Plasma epinephrine levels after epinephrine administration using different tracheal administration techniques in an adult CPR porcine model.

The aim of the study was to compare arterial plasma epinephrine levels after tracheal epinephrine application using three different tracheal instillation techniques at different tracheal levels in a porcine adult cardiopulmonary resuscitation model. In the prospective, randomized study, electrically-induced cardiopulmonary arrest was applied to 32 anaesthetized and paralyzed domestic pigs. After 3 min of cardiopulmonary arrest and 2 min of external chest compressions using a pneumatic compression device and mechanical ventilation, epinephrine was administered intravenously (20 microg/kg) or tracheally (50 microg/kg): using either direct injection into the upper end of the tracheal tube, via a catheter placed into the bronchial system and using a special tracheal application tube.

Coagulation effects of a recently developed hydroxyethyl starch (HES 130/0.4) compared to hydroxyethyl starches with higher molecular weight.

Background: Hydroxyethyl starches (HES) are known to interfere with blood coagulation according to molecular weight, the degree of substitution and the C2/C6 ratio. A recently developed low molecular hydroxyethyl starch (HES 130/0.4) was designed to reduce the blood compromising potency.

The time required to perform different methods for endotracheal drug administration during CPR.

We compared the times necessary to perform different endotracheal drug application techniques during CPR. In a simulated CPR situation with a mannequin 28 paramedics and seven emergency physicians performed different drug instillation techniques in a randomized manner: direct injection into the upper end of the endotracheal tube (group tube), via a suction catheter placed into the bronchial system (group suction catheter), via a flexible venous catheter placed into the bronchial system (group venous catheter), using an EDGAR tube (an endotracheal tube with an injection channel within the wall of the tube (group EDGAR). We measured the time necessary to prepare the drug solution and compared the time necessary to prepare and perform each instillation method and the time the ventilation was interrupted.

Plasma catecholamine levels following tracheal and intravenous epinephrine administration in swine.

We compared plasma epinephrine levels after three different tracheal epinephrine application techniques and intravenous injection in male and female anesthetized and paralyzed domestic pigs. Epinephrine was administered intravenously (10 microg/kg) (group i.v.

Intravenous clonidine decreases minimum end-tidal isoflurane for induction of electroencephalographic burst suppression.

The aim of this study was to determine the individual end-tidal isoflurane (ET ISO) threshold concentration for the induction of electroencephalographic (EEG) burst suppression with and without intravenous (I.V.) clonidine and to evaluate the EEG and cardiovascular response to skin incision during isoflurane/N2O anesthesia.

Preoperative acute hypervolemic hemodilution with hydroxyethylstarch: an alternative to acute normovolemic hemodilution?

Acute normovolemic hemodilution (ANH) may help to reduce demand for homologous blood but requires extra time and apparatus. A more simple procedure is acute hypervolemic hemodilution (HHD), where hydroxyethylstarch is administered preoperatively without removal of blood. In a prospectively randomized study we compared ANH (preoperatively 15 mL/kg autologous blood removal and replacement with 15 mL/kg of hydroxyethylstarch with HHD (15 mL/kg of hydroxyethylstarch administered preoperatively) in 49 patients undergoing hip arthroplasty.

[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".

[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).

[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".

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.

[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).

Experiences with the new inhalational agents in low-flow anesthesia and closed-circuit technique. Monitoring and technical equipment.

During recent years interest has focused on two completely fluorinated ethers, desflurane and sevoflurane, which promise a shorter induction of and emergence from anesthesia. Their physicochemical properties differ from isoflurane, enflurane and halothane, thus requiring new technical equipment and leading to a change in anesthesiological procedures. Low-flow anesthesia with desflurane can be performed, the technical equipment is available, especially vaporizers and gas analyzers.

[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).

[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.

[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).

[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.

[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.

[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).

[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.

[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.