhalational agent depend on fresh gas flow , vapour setting , and duration of anaesthesia . Comparing the cost for 1 MAC-h of anaesthesia , desflurane is more expensive at current market prices than sevoflurane and isoflurane . However , at low or minimal fresh-gas flows , the price for one MAC-h is almost the same for these volatile anaesthetics . Total intravenous anaesthesia using propofol is even more expensive , partly due to wastage , i.e. , opened ampoules with a remainder of propofol that has to be discarded after each case . When choosing an anaesthetic agent , the price of 1 ml liquid anaesthetic is an important factor . However , the overall cost-effectiveness analysis must balance the cost of the agent with its pharmacodynamic advantages such as more rapid recovery from anaesthesia . Furthermore , the indirect costs of side effects have to be taken into account . For example , nausea and vomiting lead to a prolonged stay in the recovery room after anaesthesia for outpatient surgery , which in turn incurs additional costs for antiemetic drugs and the extra time for nursing care . Therefore , a lower incidence of nausea and vomiting and a more rapid recovery from anaesthesia leading to earlier discharge from the recovery room may compensate for the higher price . Volatile agents account for up to 1% of the total intraoperative costs . In analysing the costs of 1 h of anaesthesia , other products such as plasma substitutes and blood products account for a much higher proportion than anaesthetic agents , and reductions or increases in costs pertaining to these products have a bigger impact on overall costs than do volatile anaesthetics . We conclude that volatile anaesthetics account for only a minor portion of the anaesthesia department budget and the cost of anaesthesia delivery . The higher market price of the new agents may be compensated for by the economic impact of fewer side effects and a shorter post-anaesthesia stay in the hospital . In analysing data for sevoflurane , this agent may be cost-effective , for example , for outpatient anaesthesia ." ], "offsets": [ [ 0, 2647 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.70460029.eng.abstr-passage-0", "type": "abstract", "text": [ "Methods : Using transcranial Doppler sonography ( TCD ) , we studied the effects of sevoflurane compared to equipotent doses of isoflurane on blood-flow velocity in the middle cerebral artery ( MCA ) before , during , and after general anaesthesia . In random order , 30 patients received sevoflurane ( n=15) or isoflurane ( n=15) given in stepwise-increasing doses of 0.5 , 1.0 , and 1.5 MAC in oxygen/air ( FiO2=0.5). Oxygen/air was then replaced by oxygen/nitrous oxide 33%/65% with decreasing doses ( 1.5 , 1.0 , 0.5 MAC ) of sevoflurane or isoflurane . During each step , ventilation was controlled to provide first normocapnia ( end-tidal pCO2=38 mmHg ) and then hypocapnia ( end-tidal pCO2=27 mmHg ) . MCA blood-flow velocity and pulsatility , arterial blood pressure , heart rate , and body temperature were recorded simultaneously at the end of each period . For statistical analysis , within-group comparison was made by one-way ANOVA . Differences between groups were determined by two-way analysis of variance . Age , weight , and height of the patients were compared using Student's t-test ; P 0.05 was considered significant ." ], "offsets": [ [ 0, 1140 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.70460034.eng.abstr-passage-0", "type": "abstract", "text": [ "Background : We report a case of irreversible unilateral hypoglossal nerve palsy in connection with nasal septum surgery in intubation anaesthesia . On account of the spatial distance , there is no danger of injuring the hypoglossal nerve during nasal surgery . However , in the otorhinolaryngological and anaesthesiological literature , some cases of hypoglossal palsy following endotracheal intubation , use of the laryngeal mask airway , bronchoscopy and laryngoscopy are reported ." ], "offsets": [ [ 0, 485 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.70460038.eng.abstr-passage-0", "type": "abstract", "text": [ "Life-threatening cardiovascular complications are a serious risk even for healthy patients during spinal/epidural anaesthesia . The incidence of fatal cardiovascular complications for epidural anaesthesia is 1:10000 , for spinal anaesthesia 1:7000 . In contrast , general anaesthesia has an overall mortality of only 1:28000 . Administration of IV fluids to minimise the haemodynaemic reactions of beginning sympatholysis is not always sufficient . In this study , we examined whether fractionated application of local anaesthetics via a spinal catheter would provide better haemodynamic stability ." ], "offsets": [ [ 0, 599 ] ] } ]

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[ { "id": "DerAnaesthesist.70460043.eng.abstr-passage-0", "type": "abstract", "text": [ "The authors report a rare , recently diagnosed and atypical mishap during one-lung ventilation ( OLV ) via a double lumen tube ( DLT ) and left-sided thoracotomy : an ipsilateral pneumothorax during ventilation of the right lung . This occurred in a 63-year-old patient with chronic obstructive airway disease who was scheduled for urgent repair of a descending thoracic aortic aneurysm . Anaesthesia and surgery were uneventful until aortic cross-clamping release . The common presentation of increased intrathoracic extrapleural pressure owing to a pneumothorax in patients with mechanically ventilated lungs is a rapid decrease in oxygen saturation , followed or paralleled by haemodynamic deterioration . Although the above presentation could be seen in this case , the diagnosis of a tension pneumothorax was delayed twice . First , symptoms were initially obscured by haemodynamic changes resulting from a head-down tilt and aortic declamping . Second , since the lack of consolidation after aortic declamping focused attention on the airway problems , complications resulting from the use of a DLT were primarily considered . In particular , since breathing sounds were detectable initially , malposition or torsion of the DLT had to be excluded by fibre-optic bronchoscopy , which involved a further delay . Finally , two observations led to the diagnosis of a right-sided tension pneumothorax : ( 1 ) bullae of the contralateral lung , detected during thoracotomy ; ( 2 ) the finding that ventilation of both lungs and the left lung subsequently increased arterial ( SaO2) and mixed venous oxygen saturation ( SvO2) and the circulatory status , but ventilation of the right lung caused a deterioration . Chest radiography and insertion of a chest tube with drainage of air , thereafter , validated our hypothesis . The time course of oxygen desaturation during OLV and tension pneumothorax was as severe as expected ; the time course of haemodynamic deterioration , however , appeared quicker and had more impact than expected . Assuming that mediastinal deviation was not hindered by contralateral intrathoracic pressure during thoracotomy , we believed that circulation should be depressed later or to a lesser extent in patients with an intraoperative pneumothorax . Yet , during thoracotomy , decrease in cardiac filling and output during tension pneumothorax in OLV obviously results primarily from the immovability of the mediastinum owing to mediastinal fixation and is at least as decisive as the contralateral intrathoracic pressure in closed-chest patients . In summary , a tension pneumothorax during one-lung ventilation and thoracotomy is a rare , but disastrous complication during the use of a DLT , which has not , to our knowledge , been reported previously . We recommend that tension pneumothorax be added to the list of complications and problems during OLV by the use of a DLT , especially in patients with structural lung diseases ." ], "offsets": [ [ 0, 2963 ] ] } ]

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[ { "id": "DerAnaesthesist.70460081.eng.abstr-passage-0", "type": "abstract", "text": [ "Thermoregulation and its impairment by anaesthesia and surgery has recently been brought back into focus by researchers and clinicians . All volatile and IV anaesthetics , opioids , as well as spinal and epidural anaesthesia increase the inter-threshold range of thermoregulation from 0.2 ° C to 4 ° C between vasodilation and vasoconstriction . Thermoregulatory vasoconstriction and shivering occurs in anaesthetized patients at lower core temperatures than in awake subjects . Following induction of general or spinal/epidural anaesthesia , core temperature decreases significantly due to internal redistribution of body heat from the core thermal compartment to peripheral tissues . About 1 h after induction of general anaesthesia and initial redistribution hypothermia , a real reduction in body heat occurs as heat loss exceeds metabolic heat production . Heat loss is further increased due to low operating room temperatures , evaporation from open body cavities , and cold IV fluids . Peripheral thermoregulatory vasoconstriction is triggered by core temperatures between 33 ° C and 35 ° C , and is able to slow heat loss . However , body heat content continues to decrease even though core temperatures remain nearly constant . During spinal or epidural anaesthesia thermoregulation remains intact in the unblocked body segments , leading to reduced real heat loss when compared to general anaesthesia ." ], "offsets": [ [ 0, 1412 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.70460091.eng.abstr-passage-0", "type": "abstract", "text": [ "Methods : In February 1995 a questionnaire was sent out on perioperative management during neurosurgical operations performed in the sitting position to 136 centres and hospitals within the Federal Republic of Germany that perform neuroanaesthesia . The response rate was 61.02% . Besides the question of perioperative monitoring during neurosurgical operations in the sitting position , we asked about currently used positions for patients during the following neurosurgical operations : posterior fossa , craniospinal and posterior cervical surgery . Results : Of all centres , 32.9% use the sitting position only for posterior fossa and craniospinal surgery . For posterior cervical surgery the sitting and prone positions are favoured by 25.6% of all clinics . Nonspecific basic monitoring ( electrocardiogram , pulse oximetry , central venous pressure , invasive or noninvasive arterial pressure ) is an accepted standard in all clinics . Capnometry , as a specific monitor for venous air embolism , is used in all centres ( 100% ) . Precordial Doppler ultrasound ( US ) monitoring is used in 69.2% of all clinics ; 3.8% use transoesophageal Doppler US as a diagnostic method for venous air embolism . Discussion : The sitting position is the preferred position for posterior fossa and craniospinal surgery in neurosurgical patients in Germany . For posterior cervical surgery the German centres use both the sitting and prone positions . Alternative positions like the lateral or the \" park-bench \" positions are hardly ever used . The essential monitoring devices for neurosurgical operations in the sitting position , as recommended after the survey by the German Society for Anaesthesiology and Intensive Care Medicine ( DGAI ) in 1995 , are predominantly used . However , the use of Doppler US ( precordial or transoesophageal ) for the detection of venous air embolism and the preoperative diagnosis of a persistent foramen ovale is not yet widespread . Conclusions : To determine the effect of the recommendations by the DGAI on clinical practice , the survey will be repeated in 1997." ], "offsets": [ [ 0, 2097 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.70460096.eng.abstr-passage-0", "type": "abstract", "text": [ "Mivacurium has a short duration of action because it is rapidly hydrolysed by plasma cholinesterase . There is ongoing controversy concerning the antagonism of mivacurium-induced neuromuscular block , firstly because of its short spontaneous recovery time , and secondly because the metabolism of mivacurium may be inhibited by anticholinesterases . We therefore compared neostigmine and edrophonium reversal of deep and moderate mivacurium-induced blocks ." ], "offsets": [ [ 0, 457 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.70460101.eng.abstr-passage-0", "type": "abstract", "text": [ "Intraoperative autotransfusion ( MAT ) , preoperative autologous blood donation , and preoperative normovolaemic haemodilution are three different methods to avoid homologous blood transfusion during surgical procedures . The controversial use of MAT via cell saver in tumour surgery as well as contamination of the operative field with urine illustrate the particular difficulties of autologous blood transfusion in connection with radical prostatectomy . We investigated changes in the osmotic resistance of the retransfused red blood cells ( RBC ) , bacterial contamination , changes in coagulation parameters , and the presence of tumour cells ." ], "offsets": [ [ 0, 649 ] ] } ]

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"type": "umlsterm", "text": [ "tumour" ], "offsets": [ [ 269, 275 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027651" } ] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "surgery" ], "offsets": [ [ 276, 283 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038894" }, { "db_name": "UMLS", "db_id": "C0038895" } ] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s2-t6", "type": "umlsterm", "text": [ "urine" ], "offsets": [ [ 337, 342 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042036" }, { "db_name": "UMLS", "db_id": "C0042037" } ] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s2-t7", "type": "umlsterm", "text": [ "blood" ], "offsets": [ [ 396, 401 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005767" }, { "db_name": "UMLS", "db_id": "C0005768" }, { "db_name": "UMLS", "db_id": "C0005835" } ] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s2-t8", "type": "umlsterm", "text": [ "prostatectomy" ], "offsets": [ [ 441, 454 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033573" } ] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s2-t9", "type": "umlsterm", "text": [ "blood transfusion" ], "offsets": [ [ 396, 413 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005841" } ] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s2-t10", "type": "umlsterm", "text": [ "autologous blood transfusion" ], "offsets": [ [ 385, 413 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005842" } ] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "blood" ], "offsets": [ [ 531, 536 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005767" }, { "db_name": "UMLS", "db_id": "C0005768" }, { "db_name": "UMLS", "db_id": "C0005835" } ] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "cells" ], "offsets": [ [ 537, 542 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0007634" } ] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "RBC" ], "offsets": [ [ 545, 548 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0014792" } ] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s3-t4", "type": "umlsterm", "text": [ "bacterial" ], "offsets": [ [ 553, 562 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0521009" } ] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s3-t5", "type": "umlsterm", "text": [ "coagulation" ], "offsets": [ [ 590, 601 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005790" } ] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s3-t6", "type": "umlsterm", "text": [ "tumour" ], "offsets": [ [ 635, 641 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027651" } ] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s3-t7", "type": "umlsterm", "text": [ "cells" ], "offsets": [ [ 642, 647 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0007634" } ] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s3-t8", "type": "umlsterm", "text": [ "blood cells" ], "offsets": [ [ 531, 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[]

[]

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"id": "DerAnaesthesist.70460101.eng.abstr-s3-r7-t6.1-t1.1", "type": "produces", "arg1_id": "DerAnaesthesist.70460101.eng.abstr-s3-t6", "arg2_id": "DerAnaesthesist.70460101.eng.abstr-s3-t1", "normalized": [] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s3-r8-t1.1-t8.1", "type": "surrounds", "arg1_id": "DerAnaesthesist.70460101.eng.abstr-s3-t1", "arg2_id": "DerAnaesthesist.70460101.eng.abstr-s3-t8", "normalized": [] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s3-r10-t1.1-t3.1", "type": "surrounds", "arg1_id": "DerAnaesthesist.70460101.eng.abstr-s3-t1", "arg2_id": "DerAnaesthesist.70460101.eng.abstr-s3-t3", "normalized": [] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s3-r11-t6.1-t4.1", "type": "associated_with", "arg1_id": "DerAnaesthesist.70460101.eng.abstr-s3-t6", "arg2_id": "DerAnaesthesist.70460101.eng.abstr-s3-t4", "normalized": [] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s3-r13-t6.1-t1.2", "type": "produces", "arg1_id": "DerAnaesthesist.70460101.eng.abstr-s3-t6", "arg2_id": "DerAnaesthesist.70460101.eng.abstr-s3-t1", "normalized": [] }, { "id": "DerAnaesthesist.70460101.eng.abstr-s3-r14-t1.1-t9.1", "type": "surrounds", "arg1_id": "DerAnaesthesist.70460101.eng.abstr-s3-t1", "arg2_id": "DerAnaesthesist.70460101.eng.abstr-s3-t9", "normalized": [] } ]

[ { "id": "DerAnaesthesist.70460108.eng.abstr-passage-0", "type": "abstract", "text": [ "The reliability of continuous fibreoptic oximetry in cerebral venous blood and its correlation with intracranial and cerebral perfusion pressures ( pressure-volume curve ) were examined in an experimental porcine study ." ], "offsets": [ [ 0, 220 ] ] } ]

[ { "id": "DerAnaesthesist.70460108.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "oximetry" ], "offsets": [ [ 41, 49 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030021" } ] }, { "id": "DerAnaesthesist.70460108.eng.abstr-s1-t2", "type": "umlsterm", "text": [ "blood" ], "offsets": [ [ 69, 74 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005767" }, { "db_name": "UMLS", "db_id": "C0005768" }, { "db_name": "UMLS", "db_id": "C0005835" } ] }, { "id": "DerAnaesthesist.70460108.eng.abstr-s1-t3", "type": "umlsterm", "text": [ "perfusion" ], "offsets": [ [ 126, 135 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0031001" } ] }, { "id": "DerAnaesthesist.70460108.eng.abstr-s1-t4", "type": "umlsterm", "text": [ "pressures" ], "offsets": [ [ 136, 145 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033095" } ] }, { "id": "DerAnaesthesist.70460108.eng.abstr-s1-t5", "type": "umlsterm", "text": [ "pressure-volume" ], "offsets": [ [ 148, 163 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033095" } ] }, { "id": "DerAnaesthesist.70460108.eng.abstr-s1-t6", "type": "umlsterm", "text": [ "porcine" ], "offsets": [ [ 205, 212 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039005" } ] } ]

[]

[]

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[ { "id": "DerAnaesthesist.70460114.eng.abstr-passage-0", "type": "abstract", "text": [ "Major incidents are high-profile events where many lives are at stake . The response of the health-care-related agencies has to be well-planned and co-ordinated , thus retaining the public's confidence in the emergency services whilst efficiently responding to those in need . The communication between supervising officers such as medical incident officer ( MIO ) and ambulance incident officer ( AIO ) with the ambulance personnel is vital for the proper employment of doctors and ambulance teams at the incident scene . In Germany the experience gained at such events has not yet been collected into a single coherent and comprehensive analysis . This study investigates the delivery of ambulance vehicles and personnel at major incidents . Was appropriate emergency treatment and transport for each seriously injured patient possible ? Were the communication structures between the supervising officers and the ambulance teams sufficient to provide effective co-ordination and utilisation of the teams at the scene ?" ], "offsets": [ [ 0, 1020 ] ] } ]

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"type": "umlsterm", "text": [ "communication" ], "offsets": [ [ 281, 294 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009452" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "ambulance" ], "offsets": [ [ 369, 378 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002422" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "ambulance" ], "offsets": [ [ 413, 422 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002422" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s3-t4", "type": "umlsterm", "text": [ "personnel" ], "offsets": [ [ 423, 432 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0024752" }, { "db_name": "UMLS", "db_id": "C0700103" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s3-t5", "type": "umlsterm", "text": [ "employment" ], "offsets": [ [ 457, 467 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0014003" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s3-t6", "type": "umlsterm", "text": [ "doctors" ], "offsets": [ [ 471, 478 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0031831" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s3-t7", "type": "umlsterm", "text": [ "ambulance" ], "offsets": [ [ 483, 492 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002422" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s4-t1", "type": "umlsterm", "text": [ "Germany" ], "offsets": [ [ 526, 533 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0017480" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s4-t2", "type": "umlsterm", "text": [ "single" ], "offsets": [ [ 605, 611 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0087136" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s4-t3", "type": "umlsterm", "text": [ "analysis" ], "offsets": [ [ 639, 647 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002778" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s5-t1", "type": "umlsterm", "text": [ "delivery" ], "offsets": [ [ 678, 686 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0011209" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s5-t2", "type": "umlsterm", "text": [ "ambulance" ], "offsets": [ [ 690, 699 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002422" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s5-t3", "type": "umlsterm", "text": [ "vehicles" ], "offsets": [ [ 700, 708 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042444" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s5-t4", "type": "umlsterm", "text": [ "personnel" ], "offsets": [ [ 713, 722 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0024752" }, { "db_name": "UMLS", "db_id": "C0700103" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s6-t1", "type": "umlsterm", "text": [ "emergency" ], "offsets": [ [ 760, 769 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013956" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s6-t2", "type": "umlsterm", "text": [ "treatment" ], "offsets": [ [ 770, 779 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0087111" }, { "db_name": "UMLS", "db_id": "C0039798" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s6-t3", "type": "umlsterm", "text": [ "transport" ], "offsets": [ [ 784, 793 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005528" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s6-t4", "type": "umlsterm", "text": [ "patient" ], "offsets": [ [ 821, 828 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s6-t5", "type": "umlsterm", "text": [ "emergency treatment" ], "offsets": [ [ 760, 779 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013969" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s7-t1", "type": "umlsterm", "text": [ "communication" ], "offsets": [ [ 849, 862 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009452" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s7-t2", "type": "umlsterm", "text": [ "ambulance" ], "offsets": [ [ 915, 924 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002422" } ] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s7-t3", "type": "umlsterm", "text": [ "utilisation" ], "offsets": [ [ 981, 992 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042153" } ] } ]

[]

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"arg1_id": "DerAnaesthesist.70460114.eng.abstr-s7-t3", "arg2_id": "DerAnaesthesist.70460114.eng.abstr-s7-t1", "normalized": [] }, { "id": "DerAnaesthesist.70460114.eng.abstr-s7-r2-t2.1-t1.1", "type": "issue_in", "arg1_id": "DerAnaesthesist.70460114.eng.abstr-s7-t2", "arg2_id": "DerAnaesthesist.70460114.eng.abstr-s7-t1", "normalized": [] } ]

[ { "id": "DerAnaesthesist.70460121.eng.abstr-passage-0", "type": "abstract", "text": [ "Background : Single-dose spinal anaesthesia with hyperbaric local anaesthetic provides profound analgesia and motor blockade and allows exact assessment of the analgesic level . The present prospective , randomised study compares a mixture of plain 0.5% bupivacaine and hyperbaric 4% mepivacaine with hyperbaric 0.5% bupivacaine with regard to onset time of analgesia and duration of the sensory and motor blockade ." ], "offsets": [ [ 0, 416 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.70460126.eng.abstr-passage-0", "type": "abstract", "text": [ "\" Stay and play , \" especially in emergency patients with unstable vital functions , offers definite advantages compared to \" scoop and run \" policies . Typical medical and tactical aspects can be identified to judge the amount of diagnostic and therapeutic measures necessary at the site and during transport . Scoop and run seems to be appropriate only rarely in a area with an emergency medical system in the German style ." ], "offsets": [ [ 0, 426 ] ] } ]

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[ { "id": "DerAnaesthesist.70460133.eng.abstr-passage-0", "type": "abstract", "text": [ "In a recently published German multicenter study , 25% of the patients with witnessed cardiac arrest outside the hospital were resuscitated successfully and discharged from the hospital . Approximately 100,000 people suffer a fatal cardiac arrest in Germany anually , which is approximately tenfold the number of deaths from motor vehicle accidents . Cardiopulmonary resuscitation ( CPR ) performed by bystanders is an important part of the chain of survival to minimize the time interval without artificial circulation and ventilation in a cardiac arrest victim . This is especially important in areas with long response times of the emergency medical service ( EMS ) . Early examples of ventilation have been described throughout history . References to mouth-to-mouth ventilation ( MTMV ) are found in the Bible , in a description of the resuscitation of a coal miner in 1744 , and in an experiment in 1796 demonstrating that exhaled gas was safe for breathing . In 1954 , Elam and colleagues described artificial respiration with the exhaled gas of a rescuer using a mouth-to-mask ventilation method . The modern CPR era started with the combination of MTMV and chest compressions 35 years ago . However , the value of MTMV is currently under discussion because of a widespread fear of transmission of infectious diseases . Health-care professionals have stated in several studies that they may withhold MTMV when confronted with a cardiac arrest in a stranger . Although an infection with Mycobacterium tuberculosis is more likely than one with HIV via MTMV , the fear of the public is understandable . An expert committee of the American Heart Association stated that MTMV may be omitted in the initial phase of cardiac arrest , and considered recommending chest compressions only if the EMS will arrive rapidly . In paralyzed volunteers , however , ventilation induced by chest compressions was not able to provide sufficient gas exchange , especially when the airway was not protected . Laboratory investigations studying ventilation during CPR showed controlversial results ; in one animal model of cardiac arrest with muscle paralysis , chest compressions were not sufficient for adequate gas exchange , but active compression-decompression CPR achieved reasonable ventilation . Animal models that prevented gasping during cardiac arrest required ventilation during CPR , whereas gasping animals seemed to be satisfactorily ventilated with chest compressions alone . The question whether spontaneous gasping after cardiac arrest in humans may be sufficient for oxygenation and carbon dioxide elimination is debatable , and remains unanswered at this time . When cardiac arrest is monitored , frequent coughing by the patient may maintain artificial ventilation and circulation for 30 s. The strategy to compress the thorax first and then maintain the airway and perform ventilation may only have an advantage for the first 30 s of CPR . Therefore , MTMV remains the therapy of choice to ventilate the victim of cardiac arrest . If a rescuer chooses to not perform MTMV , at least chest compressions should be administered . During ventilation with an unprotected airway , tidal volumes of 0.5 l instead 0.8-1.2 l may have an advantage . This strategy would decrease the inspiratory flow rate and , therefore , peak airway inflation pressure , which is associated with stomach inflation . Animal models indicate that lower esophageal sphincter pressure may decrease rapidly to 5 cm H2O during cardiac arrest , which may further increase the importance of a low peak airway pressure during ventilation with an unprotected airway . Gastric inflation may cause , besides regurgitation , aspiration , and pneumonia , an increased intragastric pressure , which may push up the diaphragm , decrease lung compliance , and induce a vicious circle of hypoventilation and stomach inflation . The value of cricoid pressure during ventilation with an unprotected airway has to be addressed ." ], "offsets": [ [ 0, 3988 ] ] } ]

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[ { "id": "DerAnaesthesist.70460186.eng.abstr-passage-0", "type": "abstract", "text": [ "Study objective : Ketoprofen exerts its clinical effect by inhibition of prostaglandin synthesis , but also acts as an NMDA-receptor antagonist by means of the kynurenic acid . Based on ketoprofen's supposed central mechanism of analgesia , we expected a pre-emptive effect , which was assessed by the present study ." ], "offsets": [ [ 0, 317 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.70460191.eng.abstr-passage-0", "type": "abstract", "text": [ "Introduction : Almost all patients treated with opioids suffer from constipation . Numerous laxatives are used to overcome the problem , but none has yet been found to yield favourable results in all patients . Several studies have attempted to reverse opioid-induced constipation by the use of oral naloxone . Experiments carried out in rats showed that morphine-induced constipation is reduced by oral naloxone without impairment of antinociception [ 4 ] . However , evaluation of clinical studies reveals that there is uncertainty about the dosage regimen ( the daily dose of naloxone ranged from 0.5% to about 60% that of morphine ) and a lack of larger numbers of patients studied ." ], "offsets": [ [ 0, 687 ] ] } ]

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[ { "id": "DerAnaesthesist.70460195.eng.abstr-passage-0", "type": "abstract", "text": [ "The objective of the study was to investigate the clinical effectiveness of increasing the dosage of prilocaine for a combined 3-in-1/sciatic nerve block from 500 to 650 mg ( open study with 29 patients compared with 30 patients from a former study ) and to validate these findings in a second stage ( randomised study comparing two groups of 30 patients each ) . Not only was clinical effectiveness improved by increasing the dose to 650 mg , but methaemoglobinaemia and toxicity were not relevant problems . With the higher dosage , development of the block was slightly faster ( onset and completion ) ; there were fewer unsatisfactory blocks ; and clinically relevant plasma levels of methaemoglobin did not occur ." ], "offsets": [ [ 0, 719 ] ] } ]

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[ { "id": "DerAnaesthesist.70460201.eng.abstr-passage-0", "type": "abstract", "text": [ "Closed-system anaesthesia provides the best prerequisites for optimal warming and humidification of anaesthetic gases . The PhysioFlex anaesthesia machine fascilitates quantitative closed-system anaesthesia . Furthermore , its design may improve the climatisation of the anaesthetic gases by revolving the system volume at 70 l/min , using a small soda-lime canister to allow optimal usage of the heat and moisture generated by CO2 absorption and by integrating all system components in thermally isolating housing . To determine the capacity of the PhysioFlex to climatise anaesthetic gases , we evaluated the heat and humidity profile at four characteristic places in the anaesthetic circuit under standardised conditions in a model ." ], "offsets": [ [ 0, 736 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.70460207.eng.abstr-passage-0", "type": "abstract", "text": [ "We report a rare case of spontaneously developing generalised gas gangrene with massive rhabdomyolysis after a cholecystectomy and drainage of a hepatic abscess . On preoperative physical examination the patient appeared severely ill and was icteric and oliguric . Laboratory evaluation showed signs of systemic inflammation , elevated lactate levels , evidence of disseminated intravascular coagulation ( DIC ) , and increased levels of serum creatine kinase ( CK ) activity . Abdominal ultrasound and endoscopic retrograde cholangiography showed a gallbladder perforation and a hepatic abscess . Cholecystectomy and drainage of the abscess was performed immediately and without technical problems . After postoperative admission to the intensive care unit , the patient showed evidence of generalised myonecrosis with subcutaneous gas formation and acute renal failure . Initially , there were few other signs of systemic toxicity ; the patient was not hypotensive and the pulmonary gas exchange was normal . Within hours diffuse swelling of his right leg developed with cutaneous gangrene and a compartment syndrome . After fasciectomy and extensive surgical debridement , uncontrollable bleeding due to DIC developed from the fasciectomy site , which finally required exarticulation of the leg at the hip joint . At this point , multiple organ failure including severe adult respiratory distress syndrome was present . Two days after cholecystectomy , the patient died from hypoxic cardiocirculatory failure . Clostridium perfringens was repeatedly isolated from the wounds . Besides gas gangrene , the differential diagnosis of such infections includes localised clostridial cellulitis , nonclostridial anaerobic cellulitis caused by mixed aerobes and anaerobes , and type I or type II necrotising fasciitis . Patients with systemic necrotising infections should be treated with broad-spectrum antimicrobial regimens ( penicillin G , 3rd generation cephalosporins , clindamycin , and aminoglycosides ) . An otherwise unexplained elevation of serum CK activity in the presence of acute cholecystitis may suggest haematologic spread of an aggressive myolytic agent and the beginning of myonecrosis . This should prompt immediate surgical exploration after establishing broad-spectrum antibiotic coverage . The role of hyperbaric oxygen treatment in this situation remains to be established . If hyperbaric oxygen is to be employed , it should neither delay surgical exploration nor jeopardise the patient with the hazards of an interhospital transport ." ], "offsets": [ [ 0, 2556 ] ] } ]

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[ { "id": "DerAnaesthesist.70460211.eng.abstr-passage-0", "type": "abstract", "text": [ "Generalized muscle weakness in critically ill patients can result in prolonged periods of artificial ventilation and longer stays in the intensive care unit . Both neuropathic ( critical illness polyneuropathy ) and myopathic ( critical illness myopathy ) abnormalities seem to play an important role for this prolonged weakness . This article reviews its complex differential diagnosis with special emphasis on the current understanding of the neuromuscular syndromes . An efficient diagnostic plan is necessary for the exclusion of other curable causes of prolonged muscle weakness even in the presence of polyneuromyopathic changes . Psychological support of the patient and prophylaxis of secondary complications of prolonged immobilization are crucial when specific therapy is not possible ." ], "offsets": [ [ 0, 796 ] ] } ]

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[ { "id": "DerAnaesthesist.70460220.eng.abstr-passage-0", "type": "abstract", "text": [ "In a recent German multicenter study , 25% of the patients who suffered a witnessed cardiac arrest outside the hospital were resuscitated successfully and were discharged from the hospital . Approximately 100000 people suffer a fatal cardiac arrest in Germany annually , which is about ten times more than deaths resulting from motor vehicle accidents . New devices and techniques for cardiopulmonary resuscitation ( CPR ) have been developed in order to enhance the efficacy of chest compressions during CPR . The purpose of the present article is to review mechanisms of blood flow during CPR , to discuss CPR devices and techniques ( vest CPR , CPR with interposed abdominal compressions , active compression-decompression ( ACD ) CPR , phased chest and abdominal compression-decompression CPR , and to further evaluate results from subsequently published laboratory and clinical studies ." ], "offsets": [ [ 0, 892 ] ] } ]

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