Remifentanil or sufentanil for coronary surgery: comparison of postoperative respiratory impairment.

Background And Objective: High-dose opioid anaesthesia contributes to decreasing metabolic and hormonal stress responses in patients undergoing cardiac surgery. However, the increase in context-sensitive half-life of opioids given as a high-dose regimen can affect postoperative respiratory recovery. In contrast, remifentanil can be given in high doses without prolonging context-sensitive half-life due to its rapid metabolism.

Treatment of meningitis due to methicillin-resistant Staphylococcus epidermidis with linezolid.

Methicillin-resistant Staphylococcus epidermidis (MRSE) can cause nosocomial meningitis in the presence of prosthetic devices. Vancomycin is the treatment of choice, but its penetration into the cerebrospinal fluid is poor, especially in cases without severe meningeal inflammation. We successfully used linezolid to treat a case of posttraumatic MRSE meningitis with a low-level inflammatory response.

The effect of remifentanil or fentanyl on postoperative vomiting and pain in children undergoing strabismus surgery.

Unlabelled: Postoperative vomiting (POV) after strabismus surgery in children results in discomfort and prolonged hospital stays. Opioids increase the incidence of POV. Remifentanil has a context-sensitive half-life of 3 to 4 min, and how this short half-life influences POV in those patients is unknown.

[Patient safety and errors in medicine: development, prevention and analyses of incidents].

"Patient safety" and "errors in medicine" are issues gaining more and more prominence in the eyes of the public. According to newer studies, errors in medicine are among the ten major causes of death in association with the whole area of health care. A new era has begun incorporating attention to a "systems" approach to deal with errors and their causes in the health system.

Effect of tracheal intubation or laryngeal mask airway insertion on intraocular pressure using balanced anesthesia with sevoflurane and remifentanil.

Study Objectives: To study the effect of tracheal intubation or laryngeal mask airway (LMA) insertion on intraocular pressure (IOP) in strabismus patients undergoing balanced anesthesia with sevoflurane and remifentanil.

Design: Open, prospective, randomized study.

Setting: Tertiary care academic medical institution.

Functional imaging of the monkey brain.

Functional magnetic resonance imaging (fMRI) has become an essential tool for studying human brain function. Here we describe the application of this technique to anesthetized monkeys. We present spatially resolved functional images of the monkey cortex based on blood oxygenation level dependent (BOLD) contrast.

Effects of the combinations propofol/alfentanil and midazolam/fentanyl on blood pressure and contact phase system during coronary surgery.

Perioperative haemodynamic changes leading to severe circulatory problems during open-heart surgery still represent dreaded complications. The aim of this study was to examine the relationship between the use of applied anaesthetic agents and alterations of the contact phase of the intrinsic blood-clotting system, as changes within the kallikrein-kinin system can lead to a fall in blood pressure. In a randomized study, parameters of the kallikrein-kinin system, coagulation and fibrinolysis were determined for 36 patients with aortocoronary bypass operations.

[Problematic intubation in the patient with laryngeal-hypopharyngeal carcinoma. Retrograde controlled fiber bronchoscopy technique].

Retrograde or fiberoptic intubation techniques are recommended for patients in whom intubation is difficult; however, each method has its own limitations. Good results have been reported with a combination of both techniques, i.e.

[Inadvertant suture fixation of a Swan-Ganz catheter to the pulmonary artery following heart surgery].

We report a patient undergoing redo cardiac surgery for combined replacement of the aortic and mitral valves. During the course of the operation, a Swan-Ganz catheter - positioned preoperatively - was accidentally fixed to the wall of the pulmonary artery. As this did not interfere with cardiac output measurement or the pulmonary artery pressure wave form, the fixation was not noticed until an attempt was made to remove the catheter.

Variance of cardiorespiratory parameters during gynaecological surgery with CO2-pneumoperitoneum.

Laparoscopic procedures with CO2-pneumoperitoneum are used widely in gynaecology and surgery. The effects of a 15 degrees head-down position, different intra-abdominal pressures (IAP) and CO2-insufflation flows on cardiorespiratory parameters were studied prospectively in 18 gyneacologic patients under general anaesthesia. The 15 degrees head-down position led to significant changes in heart rate (-6%) and in central venous pressure (+53%).

Pulmonary venodilation by isoflurane improves gas exchange during Escherichia coli bacteremia.

Objective: To determine how isoflurance affects the longitudinal distribution of pulmonary vascular resistance and pulmonary gas exchange during Escherichia coli bacteremia.

Design: Prospective, controlled study with open-label assignment of animals to two groups.

Setting: Laboratory.

Pulmonary artery occlusion-left atrial pressure gradient: an important factor in determining pulmonary venous vascular resistance in acute pulmonary failure.

Objective: To determine whether pulmonary artery occlusion pressure (PAOP) accurately reflects left atrial pressure (LAP) in acute pulmonary failure.

Design: Sham-controlled laboratory investigation on Goettingen minipigs.

Interventions: Induction of acute respiratory failure by a 4-hr infusion of live Escherichia coli bacteria in 11 animals; two animals served as the control group.

Pulmonary capillary pressure and gas exchange after E. coli bacteremia in pigs.

In 9 Goettingen minipigs we studied the effect of E. coli bacteremia on effective pulmonary capillary pressure and the longitudinal distribution of pulmonary vascular resistance. Precapillary pressure gradient (dPa) was calculated as the difference between mean pulmonary artery pressure (MPP) and effective pulmonary capillary pressure (Pc) (dPa = MPP-Pc), postcapillary pressure gradient (dPv) as the difference between Pc and left atrial pressure (dPv = Pc-LAP).

[Pulse oximetry: an indicator for the closure of a tracheostome after lateral fixation of the vocal cords (cordopexy)].

The aim of the study was to establish an objective method to predict proper breathing after the closure of the tracheostomy in patients operated upon for laryngeal diplegia by lateral cordopexy. The method is non-invasive, quantitative and independent of the patient. The study covers 18 patients in whom the closure was performed after fixation of the vocal in whom it was performed prior to the operation.

[Lung inflation or mechanical ventilation in extracorporeal circulation?].

Extracorporeal circulation (ECC), with its shock-like pulmonary perfusion, leads to pathomorphologic and functional pulmonary changes, the postperfusion syndrome. This study investigated the effects of different types of ventilation during ECC on postoperative pulmonary function and the resulting pulmonary blood gas changes. METHOD.

Acute blood pressure increase during the perioperative period.

Hypertensive reactions occur frequently in the perioperative setting. Perioperative blood pressure elevation is generally amenable to treatment in previously normotensive patients. Alterations in cerebral autoregulation and myocardial performance in chronic hypertension limit the compensatory range available to cope with perioperative blood pressure changes.

Early detection of inadvertent oesophageal intubation: pulse oximetry vs. capnography.

The aim of our retrospective study was to evaluate the efficacy of routine pulse oximetry and capnometry for detection of oesophageal tube misplacement. Patients undergoing ENT interventions at our hospital are routinely monitored by ECG, arterial blood pressure by cuff, capnography, and pulse oximetry. Beat-to-beat values of Sao2 and CO2 waveform were recorded by a graphic printer connected to a microcomputer, ASA I patients were routinely preventilated with FIO2 = 0.

[Complaints in the postoperative phase related to anesthetics].

In two prospective, randomized studies the frequency of headache, nausea, vomiting, and analgesic requirement during the first postoperative 24 h was observed in order to study differences between the sexes and the inhalation anesthetics halothane, enflurane, isoflurane, or balanced anesthesia with enflurane/alfentanil. Nausea and vomiting were more frequent after enflurane than after halothane or isoflurane. There was no significant difference between anesthetics and frequency of headache, but there were significant differences in postoperative analgesic requirements which were highest after halothane and lowest after isoflurane.

[Success rate and complications of a modified retrograde intubation technic in 36 patients].

The main disadvantage of guided blind intubation (Waters technique) is injury to the mucous membrane and cartilaginous skeleton of the larynx. Thirty-six patients scheduled for laryngectomy were intubated using a modified Waters technique. The practicability of this technique as well as the type and extent of damage to the laryngeal tissue were evaluated under controlled conditions.

[Cardiorespiratory problems in the use of calcium antagonists for vasospasm prophylaxis in subarachnoid hemorrhage].

Since studies by Allen et al. [1] calcium antagonists have been commonly used for prevention of cerebral vasospasm in patients suffering from acute subarachnoid hemorrhage (SAH). Vasodilatation-induced hypotension, increase of cardiac output and intrapulmonary shunting (Qs/Qt) are wellknown cardiovascular effects.

[Long-term intubation following tracheotomy].

Between 1981 and 1983 tracheotomy was performed on 61 patients in the Surgical University Clinic of Tübingen. The dominant factors in indication of tracheotomy was for 49% of patients the persistingly necessary artificial respiration, for 26% a better bronchial toilet and other reasons for 25%. With 40.