Anaesthesia and systemic oxygenation.

Background: Anaesthesia induction and deep anaesthesia may be accompanied by a considerable haemodynamic depression, especially in patients suffering from cardiovascular diseases. A decrease in cardiac index (CI) leads to a concomitant decrease in oxygen transport (DO2I). We examined whether these changes in haemodynamic performance and oxygenation can cause an oxygen debt and anaerobic metabolism.

[Laparoscopic cholecystectomy as a suitable procedure for patients with cardiopulmonary risk factors?].

There is considerable debate whether or not the laparoscopic technique for cholecystectomy supersedes conventional procedures in patients with pre-existing cardiopulmonary disease. Hemodynamic stress and CO2 absorption from the peritoneum can have a negative effect on intraoperative safety. On the other hand, a more rapid recovery of lung function and a shorter stay in hospital are the obvious advantages.

Perioperative TNF alpha and IL-6 concentrations correlate with septic state, organ function, and APACHE II scores in intra-abdominal infection.

Objective: To find out if concentrations of tumour necrosis factor a (TNF alpha) and interleukin-6 (IL-6) play a part in the pathophysiology of intra-abdominal infection, and try to identify patients who would benefit from immunotherapy against TNF alpha.

Design: Prospective open study.

Setting: University hospital.

[The clinical picture and therapy of septic shock].

This special article for continued education begins with a broad definition of septic shock. The following section describes the fundamental organ dysfunctions and pathomechanisms. The different pattern of septic shock and a clearly defined therapeutic concept are also offered.

[Preoperative plasma exchange in treatment of plasma-related coagulation disorders before liver transplantation].

Patients And Methods: Seventy-two consecutive patients undergoing orthotopic liver transplantation at the Department of Surgery I, University of Vienna Medical School (OLT nos. 1 to 72), were evaluated. Their mean age was 47 years (range: 18-63 years).

[Evoked potentials in the follow-up and prognosis of patients with craniocerebral trauma].

The aims of this study were to find a reliable way of establishing the prognosis for the final outcome in the first week after head injury, to show the correlation between abnormalities in evoked potentials (EP) and clinical coma score, and finally, to document EP results in patients with the clinical diagnosis of brain death. We examined 46 patients, 23 in different states of coma and 23 with bulbar syndrome (complete absence of cortical and brain stem function). In the group of comatose patients brain stem auditory EP (BAEP) and somatosensory EP (SEP) were recorded in the first 48 h, 3-5 days, 1 week and 4 weeks after the head injury.

Effect of large volume replacement with balanced electrolyte solutions on extravascular lung water in surgical patients with sepsis syndrome.

We investigated the effect of large volume replacement with balanced electrolyte solutions on extravascular lung water (EVLW) in 16 adult surgical patients with sepsis syndrome. Patients entered the study within the 24 h period following surgical interventions for acute necrotizing pancreatitis, intra-abdominal abscesses, and/or peritonitis. Sequential measurements (n = 108) were made at intervals of 6-12 h over a 48 h period.

[Hemodynamic and metabolic changes during orthotopic liver transplantation].

Hemodynamic and metabolic profiles were obtained on 48 adult patients (mean age 46 years) undergoing orthotopic liver transplantation without using a bypass technique during the anhepatic period. Baseline measurements after induction of anesthesia (A) revealed a high-output circulatory state. During hepatic dissection (B, preclamping control), mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), and elevated cardiac index (CI) were well maintained.

[Glucose-potassium-insulin in hypodynamic septic shock].

Haemodynamic and metabolic effects of glucose-potassium-insulin (GKI) were studied in 14 patients with peritonitis. Study entry criteria were: hypodynamic septic shock (mean arterial pressure less than 50 mmHg and cardiac index less than 3.5 l/min) despite a highly positive fluid balance (greater than +2,000 ml during the last 12 h) and use of catecholamines (greater than 15 mcg/kg/min Dobutamine).

[Acute renal failure in abdominal infection. Comparison of hemodialysis and continuous arteriovenous hemofiltration].

58 patients with peritonitis and acute renal failure (ARF) were treated either by haemodialysis (HD, n = 22), continuous arteriovenous haemofiltration (CAVH, n = 9), or continuous pump-driven haemofiltration (CPDHF, n = 27). In contrast to HD, which led to severe hypotension in 31.9% of procedures and to cardiac arrest in 3 cases, CPDHF caused neither haemodynamic nor metabolic alterations.

[Evaluation of the thermal technic for the quantitative measurement of extravascular lung water].

To evaluate the accuracy of the method, sequential measurements (n = 159) of extravascular lung water (EVLW) using the thermo-dye double-indicator dilution technique were performed in 22 critically surgical ill patients. Radiographic grading of lung water content served as clinical standard. Normal mean EVLW defined radiographically without evidence of pulmonary edema was 4.

[Monitoring kidney function in abdominal infection].

In ICU patients suffering from abdominal sepsis acute renal failure (ARF) is a common (50% incidence) and often lethal (more than 80% mortality) complication. Continuous monitoring of renal function is necessary for both adequate fluid replacement and early detection of ARF. Using a programmable handheld computer the following parameters are calculated at least daily: creatinine, osmolal and free water clearance, fractional excretion of sodium and potassium and non-saline loss.

[Non-invasive pulse oximetry for the measurement of oxygen saturation in intensive care patients].

Non-invasive measurements of oxygen saturation are attractive because they provide continuous information which may result in improved patient care. We evaluated a new finger pulse oximeter as a measure of arterial oxygen saturation in critically ill patients with respiratory distress. In 12 patients studied, 133 simultaneous comparisons between in vivo (Pulse-Oximeter, Nellcor, Hayward, California) and in vitro (IL CO-Oximeter 282) oxygen-haemoglobin saturation were made.

[Problems of blood replacement in liver transplantation].

Liver transplantation often is accompanied with massive bleeding-blood losses up to 125 I have been reported. A survey of 21 transplantations describes the management for substitution of blood components. After an initial series of 18 patients including 4 cases with blood losses exceeding 100 units of blood, an attempt was made to optimize coagulation in 5 cases with NT-values below 40% by preoperative plasmapheresis.

[Pathogenic flora in the gastric juice and bronchial secretion of long-term ventilated intensive-care patients].

Nosocomial pneumonia is a major risk for long term ventilated ICU patients. The infection route may be hematogenic or via inhalation or aspiration of microorganisms. The source of aspiration is the oropharynx.

[Continuous hemofiltration in peritonitis].

During a period of 3 years 27 patients in acute renal failure (ARF) due to peritonitis underwent pump driven continuous hemofiltration (PDHF). PDHF caused neither hemodynamic nor metabolic disturbances, which in contrary are frequently seen during intermittent hemodialysis treatment in septic patients. BUN and creatinine levels fell significantly (p less than 0.