[Hyperbaric oxygenation: therapy with oxygen using hyperbaric pressure].
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Humans↗
Biomedical subjects
E Entholzner
Publications and source records attributed to E Entholzner.
[Indications for hyperbaric oxygenation in chronic diseases].
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Animals↗
[Expanding indications for hyperbaric oxygenation--current development and status of clinical evaluation].
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Blood Volume↗
[Attempt at a definition of the individual anesthesia level by repetitive pain stimulation: correlation with EEG findings].
AIM: Previous studies using EEG for assessment of depth of anaesthesia correlate anaesthetic concentration with the anaesthetic stage. This procedure neglects the well known effect of individual different susceptibility to anaesthetics. Thus, patients receiving similar concentrations of anaesthetics may not necessarily be at the same level of "anaesthetic depth". The aim of this study was to define an interindividual comparable level of anaesthesia by recording the autonomic cardiovascular reaction to a standardised painful stimulus (tetanic stimulus, 80 mA, 100 Hz). METHODS: In 61 patients undergoing orthopaedic surgery general anaesthesia was performed with isoflurane in 66% N2O. Starting from 0.4% isoflurane, endtidal isoflurane concentration was increased in a stepwise manner (0.1% isoflurane) until the patient did not show any relevant cardiovascular reaction (increase of heart rate and/or blood pressure < 10%) after tetanic stimulation of the ulnar nerve. If patients demonstrated no haemodynamic changes at 0.4% isoflurane, the concentration was decreased until a relevant cardiovascular reaction was registered. During each steady state period multichannel EEG was recorded and mean values of power density (median: microV2/Hz) were computed. RESULTS: Comparing EEG-results between both groups exhibiting a cardiovascular reaction (CVR+ , median endtidal Iso: 0.5%) and without reaction (CVR- , median endtidal Iso: 0.6%) an increase in low frequency bands and a significant decrease in high frequencies was found (Wilcoxon-test, p < 0.05). In contrast, comparing EEG-data only in relation to endtidal isoflurane concentration neglecting individual haemodynamic responses, no differences of power density in high frequency bands were detected. CONCLUSION: This method to define individual depth of anaesthesia as described, results in more consistent EEG patterns and may be useful in relating EEG to depth of anaesthesia.
Adult↗
[Comparison of the effect of desflurane and isoflurane on neuromuscular blockage with vecuronium on geriatric patients].
Volatile anaesthetics have long been known to intensify the effect of muscle relaxants. In this study we investigated the effects of desflurane and isoflurane on the neuromuscular blockade of vecuronium in geriatric patients. Fifty-two patients requiring elective surgery, aged > or = 65 years, with ASA status II - III were randomly assigned to receive general anaesthesia using desflurane (Des, n = 26) or isoflurane (Iso, n = 26). The effects of both inhalation anaesthetics on the neuromuscular blockade of vecuronium were compared by means of the duration of the depression of the first twitch (T1) of a train-of-four stimulation pattern. Succinylcholine 1.5 mg/kg was used to facilitate intubation, vecuronium 0.05 mg/kg was given as the succinylcholine wore off; additional doses of 0.01 mg/kg were given when T1 exceeded 25% of baseline amplitude. There were no significant differences in the patients' biometric data or the duration of anaesthesia. The median duration of action of the first vecuronium dose (0.05 mg/kg) was: Des: 18.3 (9.4-42.9) min and Iso: 15.9 (3.1-46.0) min. The number of repetitive dosages (0.01 mg/kg) was: Des: 5; 0-13 and Iso: 5; 0-14 and their median duration was: Des: 10.2 (3.6-37.6) min and Iso: 8.9 (2.1-43.9) min. There were no differences between the two groups (p > 0.05). These results suggest that augmentation of neuromuscular blockade by older fluorinated anesthetics is also exhibited by desflurane. The magnitude of this effect in geriatric patients is similar to that of isoflurane.
Aged↗
[EEG changes during sedation with gamma-hydroxybutyric acid].
Gamma-hydroxybutyric acid (GHB) is a naturally occurring transmitter in the mammalian brain, related to sleep regulation and possibly to energy balance in diving or hibernating animals. It has been used for almost 35 years as an intravenous agent for induction of anaesthesia and for long-term sedation. Its convincing pharmacological properties, without serious adverse effects on circulation or respiration, are compromised by its unpredictable duration of action. This is not a major problem with long-term sedation during ICU treatment. GHB has been used with good results for sedation of patients with severe brain injury, where it compares favourably with barbiturates. In animal studies, it seems to possess a protective action against hypoxia on a cellular and whole organ level. However, in some experimental animals GHB has been shown to produce seizure-like activities, and the compound is being used to produce absence-like seizures. GHB has been used in our ICU for years to provide adequate sedation for patients under controlled ventilation or for patients fighting the respirator during spontaneous respiration. No serious side effects were observed in these patients, while in some patients under haemodialysis hypernatraemia and metabolic alkalosis developed; both were reversible after discontinuation of GHB and restriction of additional sodium input (Somsanit, the commercially available GHB preparation in Germany, contains 9.2 mmol sodium/g; the daily dose averages 20-40 g GHB, i.e. 180-370 mmol sodium). PATIENTS AND METHODS. In 31 patients after major abdominal surgery, sedation was established with GHB 50 mg/kg BW injected via perfusion pump over a 20-min period. No centrally acting medication had been given for at least 2 h. A computer-based multichannel EEG system (CATEEM, MediSyst, Linden) was used, allowing for fast Fourier transformation, spectral analysis and topographical brain mapping. EEG during induction of sedation was followed after a baseline EEG (10 min) had been recorded. Patients receiving long-term sedation were studied daily for an additional 15-min period. Corresponding well to the clinical findings, EEG pattern changed to a slow delta-theta or delta-only rhythm within 10 min of the start of injection. Alpha and beta power decreased, while delta activity exhibited an increase. All changes were most obvious in frontal and central areas of the brain. In about one out of three patients, a burst--suppression pattern developed. Since automatic processing of EEG may fail to detect special patterns like the looked-for 3/s spikes and waves, the raw EEG was analysed visually by an expert neurologist. Both processed and conventionally analysed EEG were free of any seizure-like electrical activity. CONCLUSION. We conclude that animal data may not apply to the use of GHB in humans, provided the dose is limited to the clinical needs. GHB is used in clinical practice in doses twice as high, or even higher, than the one we use for induction, without obvious side effects. However, the suppression of theta rhythm we observed in about half of the patients studied may indicate that even less than 50 mg/kg BW might be sufficient for adequate sedation.
Abdomen↗
A lower solubility recommends the use of desflurane more than isoflurane, halothane, and enflurane under low-flow conditions.
STUDY OBJECTIVE: To determine whether the lower solubility of desflurane, over that of isoflurane, enflurane, and halothane, favors its use in low-flow anesthesia. DESIGN: Prospective clinical study. SETTING: Technical University of Munich. PATIENTS: 40 elderly (> or = 65 yrs), ASA physical status II and III surgical patients. INTERVENTIONS: All patients were anesthetized and received delivered concentrations (FD) of 4% desflurane, 1.5% isoflurane, 1.8% enflurane, or 0.9% halothane (n = 10 patients for each anesthetic) in a fresh gas inflow of 3 L/min (high-flow), until end-tidal target concentrations (FA) of 2% desflurane, 0.5% isoflurane, 0.6% enflurane, and 0.3% halothane were obtained. After 30 minutes, the inflow was decreased to 1 L/min (low-flow), and the FD and the inspired concentration (FI) were adjusted to maintain the target concentration. MEASUREMENTS AND MAIN RESULTS: The concentrations of the halogenated anesthetics, as well as nitrous oxide, oxygen (O2), and carbon dioxide, were measured in delivered gas at the common gas outlet and at the endotracheal tube connector. Transcutaneous O2 saturation, noninvasive blood pressure, and heart rate were also measured. During the first 30 minutes of high-flow administration, the target concentration was attained sooner with desflurane than with isoflurane, enflurane, or halothane (median levels: 4 min vs. 6 min, 8 min, or 10 min; p < 0.01). After the reduction of inflow to 1 L/min, FD had to be materially increased to maintain F1 and FA for the more soluble anesthetics, but not for desflurane. CONCLUSIONS: At low flows, FD provides a reasonable surrogate of F1 and FA for desflurane, but not for isoflurane, enflurane, or halothane. The rapid and predictable titrability of desflurane favors its safe use in low-flow technique.
Aged↗
[Anesthesia with low fresh gas flow in clinical routine use].
Anaesthesia in low-flow techniques gains increasing interest. The possibility of cost reduction, widespread use of highly developed anaesthesia machines and monitors, and introduction of two new fluorinated inhalational anaesthetics with low solubility in human tissues encourage the use of low-flow anaesthesia techniques. Further advantages are improved climatisation of breathing gas and estimation or even measurement of the important parameter "oxygen consumption". The anaesthesia machines and inhalational anaesthetics currently available allow a safe use of low-flow techniques if safety requirements are complied with (tight circle system, monitoring of: inspired oxygen concentration, minute ventilation, airway pressure, transcutaneous oxygen saturation). Low-flow anaesthesia techniques using a fresh gas flow rate of 1 l/min can be performed with almost every anaesthesia machine. However, the use of multigas monitors, analyzing most parts of the breathing gas, facilitates the use of low-flow techniques. Multigas monitors and anaesthesia machines equipped with intermittent fresh gas delivery are recommended for the use of fresh gas flow rates close to the metabolic rate. Because of its physicochemical properties the new inhalational anaesthetic desflurane offers advantages for the use in low-flow anaesthesia techniques.
Anesthesia, Closed-Circuit↗
A multicenter study of phospholipase A2 in patients in intensive care units.
BACKGROUND: Multiple organ failure (MOF) is becoming the most common cause of death in patients in surgical intensive care units. In this respect, a multicenter study in four different groups of patients in surgical intensive care units was done to evaluate the role of phospholipase A2 (PLA2) in comparison with C-reactive protein (CRP) and polymorphonuclear (PMN) elastase. STUDY DESIGN: A total of 223 patients entered the study: 73 patients with multiple injuries, 46 patients with diffuse peritonitis, 52 patients with sepsis, and 52 patients in a control group who were at a higher risk for postoperative sepsis after defined surgical interventions. The patients underwent a daily monitoring of PLA2, CRP, and PMN elastase for seven days. RESULTS: Phospholipase A2 activity remained within the normal range in patients with multiple injuries and patients in the control group, indicating that this parameter is not influenced by the postaggression metabolism. In contrast, in patients with peritonitis, high PLA2 values were found from the beginning. The efficiency for predicting a lethal MOF was 85 percent for PLA2 (cut-off 80 U/L) in patients if determined at the day of operation. A comparably favorable efficiency (84 percent) was demonstrated for PMN elastase in patients with multiple injuries (cut-off 205 micrograms/L) measured at day one. CONCLUSIONS: These efficiency rates of PLA2 in peritonitis and PMN elastase in multiple injuries were comparable or even better than multifactorial scoring systems used in the study. C-reactive protein did not contribute to an early estimation of the prognosis in all groups analyzed. Therefore, the measurement of PLA2 in patients with diffuse peritonitis and PMN elastase in patients with multiple injuries, as single parameters, is recommended to estimate the individual risk for the occurrence of lethal MOF.
Adolescent↗
[Comparison of the effectiveness of orally administered clorazepate dipotassium and nordiazepam on preoperative anxiety].
Clorazepate dipotassium (Tranxilium) is one of the benzodiazepines which is widely used for oral premedication. After oral administration it is decarboxylated to its active metabolite nordiazepam (desmethyldiazepam). Nordiazepam is also commercially available in the form of drops (Tranxilium N). The aim of the present study was to compare the effect of these drugs on preoperative anxiety. One hundred and eight patients scheduled for orthopaedic surgery (ASA I-II) were studied. Medication was administered at 10 p.m. the evening before surgery (E) and at 7 a.m. on the morning of surgery (M). There were four groups: 1) E no medication; M clorazepate dipotassium; 2) E no medication; M nordiazepam; 3) E clorazepate dipotassium; M clorazepate dipotassium, 4) E clorazepate dipotassium; M nordiazepam. Dosages were: clorazepate dipotassium: body weight < 55 kg: 10 mg; body weight > 55 kg: 20 mg; nordiazepam: 1 gtt/kg; 5 mg = 24 gtt). Anxiety was measured by using the self-evaluating Erlangen anxiety scales, which measure both background and situational anxiety. Background anxiety (EAS-H) was evaluated during the evening before surgery; situational anxiety (EAS-S) was evaluated at the same time and also on the day of surgery before premedication and immediately before surgery. Pulse rate was measured each time the test was administered. There were no differences between the groups in sex, age, weight or the intervals between premedication and anaesthesia induction (p > 0.05). There were no statistically significant differences between the groups with respect to background anxiety. Situational anxiety did not significantly increase or decrease at any of the testing times, nor were there any differences between the groups (p > 0.05). Heart rate did not vary between the groups or with time (p > 0.05). In this group of patients undergoing elective orthopaedic procedures, clorazepate prevented a rise in anxiety in the immediate preoperative period. Since clorazepate is rapidly metabolized to nordiazepam when administered orally it might be predicted that the two drugs have similar properties. This hypothesis is confirmed by the results of the present study. We conclude that orally administered clorazepate dipotassium and nordiazepam have a similar effect on preoperative anxiety.
Administration, Oral↗
[Hypervolemic hemodilution as a means of preventing homologous blood transfusion. A simple alternative to acute normovolemic hemodilution].
PROBLEM: Acute normovolenic hemodilution (ANH) is timeconsuming and complicated, and has only a small effect in reducing the need for homologous blood. A simpler procedure is hypervolemic hemodilution (HHD). In the present prospective, randomized study, HHD is compared with ANH for its blood-saving effect. STUDY DESIGN: Forty-nine patients undergoing total hip replacement were admitted. Group I (ANH): Withdrawal of 15 ml/kg bodyweight autologous blood and isovolemic replacement by hydroxyethyl starch (200/0.5). Group II (HHD): Infusion of 15 ml/kg bodyweight hydroxyethyl starch (200/0.5). RESULTS: No significant differences were found between the groups in terms of Hb, hematocrit and coagulation. The blood loss (intra-operative+drainage losses) was comparable in the two groups at 1274 +/- 310 ml (HHD) and 130 +/- 335 ml (ANH). During the period under investigation, 66% of the patients in the HHD group and 57% in the ANH group required no homologous blood. CONCLUSION: HHD is just as effective as ANH for reducing homologous blood requirements, and is much simpler to apply.
Blood Loss, Surgical↗
[Strategies for minimizing homologous blood transfusion in elective interventions].
The risks associated with homologous blood transfusion necessitates the development of strategies for reducing the need for it. The most effective method is certainly preoperative donation of autologous blood, which leads to an increase in the absolute numbers of erythr789789 by the time surgery is performed. Depending on the type of preparation and storage, erythrocytes may be viable for between 49 days (liquid storage) and many years (deep frozen). By employing preoperative plasmapheresis, high-quality autologous fresh frozen plasma can be made available for use during surgery. Donation of autologous blood and plasmapheresis are preoperative measures that need to be organized. Another possibility is the use of a cell separator to recycle blood lost during surgery, and may be applied intra-operatively (aspiration from the surgical wound) or postoperative (drainage). Hemodilution has but little effect in reducing homologous blood requirements. Instead of the technically complex and time-consuming acute normovolemic hemodilution (ANH), the simpler hypervolemic alternative version (HHD) should be employed. Applying all the measures described above, an appreciable reduction in the need for homologous blood can be achieved. A prerequisite, however, is close cooperation between the surgeon an anaesthesiologist.
Blood Transfusion, Autologous↗
[Drug administration via the endobronchial route. Possibilities of drug administration in emergency medicine].
For cardiopulmonary resuscitation, the endobronchial route represents a good means of administering drugs with a systemic effect, such as adrenaline and atropine, even without a venous line. Via this route, however, higher doses are needed (2.5 times as much as those normally given intravenously). In order to produce a larger surface area within the bronchio-alveolar space and thus speed up absorption, the drugs are diluted in 5-10 ml solvent (isotonic saline solution or distilled water). For endobronchial administration of a drug, various techniques are employed, for example, simply injecting it into the upper end of the (endotracheal) tube, puncture of the tube the use of an application probe introduced into the endobronchial tube, aspiration or venacaval catheter, or the EDGAR tube with an injection needle incorporated within the tube wall. After injection, the diluted medication is distributed into the tiny branches of the bronchial tree by repeated hyperventilation. Despite the need for an adequate alternative to the venous route in the field of cardiopulmonary resuscitation, we still have very few reliable facts about the endobronchial application technique.
Administration, Inhalation↗
[Electroencephalographic demonstration of central nervous system effects of different premedication regimens].
INTRODUCTION: For many years, the main goal of premedication was prevention of the dangerous side effects sometimes encountered in anesthetics with anticholinergics, antiemetic antihistaminics, and opioids. Because the rules were always preoperative fasting, premedication was administered i.m. Thus, the onset of action was within 15-30 min from administration. In recent years, with the introduction of newer anesthetics with fewer side effects, anxiolysis became the main aim in premedication. Moreover, the oral route became popular since it obviously did not increase the acidity or volume of the gastric content. However, the uptake and thus onset of action of orally administered drugs may take longer and can differ considerably between individual patients. Therefore, the optimum interval between administration and induction of anesthesia remains controversial. The present study was carried out to examine the time course of drug action and the effects of different premedication regimens on the electroencephalogram (EEG). PATIENTS AND METHODS: After obtaining informed consent, in 38 unselected adult patients (ASA I and II, < 65 years) scheduled for elective surgery, the EEG was recorded continuously before and after premedication. The patients were randomly assigned to four groups: M: midazolam, 0.2 mg/kg BW orally; N: nordazepam, 0.2 mg/kg BW orally; AP: atropine, 0.5 mg, plus promethazine, 50 mg i.m.; APP: atropine, 0.5 mg, plus promethazine, 50 mg, plus pethidine, 0.7 mg/kg BW i.m. The EEG was recorded for a reference period of 10 min before and a study period of 30 min after premedication. Automated EEG processing was performed with CATEEM (computer-aided topographical electroencephalometry). Surface electrodes were placed according to the 10-20 system. Date were collected via an amplifier (resistance 10 M omega) and a digitalization unit (filter 0.2-35 Hz, sampling rate 512 Hz, 12 bit A/D convertor). The original EEG signals were used in an interpolation algorythm to produce an additional 82 virtual recording points, allowing for high topographical resolution. After spectral analysis (fast Fourier transformation), the different frequency ranges of the EEG power spectrum are displayed in different colors. The screen displays the on-line map with color-based topographical power distribution. In order to achieve a pharmacodynamic time profile, the study period was subdivided into three periods of 10 min each. For clinical evaluation of vigilance, a 6-grade scoring system was used 1 = awake, 6 = not arousable). RESULTS: All data are presented with respect to reference period. The power density of each frequency range for each electrode is integrated over the selected period and mean values are shown. Changes in power density with time are expressed as percentage change from reference period. Biometrical data showed no significant differences between groups. The median vigilance score 30 min after premedication (end of study period) was 4 in groups M, AP, and APP, and 3 in group N. In both benzodiazepine groups, a distinct increase in power density was found in the beta-bands, while in groups AP and APP the increase was most pronounced in the delta and theta bands. In group M, there was a linear increase in beta 1 power up to 310%, while in the beta 2 range there was a 170% maximum within the second period of 10 min. In group N, there was a similar course with a lower increase in beta 1 (220%) and beta 2 (130%). Increases in both beta-bands were most pronounced with frontal electrodes. While group M showed an increase in delta power (150%), together with moderate suppression in alpha (alpha 1 50%, alpha 2 40%), nordazepam caused only a slight increase in delta (124%) and a distinct increase in alpha 2 to 150%, predominantly in the frontal areas. Group APP showed a linear increase in both delta up to 210% and theta power to 190%. (ABSTRACT TRUNCATED)
Adult↗
[Anesthesia with the closed PhysioFlex system in comparison with conventional anesthesia procedures].
So far the anaesthetic technique of the closed circuit system in clinical routine could not be used adequately, because suitable mixtures of respiration gas components were not available and the maintenance of a sufficient gas volume in the anaesthetic circle system was not possible with the standard anaesthesia machines. The anaesthesia machine PhysioFlex was especially constructed to deliver anaesthetics in a closed circuit system. In this anaesthesia machine the concentrations of the respiratory gases and the gas volume in the circle system are automatically controlled by a feedback mechanism. We compared the closed circuit system (CC group), with a high-flow system (HF group) and a low-flow system (LF group)--each system on 10 patients. It was noted that the respiratory gas concentrations were adjustable and held constant to a greater degree precise in the circuit system. After the induction the desired inspiratory oxygen-concentration was reached within 5 minutes, the expiratory isoflurane-concentration within 10 minutes in the CC group and was maintained reliable. The consumption of liquid isoflurane was 12.9 ml/h in the HF group, 7.5 ml/h in the LF group and 5.3 ml/h in the CC group. The anaesthetic management was possible without any problems in all three groups.
Adult↗
[The determination of end-expiratory CO2 during resuscitation. Experience and results with the Normocap 200 (Fa. Datex) in preclinical resuscitation conditions].
Capnometers measure carbon dioxide (CO2) in inspired and expired air. Under physiological conditions end-tidal CO2 (peCO2) measurements closely reflect arterial pCO2 (paCO2). End-tidal CO2 concentration has been found to correlate with cardiac output in animal models and in clinical studies with cardiac arrest during cardiopulmonary resuscitation (CPR). In the present study in 23 cases of CPR end-tidal CO2 concentrations were registered during precordial compression with a transportable, battery-carried capnometer. In 7 cases of successful CPR mean concentrations of end-tidal CO2 were higher than in unsuccessful CPR (13 +/- 7 mmHg versus 8 +/- 6 mmHg). No statistical significance was found. In case of successful CPR there was a sudden rise in end-tidal CO2 up to 54 +/- 6 mmHg, indicating satisfactory spontaneous circulation. With capnometry it is possible to assess the efficacy of precordial compression during resuscitation and the return of spontaneous circulation in cardiopulmonary arrest.
Carbon Dioxide↗
[The use of propofol during diskectomy in neurosurgery].
The intravenous anaesthetic agent propofol has become more and more popular not only for induction but also for the maintenance of anaesthesia in all fields of surgery. For this purpose, different infusion rates and also combinations of propofol with opioids, nitrous oxide and volatile anaesthetic agents have been described. The present study was designed to find the best dosage regimen for short operations and rapid changes. The necessity for the frequently recommended standardized combination of propofol with opioids should be checked with respect to the cardiovascular effects. METHODS. A series of 60 patients (ASA I and II, age range 22-79 years) selected for discectomy were prospectively randomized to three groups. Half an hour before operation all patient received 0.5 mg atropine, 50 mg promethazine and 50 mg pethidine as i.m. premedication. In all groups anaesthesia was induced with propofol in a bolus dose of 2.5 mg/kg body weight over a period of approximately 45 s. After 5 mg atracurium the patients were intubated under 100 mg succinylcholine and normoventilated with 70% nitrous oxide and 30% oxygen. For relaxation 25 mg of atracurium were given. In group I propofol was administered in a dosage of 15 mg/kg body weight per hour for 10 min after induction. After this time the propofol infusion was reduced to 6 mg/kg body weight per hour. Group II received 0.1 mg fentanyl before induction. The dosage of propofol was similar to group I. In group III 0.1 mg of fentanyl was administered before induction and propofol was given with an infusion rate of 6 mg/kg body weight from the beginning. The following parameters were controlled and documented: systolic and diastolic blood pressure (SAP and DAP), heart rate (HF), end-expiratory carbon dioxide (eeCO2), inspiratory oxygen concentration (FiO2) and peripheral oxygen saturation (sO2). Recovery time was determined as the time from the end of the propofol infusion until eye-opening on command. RESULTS. In all groups anaesthesia could be induced and maintained without complications. There was a slight increase in SAP in group I after intubation, while in the groups with fentanyl a pronounced decrease of SAP was found simultaneously with induction of anaesthesia (Fig. 1). In group I HF showed significantly higher values after intubation and for the next 15 min than in group II and group III. A rapid and pronounced increase of end-tidal carbon dioxide occurred in the fentanyl groups with the beginning of spontaneous ventilation at the end of anaesthesia. There was a significantly longer recovery time in group II with fentanyl and initial higher propofol infusion rate. A correlation between dosage of propofol and recovery time could not be found. DISCUSSION. The results of this study demonstrate that a routine combination of propofol with opioids is not necessary even for painful surgical procedures if the propofol dosage is initially increased. There are differences in cardiovascular reactions between group I without and groups II and III with fentanyl, but in our patients these changes were of no clinical importance. An additional administration of fentanyl can prevent hypertensive reactions or tachycardia with intubation, but on the other hand fentanyl can also increase the cardial depression of propofol with a dangerous decrease in blood pressure and heart rate. Therefore in combination with opioids lower doses of propofol should be used for induction and maintenance of anaesthesia. If opioids are administered, signs of a residual postoperative respiratory depression have to be taken seriously.
Adult↗
[A new tube for the endobronchial application of drugs].
During cardiopulmonary resuscitation, endobronchial administration of epinephrine, atropine and lidocaine is required as the initial step. This procedure provides a decisive time advantage, since it can be effected before venous access is established. The presently available techniques (direct application, catheter insertion, etc.), however, have disadvantages (interruption of ventilation, difficult catheter placement, time loss). For this reason we have developed a tube for endobronchial drug and gas application during resuscitation (EDGAR tube). It enables direct injection into the bronchial system via a separate injection canal within the wall of the tube that terminates at the tip of the tube. In this way, simple and safe application of the drugs to the appropriate absorption surface is ensured, without any loss of time. In view of these significant advantages, the use of the EDGAR tube is recommended for intubation for resuscitation purposes.
Atropine↗