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[ { "id": "DerAnaesthesist.00490446.eng.abstr-passage-0", "type": "abstract", "text": [ "The splanchnic perfusion is reduced early in the course of any shock . The mucosa of the gut suffers most as it experiences a high oxygen demand even in the steady state . The specific arrangement of the micro vessels within the villus of the mucosa exposes the tip of the villus at the highest risk for ischemia , particularly in low flow states . As a consequence the integrity of the mucosal layer is compromised and dysfunction of the mucosal barrier may allow bacteria and toxins to translocate from the gut lumen . Activation of leukocytes and stimulation of cytokine synthesis may comprise a sustained inflammatory response syndrome . So far there is a good body of evidence that the splanchnic region may play an important role in the pathophysiological sequence from shock to organ dysfunction ." ], "offsets": [ [ 0, 804 ] ] } ]

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[ { "id": "DerAnaesthesist.00490455.eng.abstr-passage-0", "type": "abstract", "text": [ "The dysfunction of intestinal barrier allows the translocation of both endotoxin and whole bacterial organisms . It plays an important role in the development of multiple organ failure ( MOF ) . The mucosa ia one component of this barrier . Trauma , atrophie and the \" systemic inflammatory response syndrom \" increase gastrointestinal permeability . These abnormalities may contribute to the pathophysiology of sepsis . Malnutrition per se compromises the gut's barrier function . Maintenance of gastrointestinal blood flow may be facilitated by ( glutamin-enriched ? ) enteral diets . The most important conclusions of the majority of controlled trials support the concept of the very early enteral nutrition ( within 24 hours after trauma ) : the outcome of seriously ill patients is improved , the rate of complications and infections is reduced . Gastrointstinal motility disorders may interfere with the initiation and tolerance of early enteral nutrition . They may be managed by prokinetic agents ( cisapride , erythromycin ) or by bypassing the stomach with a nasoenteric tube ." ], "offsets": [ [ 0, 1087 ] ] } ]

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[ { "id": "DerAnaesthesist.00490460.eng.abstr-passage-0", "type": "abstract", "text": [ "Today , substrates with immunomodulatory effects are not only identified in all groups of macronutrients , but also in the domains of vitamines and traceelements . Mainly they interfere with 3 areas of the immune response : 1. the mucosal barrier function , 2. the cellular defense function , and 3. the local or systemic inflammatory response . Enteral formulas enriched with immune-enhancing diets are already in clinical use to encounter \" immunoparalysis \" of cellular defense during critical illness . Considering defined outcome variables , indeed , current clinical studies point out some improvements . Using an evidence based approach , a grade A recommendation was proclaimed for its broad clinical use . For defined subgroups of patients , however , presenting with most severe appearances of SIRS and consecutive organ failure , the current concept of enteral immunonutrition remains to be a matter of debate , and the evidence of clinical benefits persist to be questionable ." ], "offsets": [ [ 0, 989 ] ] } ]

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[ { "id": "DerAnaesthesist.00490466.eng.abstr-passage-0", "type": "abstract", "text": [ "Multiple organ failure ( MOF ) may occur early or late after trauma . Besides direct physical injury of organs , compromise of the microcirculation by inflammation plays an important role in the pathogenesis of MOF . Inflammation also induces counterregulatory responses which may end up in immunoparalysis . As a result , infection and sepsis with additional inflammatory damage to the microcirculation ensue thereby contributing to the late development of MOF . In addition to this biphasic model of posttraumatic MOF , there is evidence that inflammation and immunoparalysis do not only occur in sequence to each other but in parallel early after surgical procedures . The aim of the present brief review is to summarize the posttraumatic mechanisms of inflammation and immunoparalysis and to discuss how to differentiate between both pathophysiologic states ." ], "offsets": [ [ 0, 863 ] ] } ]

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[ { "id": "DerAnaesthesist.00490495.eng.abstr-passage-0", "type": "abstract", "text": [ "Serious neurological complications caused by spinal hematoma or abscess following central neuraxial block have been reported more often during the last years . In contrast , severe complications are extremely rare associated with peripheral nerve blocks . Concerned about the safety of spinal and epidural anesthesia , we encourage the use of peripheral regional techniques for procedures on the lower extremity and especially for postoperative regional analgesia . Motor block due to lumbar epidural anesthesia using high concentrations of local anesthetic makes spinal hematoma or abscess difficult to recognize . Therefore , low concentrations of local anesthestic should be used for postoperative epidural analgesia . Any increase in motor block following neuraxial blockade should raise the suspicion of a spinal compression ( e.g. hematoma or abscess ) . Other symptoms are back pain , radicular pain or paresthesia and incontinence . Disastrous neurological injuries can only be prevented by immediate diagnosis ( MR , CT or myelography ) and therapy ( surgical decompression ) ." ], "offsets": [ [ 0, 1086 ] ] } ]

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"DerAnaesthesist.00490495.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "nerve" ], "offsets": [ [ 241, 246 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027769" } ] }, { "id": "DerAnaesthesist.00490495.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "peripheral nerve" ], "offsets": [ [ 230, 246 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0031119" } ] }, { "id": "DerAnaesthesist.00490495.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "nerve blocks" ], "offsets": [ [ 241, 253 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027741" } ] }, { "id": "DerAnaesthesist.00490495.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "safety" ], "offsets": [ [ 276, 282 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0036043" } ] }, { "id": "DerAnaesthesist.00490495.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "anesthesia" ], "offsets": [ [ 306, 316 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002903" } ] }, { "id": "DerAnaesthesist.00490495.eng.abstr-s3-t3", 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[]

[]

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[ { "id": "DerAnaesthesist.00490511.eng.abstr-passage-0", "type": "abstract", "text": [ "Halothane causes impairment of cerebrovascular reactivity and autoregulation . We used transcranial Doppler sonography ( TCD ) to investigate the reaction patterns of cerebral blood flow velocities ( CBFV ) during a standardized orthostatic maneuver after premedication and during halothane anesthesia in infants ." ], "offsets": [ [ 0, 314 ] ] } ]

[ { "id": "DerAnaesthesist.00490511.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "Halothane" ], "offsets": [ [ 0, 9 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018549" } ] }, { "id": "DerAnaesthesist.00490511.eng.abstr-s1-t2", "type": "umlsterm", "text": [ "autoregulation" ], "offsets": [ [ 62, 76 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0019868" } ] }, { "id": "DerAnaesthesist.00490511.eng.abstr-s1-t3", "type": "umlsterm", "text": [ "autoregulation" ], "offsets": [ [ 62, 76 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0034982" }, { "db_name": "UMLS", "db_id": "C0220905" } ] }, { "id": "DerAnaesthesist.00490511.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "sonography" ], "offsets": [ [ 108, 118 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0041618" } ] }, { "id": "DerAnaesthesist.00490511.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "blood" ], "offsets": [ [ 176, 181 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005767" }, { "db_name": "UMLS", "db_id": "C0005768" }, { "db_name": "UMLS", "db_id": "C0005835" } ] }, { "id": "DerAnaesthesist.00490511.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "premedication" ], "offsets": [ [ 256, 269 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033045" } ] }, { "id": "DerAnaesthesist.00490511.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "halothane" ], "offsets": [ [ 281, 290 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018549" } ] }, { "id": "DerAnaesthesist.00490511.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "anesthesia" ], "offsets": [ [ 291, 301 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002903" } ] }, { "id": "DerAnaesthesist.00490511.eng.abstr-s2-t6", "type": "umlsterm", "text": [ "infants" ], "offsets": [ [ 305, 312 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021270" } ] }, { "id": "DerAnaesthesist.00490511.eng.abstr-s2-t7", "type": "umlsterm", "text": [ "blood flow velocities" ], "offsets": [ [ 176, 197 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005798" } ] } ]

[]

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[ { "id": "DerAnaesthesist.00490517.eng.abstr-passage-0", "type": "abstract", "text": [ "Background : Our study compared the haemodynamic changes after spinal anaesthesia with 2% lignocaine and 0,5% plain bupivacaine ." ], "offsets": [ [ 0, 129 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.00490523.eng.abstr-passage-0", "type": "abstract", "text": [ "We report a case of a 41-years-old woman presenting for revision of a secondary reconstructive procedure using the modified Tagliacozzi upper arm flap after subtotal maxillectomy . Because of the pedicle flap the upper arm was fixed in a pre-facial position and so fiberoptic intubation was required . After routine pre-anesthetic preparations and topical anesthesia of the nares and nasopharynx a CO2 measuring catheter as well as a O2 catheter to administer 100% oxygen was inserted deeply into the left naris . At that time , a continous infusion of 0,05 µg/ kg/min remifentanil and 2 mg/kg/h propofol was started . After 4 min , fiberoptic intubation was performed through the right nare without any technical difficulties in conscious sedation of the patient . During the entire fiberoptic intubation SaO2 was constant at 100% and capnogram tracings with etCO2 values ranging from 31 to 33 mmHg were displayed on the monitor . At the end of this second surgical procedure with fixed pre-facial upper arm position the patient was uneventfully extubated fully awake . For the time period of fiberoptic intubation the patient had complete amnesia ." ], "offsets": [ [ 0, 1150 ] ] } ]

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[ { "id": "DerAnaesthesist.00490527.eng.abstr-passage-0", "type": "abstract", "text": [ "We report on anaesthesia management for elective Caesarean section in a parturient woman with hypertrophic obstructive cardiomyopathy ( HOCM ) . Special considerations for anaesthesia are associated with this condition . Women with HOCM need a closed diagnostic and therapeutic follow-up during pregnancy . Anaesthesiologists have to be aware of the cardiac peculiarities . Special risks may arise from endogenous catecholamine release during labour or from therapy with -adrenergic drugs for treatment of blood pressure drops or suppression of uterine contractions . Epidural anaesthesia is an appropriate anaesthesia method for Caesarean section , also in patients with HOCM . Adequate hemodynamic monitoring is essential . Phenylephrine is a pure -adrenergic vasoconstrictor without inotropic effects . It is suitable for therapy of blood pressure drops induced by peripheral vasodilation ." ], "offsets": [ [ 0, 893 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.00490592.eng.abstr-passage-0", "type": "abstract", "text": [ "When heart-lung machines made extracorporeal circulation possible in the fifties , cardiac surgeons gained virtually unrestricted access to the resting , motionless heart . Valve repair and reconstruction , in particular , made great progress as a result of extracorporeal circulation . While the distinct advantages of extracorporeal circulation for cardiosurgery remain undisputed , awareness of the significant perioperative risks of extracorporeal circulation for the patient has been increasing in recent years . This has lead to an interest in alternative cardiosurgical techniques avoiding extracorporeal circulation . Inspired by minimally-invasive procedures in abdominal surgery , cardiosurgical instruments as well as surgical techniques of access to the heart and large thoracic vessels were systematically modified leading to today's minimally-invasive cardiosurgical procedures such as off-pump coronary artery bypass grafting on the beating heart . Similarly , in the field of cardiac valve repair , new cannulation techniques for instituting extracorporeal circulation make median sternotomy unnecessary . The developments described above have lead to the recent introduction of robot-assisted techniques with or without extracorporeal circulation , which are expected to make possible in the near future the performance of the whole range of cardiosurgical procedures with minimal surgical trauma ." ], "offsets": [ [ 0, 1415 ] ] } ]

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[]

[]

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"DerAnaesthesist.00490592.eng.abstr-s7-t8", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t1", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r15-t5.1-t3.1", "type": "result_of", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t5", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t3", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r16-t5.1-t3.1", "type": "measurement_of", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t5", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t3", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r17-t5.1-t9.1", "type": "associated_with", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t5", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t9", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r18-t3.1-t1.1", "type": "result_of", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t3", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t1", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r19-t2.1-t1.1", "type": "affects", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t2", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t1", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r20-t5.1-t8.1", "type": "associated_with", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t5", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t8", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r21-t5.1-t1.1", "type": "measurement_of", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t5", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t1", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r22-t9.1-t3.1", "type": "affects", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t9", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t3", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r23-t6.1-t3.1", "type": "measurement_of", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t6", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t3", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r24-t5.1-t1.1", "type": "result_of", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t5", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t1", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r25-t6.1-t1.1", "type": "measurement_of", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t6", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t1", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r26-t7.1-t1.1", "type": "result_of", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t7", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t1", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r27-t9.1-t1.1", "type": "affects", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t9", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t1", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r28-t1.1-t5.1", "type": "result_of", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t1", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t5", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r29-t5.1-t3.1", "type": "evaluation_of", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t5", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t3", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r30-t1.1-t8.1", "type": "result_of", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t1", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t8", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r31-t3.1-t5.1", "type": "result_of", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t3", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t5", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r32-t8.1-t9.1", "type": "associated_with", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t8", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t9", "normalized": [] }, { "id": "DerAnaesthesist.00490592.eng.abstr-s7-r33-t5.1-t1.1", "type": "evaluation_of", "arg1_id": "DerAnaesthesist.00490592.eng.abstr-s7-t5", "arg2_id": "DerAnaesthesist.00490592.eng.abstr-s7-t1", "normalized": [] } ]

[ { "id": "DerAnaesthesist.00490609.eng.abstr-passage-0", "type": "abstract", "text": [ "Background . We studied 40 patients ( 20 female and 20 male ) undergoing elective surgery under general anaesthesia to evaluate the effect of gender on the pharmacodynamics of rocuronium ." ], "offsets": [ [ 0, 188 ] ] } ]

[ { "id": "DerAnaesthesist.00490609.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 27, 35 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "female" ], "offsets": [ [ 41, 47 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0086287" }, { "db_name": "UMLS", "db_id": "C0015780" } ] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "male" ], "offsets": [ [ 55, 59 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0024554" }, { "db_name": "UMLS", "db_id": "C0086582" } ] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "surgery" ], "offsets": [ [ 82, 89 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038894" }, { "db_name": "UMLS", "db_id": "C0038895" } ] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "gender" ], "offsets": [ [ 142, 148 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0079399" } ] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-t6", "type": "umlsterm", "text": [ "pharmacodynamics" ], "offsets": [ [ 156, 172 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0243145" } ] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-t7", "type": "umlsterm", "text": [ "rocuronium" ], "offsets": [ [ 176, 186 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0209337" } ] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-t8", "type": "umlsterm", "text": [ "elective surgery" ], "offsets": [ [ 73, 89 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0206058" } ] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-t9", "type": "umlsterm", "text": [ "general anaesthesia" ], "offsets": [ [ 96, 115 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002915" } ] } ]

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[ { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r1-t1.1-t6.1", "type": "performs", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t1", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t6", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r2-t4.2-t2.1", "type": "issue_in", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t4", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t2", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r3-t9.1-t2.1", "type": "method_of", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t9", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t2", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r4-t6.1-t2.1", "type": "method_of", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t6", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t2", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r5-t9.1-t6.1", "type": "affects", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t9", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t6", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r6-t1.1-t2.1", "type": "interacts_with", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t1", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t2", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r7-t1.1-t2.1", "type": "issue_in", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t1", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t2", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r8-t7.1-t6.1", "type": "interacts_with", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t7", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t6", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r9-t9.1-t1.1", "type": "affects", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t9", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t1", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r10-t6.1-t7.1", "type": "interacts_with", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t6", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t7", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r11-t1.1-t9.1", "type": "performs", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t1", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t9", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r12-t6.1-t2.1", "type": "issue_in", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t6", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t2", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r13-t1.1-t3.2", "type": "interacts_with", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t1", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t3", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r14-t7.1-t2.1", "type": "issue_in", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t7", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t2", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r15-t6.1-t1.1", "type": "affects", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t6", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t1", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r16-t7.1-t6.1", "type": "affects", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t7", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t6", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r17-t9.1-t6.1", "type": "uses", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t9", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t6", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r18-t9.1-t7.1", "type": "uses", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t9", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t7", "normalized": [] }, { "id": "DerAnaesthesist.00490609.eng.abstr-s2-r19-t6.1-t7.1", "type": "uses", "arg1_id": "DerAnaesthesist.00490609.eng.abstr-s2-t6", "arg2_id": "DerAnaesthesist.00490609.eng.abstr-s2-t7", "normalized": [] } ]

[ { "id": "DerAnaesthesist.00490613.eng.abstr-passage-0", "type": "abstract", "text": [ "Objective . There is an increasing demand for internal clinical quality assurance . For this reason methods for the assessment of patients ' satisfaction and postoperative symptoms and complaints are needed . This article describes a new questionnaire for the measurement of these aspects ." ], "offsets": [ [ 0, 290 ] ] } ]

[ { "id": "DerAnaesthesist.00490613.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "Objective" ], "offsets": [ [ 0, 9 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018017" } ] }, { "id": "DerAnaesthesist.00490613.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "methods" ], "offsets": [ [ 100, 107 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0025663" }, { "db_name": "UMLS", "db_id": "C0025664" } ] }, { "id": "DerAnaesthesist.00490613.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "assessment" ], "offsets": [ [ 116, 126 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0028708" } ] }, { "id": "DerAnaesthesist.00490613.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 130, 138 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.00490613.eng.abstr-s3-t4", "type": "umlsterm", "text": [ "satisfaction" ], "offsets": [ [ 141, 153 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242428" } ] }, { "id": "DerAnaesthesist.00490613.eng.abstr-s3-t5", "type": "umlsterm", "text": [ "postoperative" ], "offsets": [ [ 158, 171 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0032790" } ] }, { "id": "DerAnaesthesist.00490613.eng.abstr-s3-t6", "type": "umlsterm", "text": [ "symptoms" ], "offsets": [ [ 172, 180 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0683368" } ] }, { "id": "DerAnaesthesist.00490613.eng.abstr-s4-t1", "type": "umlsterm", "text": [ "questionnaire" ], "offsets": [ [ 238, 251 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0034394" } ] }, { "id": "DerAnaesthesist.00490613.eng.abstr-s4-t2", "type": "umlsterm", "text": [ "measurement" ], "offsets": [ [ 260, 271 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242485" } ] } ]

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[ { "id": "DerAnaesthesist.00490625.eng.abstr-passage-0", "type": "abstract", "text": [ "An interscalene block of the brachial plexus was combined with general anaesthesia for repair of a complex chronic lesion of the shoulder . The localisation of the plexus with electro-stimulation and the injection of Bupivacain 0.5% were accomplished easily and without painful sensations . 48 hours later the block was still partially present . Paraesthesia and a sensory and motor innervation deficit affected mainly the dorsal fascicle , but also areas innervated by the median and lateral fascicles . The deficit did not completely disappear for 18 month . The cause could have been due to direct traumatisation during blockade or operation , toxic action of the injected substance ( Bupivacain 0,5% , 30 ml ) , distension of the plexus , a cervical syndrome or an aseptic plexitis , although a definite determination is not possible . However , the pattern of the lesion and the lack of pain during localisation of the plexus and injection favour traumatisation during the acromioplasty ." ], "offsets": [ [ 0, 993 ] ] } ]

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[ { "id": "DerAnaesthesist.00490629.eng.abstr-passage-0", "type": "abstract", "text": [ "Numerous factors have been claimed to influence postoperative nausea and vomiting ( PONV ) . A critical review of the literatur reveals , that strong evidence based on original double-blind , randomized , controlled trials or their meta-analyses is only available for very few risk factors . For most other factors , although mentioned in narrative reviews , there is insufficient evidence . Sufficient evidence on original data or meta-analyses is present for female gender , a history of PONV or motion sickness , non-smoking-status , young age , volatile anaesthetics , nitrous oxide and postoperative opioids . Factors with conflicting results are the menstrual cycle , hypnotics for induction , mask ventilation and nasogastric tube , the experience of the anaesthetist , muscle relaxants and their antagonists and laparoscopic procedures . Insufficient evidence is present for the other types of operation , psychological factors including anxiety and pain . No evidence due to lack of data applies to postoperative movement , hemodynamic stability , hypercarbia and acid-base-shifts . For adipositas there is not only a lack of evidence for an effect but evidence for a lack of effect based on several multivariate analyses . In conclusion , we have developed the following simplified view : PONV is mainly caused by opioids and volatile anaesthetics when applied to susceptible patients ( females , non-smoker , positive history of previous sickness ) ." ], "offsets": [ [ 0, 1461 ] ] } ]

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[ { "id": "DerAnaesthesist.00490675.eng.abstr-passage-0", "type": "abstract", "text": [ "Procedures in clinical nutrition have gained both invasiveness as well as the complexity . Thus improved education of professionals and their alliance in hospital based nutritional support teams ( NST ) is demanding . Two forms of collaboration , the \" interdisciplinary nutritional committee \" and the \" department for nutritional therapy \" , are discussed . It is the goal of this contribution to present structure and tasks of an independently working department for nutritional support therapy . The pertinent areas of activity are composed as followed : clinical nutritional therapy , home nutrition , education , research , and quality management . The team members include the physician , the dietitian , the nurse , the nutritionist , and the pharmacist . The individual tasks as well as the areas of responsibility are presented . We discuss , whether nutritional support teams might be suitable to achieve cost reduction , provided adequate working conditions are available . Issues like \" performance related reimbursement \" and \" NST certification \" by health care organizations are discussed . We also elude to the option to merge services with other health care providers in order to built up an inter-disciplinary organization system . We conclude that nutritional support teams have to be prepared to meet hospital needs . Costs/benefit balances have to be assessable and must be documented . Although the effectiveness of selected nutritional support teams was clearly shown , it is the challenge of each individual team to produce proof of effectiveness for itself . Acceptable working conditions , however , should be provided as they have to be considered indispensable to achieve high quality performance ." ], "offsets": [ [ 0, 1727 ] ] } ]

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[ { "id": "DerAnaesthesist.00490706.eng.abstr-passage-0", "type": "abstract", "text": [ "Anaesthesia both for adenotomy ( AT ) and for tonsillectomy ( TE ) frequently presents a challenge . On one hand , children scheduled for adenotomy often have upper airway infections and are thus at risk of laryngo- and bronchospasm ; on the other hand the ENT surgeon and the anaesthetist have to share the \" workspace \" in the patient's mouth . Since the succinyl choline debate in the early 1990s , the question of the best muscle relaxant has gone hand in hand with that of the most appropriate means of securing the airway . The concept of the laryngeal mask as airway was initially greeted with scepticism . Following several years ' use of the mask for this purpose in AT and TE in young children , we report our experience and summarise the literature on this topic . The laryngeal mask represents a safe alternative to intubation , provided there is close cooperation with the ENT surgeon ." ], "offsets": [ [ 0, 899 ] ] } ]

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[]

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"DerAnaesthesist.00490706.eng.abstr-s6-r1-t2.1-t3.1", "type": "uses", "arg1_id": "DerAnaesthesist.00490706.eng.abstr-s6-t2", "arg2_id": "DerAnaesthesist.00490706.eng.abstr-s6-t3", "normalized": [] }, { "id": "DerAnaesthesist.00490706.eng.abstr-s6-r2-t2.1-t1.1", "type": "uses", "arg1_id": "DerAnaesthesist.00490706.eng.abstr-s6-t2", "arg2_id": "DerAnaesthesist.00490706.eng.abstr-s6-t1", "normalized": [] } ]

[ { "id": "DerAnaesthesist.00490713.eng.abstr-passage-0", "type": "abstract", "text": [ "Objective . Randomised controlled trials investigating the efficacy of dexamethasone alone or in combination with other antiemetics to prevent postoperative nausea and vomiting ( PONV ) were included in a meta-analysis to estimate the relative efficacy of these treatments ." ], "offsets": [ [ 0, 274 ] ] } ]

[ { "id": "DerAnaesthesist.00490713.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "Objective" ], "offsets": [ [ 0, 9 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018017" } ] }, { "id": "DerAnaesthesist.00490713.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "dexamethasone" ], "offsets": [ [ 71, 84 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0011777" } ] }, { "id": "DerAnaesthesist.00490713.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "antiemetics" ], "offsets": [ [ 120, 131 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003297" } ] }, { "id": "DerAnaesthesist.00490713.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "postoperative" ], "offsets": [ [ 143, 156 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0032790" } ] }, { "id": "DerAnaesthesist.00490713.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "nausea" ], "offsets": [ [ 157, 163 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027497" } ] }, { "id": "DerAnaesthesist.00490713.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "vomiting" ], "offsets": [ [ 168, 176 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042963" } ] }, { "id": "DerAnaesthesist.00490713.eng.abstr-s2-t6", "type": "umlsterm", "text": [ "PONV" ], "offsets": [ [ 179, 183 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0520909" } ] }, { "id": "DerAnaesthesist.00490713.eng.abstr-s2-t7", "type": "umlsterm", "text": [ "meta-analysis" ], "offsets": [ [ 205, 218 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0282458" } ] }, { "id": "DerAnaesthesist.00490713.eng.abstr-s2-t8", "type": "umlsterm", "text": [ "relative" ], "offsets": [ [ 235, 243 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0080103" } ] }, { "id": "DerAnaesthesist.00490713.eng.abstr-s2-t9", "type": "umlsterm", "text": [ "treatments" ], "offsets": [ [ 262, 272 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0087111" }, { "db_name": "UMLS", "db_id": "C0039798" } ] }, { "id": "DerAnaesthesist.00490713.eng.abstr-s2-t10", "type": "umlsterm", "text": [ "postoperative nausea" ], "offsets": [ [ 143, 163 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0520904" } ] }, { "id": "DerAnaesthesist.00490713.eng.abstr-s2-t11", "type": "umlsterm", "text": [ "Randomised controlled trials" ], "offsets": [ [ 12, 40 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0282440" } ] } ]

[]

[]

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[ { "id": "DerAnaesthesist.00490725.eng.abstr-passage-0", "type": "abstract", "text": [ "Objectives . We studied the epidemiology and outcome of prehospital pediatric emergencies treated by a physician-staffed mobile intensive care unit ( MICU ) ." ], "offsets": [ [ 0, 158 ] ] } ]

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[ { "id": "DerAnaesthesist.00490732.eng.abstr-passage-0", "type": "abstract", "text": [ "Objectives . To establish a surveillance system as an element of internal quality management , participating intensive care units ( ICUs ) report their ICU-associated infection surveillance data for aggregation into a national database ." ], "offsets": [ [ 0, 237 ] ] } ]

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[ { "id": "DerAnaesthesist.00490788.eng.abstr-passage-0", "type": "abstract", "text": [ "Impaired right ventricular ( RV ) function may be caused by pulmonary hypertension or myocardial ischemia . It is characterized by a dilation of the RV , which is followed by an increase of wall tension and O2-consumption and a decrease of RV ejection fraction ( RV `dysfunction'). If a drop of arterial pressure occurs this my precipitate RV failure and shock ( RV `insufficiency'). Diagnosis of RV failure and monitoring of RV function is difficult . Sometimes , even a severe impairment of RV function goes undetected or is misinterpreted . Patients in the operating room or on intensive care units seem to be especially prone to RV dysfunction and failure . Since a causative therapy often is not readily available , adequate symptomatic therapy is of utmost importance . Four basic principles have to be considered : 1 ) Optimizing preload : The failing RV requires adequate filling for preservation of stroke volume . On the other hand , overdistension of the RV may result in RV ischemia , thereby further deteriorating RV function Hence , volume loading is important , but requires continuous monitoring . 2 ) Maintenance of aortic pressure : Vasopressors are indicated if there is a critical drop of coronary perfusion pressure . Norepinephrine presently is the drug of choice for this purpose . 3 ) Reduction of RV afterload : Whereas intravenous vasodilators are limited in their efficacy in dilating pulmonary vessels due to systemic side effects , inhaled vasodilators result in selective pulmonary vasodilation and may improve RV function . 4 ) Increase of RV contractility : In RV failure and shock , norepinephrine and epinephrine are the drugs of choice . Inodilators are well suited for reducing pulmonary vascular resistance due to their positive inotropic and vasodilating effects . Since systemic vasodilation may occur , these drugs must only be used in hemodynamically stable patients ." ], "offsets": [ [ 0, 1909 ] ] } ]

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[ { "id": "DerAnaesthesist.00490810.eng.abstr-passage-0", "type": "abstract", "text": [ "From January 1997 until June 1999 , the complete durations of stay of 3152 outpatients were entered into a computerized documentation system . The scope of the data entry went from patient admission to patient release . The objective was to determine the usefulness of the anaesthesia information management system ( AIMS ) in producing complete and high-quality documentation in the field of outpatient operations . Some aspects and results from routine work are presented here ." ], "offsets": [ [ 0, 480 ] ] } ]

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[ { "id": "DerAnaesthesist.00490816.eng.abstr-passage-0", "type": "abstract", "text": [ "Introduction . This study investigates the effects of acamprosate , a glutamatergic modulator , and the lipid peroxidation inhibitor U-101033E on neurological outcome following incomplete cerebral ischemia and reperfusion in rats ." ], "offsets": [ [ 0, 231 ] ] } ]

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}, { "id": "DerAnaesthesist.00490816.eng.abstr-s2-r33-t10.1-t3.1", "type": "interacts_with", "arg1_id": "DerAnaesthesist.00490816.eng.abstr-s2-t10", "arg2_id": "DerAnaesthesist.00490816.eng.abstr-s2-t3", "normalized": [] } ]

[ { "id": "DerAnaesthesist.00490822.eng.abstr-passage-0", "type": "abstract", "text": [ "Introduction . Long-term treatment in surgical intensive care units ( SICU ) subjects the patient to a high degree of somatic , psychological , and social stress . The aim of this study was to determine their outcome in terms of quality of life and health status ." ], "offsets": [ [ 0, 264 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.00490869.eng.abstr-passage-0", "type": "abstract", "text": [ "Today , xenon anaesthesia becomes an interesting object due to xenon's positive ecological aspects as well as its nearly ideal properties as an anaesthetic gas . The application of xenon provides advantages regarding intraoperative hemodynamic stability and the recovery period . Xenon increases tissue perfusion in most organ systems . This increase of tissue perfusion during an operation can be important during some surgical procedures and may improve postoperative outcome . In anaesthetic concentrations xenon leads to an increase in cerebral perfusion . For that reason , xenon should be avoided in patients with increased cerebral pressure or cerebral perfusion disorders . Therefore , further clinical investigations are necessary to improve these clinical findings . The development of accepted indications of xenon anaesthesia becomes necessary regarding a limited availability and high costs of the gas . Focussing this target , more clinical and experimental investigations will become necessary in the next years ." ], "offsets": [ [ 0, 1028 ] ] } ]

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"arg2_id": "DerAnaesthesist.00490869.eng.abstr-s8-t2", "normalized": [] }, { "id": "DerAnaesthesist.00490869.eng.abstr-s8-r3-t2.1-t3.1", "type": "interacts_with", "arg1_id": "DerAnaesthesist.00490869.eng.abstr-s8-t2", "arg2_id": "DerAnaesthesist.00490869.eng.abstr-s8-t3", "normalized": [] }, { "id": "DerAnaesthesist.00490869.eng.abstr-s8-r4-t2.1-t1.1", "type": "affects", "arg1_id": "DerAnaesthesist.00490869.eng.abstr-s8-t2", "arg2_id": "DerAnaesthesist.00490869.eng.abstr-s8-t1", "normalized": [] } ]

[ { "id": "DerAnaesthesist.00490875.eng.abstr-passage-0", "type": "abstract", "text": [ "In order to plan the daily routine of a surgical day care unit optimally and effectively , it is indispensable to know the causes of unanticipated admission of outpatients . The purpose of this experiment was to evaluate the influences and predictors of unanticipated admission of patients in our day care unit for ambulatory surgery . The data sets of 3152 surgical outpatients were evaluated . The duration of stay had been entered online by computers ." ], "offsets": [ [ 0, 455 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.00490887.eng.abstr-passage-0", "type": "abstract", "text": [ "S-100 protein and neuron-specific enolase ( NSE ) serum concentrations serve as markers of cerebral damage in cardiac surgery , neurology , or after head injury . In these circumstances , S-100 and NSE levels correspond with the results of neuropsychological tests . The present study investigated the diagnostic value in orthopaedic patients after joint replacement ." ], "offsets": [ [ 0, 368 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.00490893.eng.abstr-passage-0", "type": "abstract", "text": [ "The paper focuses on the cultural history of brain death in Germany in the second half of the 20th century . It analyzes scientific and public discourses on the relevance of brain death and the importance of medical innovations in intensive care medicine . The paper examines how the public reacted when heart transplantation led to an urgent need for a new definition of death . It will be shown how the concept of brain death was accepted by the public , introduced into clinical routine , and implemented through medical and legal policies . Finally , it will be analyzed why the public consensus on brain death was definitely questioned in the last ten years . An understanding of the use of the concept of brain death by scientists , lawyers , theologians , and the public during the last three decades may help to shed light on the social role of science in modern and late-modern societies ." ], "offsets": [ [ 0, 898 ] ] } ]

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[ { "id": "DerAnaesthesist.00490901.eng.abstr-passage-0", "type": "abstract", "text": [ "A 50 year old female patient received anaesthesia of the arm by the vertical infraclavicular blockade of the plexus brachialis ( VIP ) . Postoperatively an ipsilateral pneumothorax occured complicated by pleural effusion and a contralateral bronchopneumonia , which resolved completely after treatment . The blockade of the plexus was performed correctly , failures in determining the correct point of needle insertion could be excluded . Therefore a pneumothorax has to be regarded as a specific complication of the VIP , which might occur despite correct technique , and requires that the patient be informed of this eventuality . Nevertheless , the VIP is an important method due to its high success rate concerning blockade of the musculocutaneous nerve and tolerance of tourniquet . The risk of a pneumothorax is about 0.2 to 0.7% ." ], "offsets": [ [ 0, 837 ] ] } ]

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"db_name": "UMLS", "db_id": "C0025664" } ] }, { "id": "DerAnaesthesist.00490901.eng.abstr-s5-t3", "type": "umlsterm", "text": [ "nerve" ], "offsets": [ [ 752, 757 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027769" } ] }, { "id": "DerAnaesthesist.00490901.eng.abstr-s5-t4", "type": "umlsterm", "text": [ "tourniquet" ], "offsets": [ [ 775, 785 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040519" } ] }, { "id": "DerAnaesthesist.00490901.eng.abstr-s5-t5", "type": "umlsterm", "text": [ "musculocutaneous nerve" ], "offsets": [ [ 735, 757 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026855" } ] }, { "id": "DerAnaesthesist.00490901.eng.abstr-s6-t1", "type": "umlsterm", "text": [ "risk" ], "offsets": [ [ 792, 796 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0035647" } ] }, { "id": "DerAnaesthesist.00490901.eng.abstr-s6-t2", "type": "umlsterm", "text": [ "pneumothorax" ], "offsets": [ [ 802, 814 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0032328" }, 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[]

[]

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[ { "id": "DerAnaesthesist.40430001.eng.abstr-passage-0", "type": "abstract", "text": [ "It is the purpose of this review to outline the principles of biometric methods in clinical research . Several study designs such as cohort studies , case-control studies or randomized controlled trials are explained in detail , and their problems and their interpretation are discussed . It is demonstrated that observational studies may yield valuable information about associations between exposure and outcome variables but that only properly designed randomized clinical trials of adequate sample size make it possible to answer research questions about causal relationships . It is emphasized that good clinical research depends on properly designed studies more than on complicated statistical procedures ." ], "offsets": [ [ 0, 713 ] ] } ]

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[ { "id": "DerAnaesthesist.40430009.eng.abstr-passage-0", "type": "abstract", "text": [ "Homologous transfusion is associated with infectious and immunological risks . Preoperative autologous deposit reduces homologous transfusion requirements considerably . Usually donations are carried out at weekly intervals . In this study we investigated the effect of shorter donation intervals on erythropoiesis and perioperative transfusion requirements . Methods . A total of 40 consecutive patients scheduled for hip arthroplasty and taking part in an autologous donation programme were randomly assigned to two groups : group I gave blood on day 0 , 3 , 7 ( and 14 ) , group II at weekly intervals . The aim was deposit of three blood units of 450 ml . A patient was deferred if hemoglobin concentration prior to donation fell below 11 g/dl , and in this case 100 mg Fe2+ three times daily was prescribed . Blood was stored with CPDA-1 anticoagulant . Surgery was performed between day 28 and 35. A perioperative hemoglobin concentration lower than 9 g/dl was considered a transfusion trigger . Results . Group I was made up of 21 patients ( 10 women , 11 men , aged 39 - 69 years ) who gave blood at short intervals , and group II of 19 patients ( 10 women , 9 men , aged 37 - 77 years ) who gave blood at weekly intervals . General data , calculated blood volume and erythrocyte mass prior to donation were comparable . Each patient donated three units . Four patients had to be deferred once , one in group I , three in group II . The hemoglobin concentration in group I decreased from 13.9 +/- 1.2 g/dl ( x +/- SD ) to 13.3 +/- 1.0 g/dl prior the operation , in group II from 13.5 +/- 1.3 g/dl to 12.5 +/- 1.1 g/dl . Preoperatively the hemoglobin concentrations differed significantly ( P 0.05 ) , as did calculated erythrocyte mass ( 1633 versus 1474 ml , P 0.05 ) . Reticulocytes increased from 46x103/µl ( median ) to a maximum of 94x103/µl on day 7 in group I , and from 44x103/µl to 108x103/µl in group II on day 14. Serum ferritin decreased from 122 µg/l ( median ) to 82 µg/l in group I , and from 140 µg/l to 77 µg/l in group II . These parameters did not differ statistically between the two groups . Intra- and postoperative blood loss amounted to 2175 ml ( median ) in group I versus 1430 ml in group II ( P 0.05 ) . The perioperative hemoglobin concentration was similar in the two groups . Homologous transfusion requirements were similar in the two groups ( 1 unit in group I , vs 3 units in one patient and 1 unit in two patients in group II ) . Conclusions . Short donation intervals resulted in a higher preoperative erythrocyte mass after similar preoperative deposit , and significantly higher blood loss was tolerated with similar homologous transfusion volume ." ], "offsets": [ [ 0, 2693 ] ] } ]

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[ { "id": "DerAnaesthesist.40430016.eng.abstr-passage-0", "type": "abstract", "text": [ "The rapid sequence induction of anaesthesia in patients with an increased risk of pulmonary aspiration is a quite involved procedure associated with many potential dangers . A new nasogastric balloon tube has been developed , which will prevent the reflux of gastric contents by blocking the cardia with a balloon . It was the aim of this initial study to assess the efficiency of the tube in animals , healthy volunteers and patients . Methods . With the approval of the Animal Ethics Committee , a total of 16 anaesthetised pigs were used for the animal experiments . Balloon occlusion of the cardia was performed in 10 pigs . Six further pigs with an unblocked cardia served as controls . Vomiting and regurgitation was provoked in each animal using six different manoeuvres while the gastro-oesophageal ( lower oesophageal ) sphincter and intragastric pressures were monitored and the lower oesophagus was continuously inspected using an endoscope . With local Ethics Committee approval and informed written consent , ( 1 ) repeated vomiting was provoked in 16 awake , healthy adult volunteers ( 10 females , 6 males , 29 +/- 4 years ) with a fluid-filled stomach in the presence and in the absence of balloon occlusion of the cardia , while intragastric pressure was monitored , and ( 2 ) 30 patients ( 21 - 89 years ) with an increased risk of pulmonary aspiration scheduled for abdominal or traumatologic surgery received conventional induction of anesthesia after blocking of the cardia with the balloon . Results . Pigs ( n=10) with a blocked cardia showed no gastrooesophageal reflux during a total of 60 manipulations to provoke vomiting and regurgitation , while 28 of the 36 provoking manipulations induced reflux in pigs ( n=6) with an unblocked cardia . Among the healthy volunteers with a blocked cardia ( n=16), reflux of gastric contents was not observed during repeated attempts to stimulate vomiting . After termination of the occlusion of the cardia , reflux was able to be induced by 14 of the 16 volunteers . In 30 patients with an increased risk of pulmonary aspiration the cardia was blocked and anaesthesia was induced using a mask and manual ventilation without encountering any problems . The average time from loss of consciousness to tracheal intubation was 164 +/- 8 s. Conclusions . It is concluded from the present results , with further clinical studies pending , that the gastric balloon probe permits low-risk conventional induction sequence of anaesthesia in patients with an increased risk for pulmonary aspiration and that the device may also be safely used during the extubation phase ." ], "offsets": [ [ 0, 2626 ] ] } ]

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[ { "id": "DerAnaesthesist.40430026.eng.abstr-passage-0", "type": "abstract", "text": [ "The duration of spinal anaesthesia in infants is short compared to adult patients . When tetracaine is used , the addition of epinephrine significantly prolongs the duration . For bupivacaine , however , the influence of epinephrine on the duration is not clear . We investigated the effects of epinephrine 1 : 200 000 added to bupivacaine 0.5% on duration and haemodynamics . Patients and Methods . Ten former pre-term infants with postnatal respiratory problems , scheduled for bilateral inguinal hernia repair , were enrolled in the study after informed parental consent had been obtained . The infants were fasted at least 4 h prior to surgery . If they did not receive i.v. infusions before surgery , a bolus of 10 ml/kg Ringer's acetate was injected after inserting the i.v. cannula , followed by a continuous infusion of 8 ml/kg 2/3 N NaCl with 5% dextrose . Spinal anaesthesia was performed in a sitting position with 0.6 ml bupivacaine 0.5% . Five patients received plain bupivacaine ( group I ) and five bupivacaine with epinephrine 1 : 200 000 ( group II ) . Heart rate registered by ECG and non-invasive blood pressure were recorded prior to positioning the baby for lumbar puncture and 2 , 5 , 10 , and 20 min after injection of bupivacaine . The duration of spinal anaesthesia was defined as the time from injection to the time when the first movements of the legs were observed after stimulation . For testing statistical differences the U test was used between the groups and the Wilcoxon and Wilcox test within the groups . Results ( expressed as median and range ) . Additional epinephrine significantly prolonged the duration of spinal anaesthesia ( group II : 95 min [ 60 - 120 ] vs group I : 50 min [ 37 - 85 ] ) . Haemodynamic parameters did not differ at any time between or within the groups . In group I , one infant had high spinal anaesthesia with impaired respiration but without cardiovascular effects ; after 10 min of assisted ventilation by mask , sufficient respiration as judged by pulse oximetry and clinical observation had returned . The duration of spinal anaesthesia in this child was 60 min . Conclusions . Epinephrine 1 : 200 000 significantly prolongs the duration of spinal anaesthesia in former preterm infants . Haemodynamic parameters in this age group remain unchanged during spinal anaesthesia and are not influenced by the addition of epinephrine ." ], "offsets": [ [ 0, 2397 ] ] } ]

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[ { "id": "DerAnaesthesist.40430036.eng.abstr-passage-0", "type": "abstract", "text": [ "In a controlled prospective randomized study , defibrillation by emergency medical technicians ( EMTs ) was compared with the current standard of care in Germany ( basic life support by EMTs and defibrillation by emergency physicians only ) in order to answer the following questions : 1. Does EMT defibrillation improve the survival rate and long-term prognosis of patients in ventricular fibrillation as compared to the current German standards in resuscitation ( basic life support by EMTs and defibrillation by emergency physicians ) ? 2. Are the prerequisites for the use of semiautomatic defibrillators fulfilled in the emergency medical systems ( EMS ) of the participating centers ? Methods . The study phase includes randomization of 121 adult patients with witnessed cardiac arrest and ventricular fibrillation ( VF ) as first ECG rhythm . Prior to the onset of the study , all EMTs of the participating EMS systems were retrained in basic life support ( BLS ) measures . In each center , randomly assessed EMT-Ds ( EMTs trained in Defibrillation ) were trained to use semiautomatic defibrillators . With the help of one-line tape recording , the time intervals during resuscitation and treatment steps were evaluated . Successfully resuscitated patients were followed up with the help of the Glascow Coma Scale and the Pittsburgh Cerebral and Overall Performance Categories . Results . From 1 February 1991 until 28 June 1992 , 159 patients with VF were randomized . In 121 cases , collapse was witnessed . 25% ( 14/57 ) of the patients receiving defibrillation by EMT-Ds ( study group=S) were discharged from the hospital alive . In the control group , 52 patients were defibrillated by emergency physicians , following BLS by EMTs [ control group 1=C1; discharged : 29% ( 15/52 ) ] . Fifty patients received BLS and advanced cardiac life support ( ACLS ) by the emergency physicians crews [ control group 2=C2; discharged 18% ( 9/50 ) ] . In the study group , the median time interval from collapse of the patient until initiation of BLS measures was 7.7 min , 7 min in C1 and 8 min in C2. ACLS measures were initiated significantly earlier ( P 0.05 ) in the control groups , as compared to the study group [ S : 13 min , C1: 11 min ; C2: 10.3 min ] . Sixty-seven percent ( 30/45 ) of the study patients and 46% ( 36/76 ) of the control patients were defibrillated within 12 min . Study patients were defibrillated earlier ( P 0.05 ) ( S : 9.9 min ; C1: 12.2 min ; C2: 12.75 min ) ; return of spontaneous circulation ( ROSC ) was achieved earlier ( P 0.05 ) in the study group [ S : 14 min ; C1: 19 min ; C2: 18.2 min ] and the number of patients in the study group requiring no epinephrine during resuscitation was higher ( P 0.01 ) than in the control groups [ S : 35.3% ( 12/34 ) ; C1: 10% ( 4/40 ) ; C2: 10.5% ( 4/38 ) ] . Furthermore , the total amount of epinephrine [ mean ( +/- standard error ) ] administered in the study group [ S : 2.35 ( +/- 0.49 ) mg ; C1: 6.71 ( +/- 0.98 ) mg ; C2: 7.71 ( +/- 1.31 ) mg ] was significantly lower ( P 0.05 ) . No significant differences in neurological long-term prognosis were found for the groups investigated . Conclusion . Neither the initial survival rate the number of patients discharged alive , nor the neurological long-term prognosis was significantly different for any of the groups investigated . Because of apparent differences in indirect prognostic parameters ( time interval until ROSC , number of patients requiring no epinephrine ) and because of the fact that the time interval to the first defibrillation was reduced by EMT defibrillation , EMT-Ds may perform defibrillation if : ( a ) they reach the patient before the emergency physician and ( b ) if they are trained intensively and supervised continuously . In order to increase the efficiency of defibrillation by EMT-Ds , far-reaching changes in our EMS are mandatory : ( a ) a reduction in the time interval from collapse until initiation of BCLS measures by intensifying layperson CPR training ;" ], "offsets": [ [ 0, 4033 ] ] } ]

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[ { "id": "DerAnaesthesist.40430073.eng.abstr-passage-0", "type": "abstract", "text": [ "At Leipzig University , preoperative pulmonary function testing has been performed for about 3 years in order to detect and classify patients at high pulmonary risk . During the postoperative period , the risk of developing pulmonary complications is particularly high due to factors influencing respiratory mechanics such as the supine position , pain , residual effects of narcotic drugs , etc. It has often been emphasised that an underlying ventilatory disturbance such as obstructive lung disease or smoking may enhance the postoperative pulmonary risk , although the extent of the influence of preoperative pulmonary diseases on the postoperative complication rate is still controversial . The prediction of postoperative lung function from preoperative spirometric values is complicated by factors such as patient cooperation , pulmonary complications secondary to aspiration , infection , peritonitis , etc. , and by differing and therefore non-comparable postoperative care . For this reason , the criteria for assessing pulmonary risk vary widely . Methods . We examined 339 patients ( mean age 59.3 years ) preoperatively by quiet and forced spirometry ; in most cases we also measured airway resistance and functional residual capacity . We estimated the postoperative lung function using the quadrant scheme of Miller and compared this risk class with our spirometric diagnosis and the postoperative clinical course . Results . According to our results , Miller's classification seems inadequately differentiated for patients with mild to moderate ventilatory disturbances . A relatively high percentage of these patients were considered to have normal postoperative lung function . Some patients with severely diminished pulmonary function were classified as having sufficient postoperative lung function . The number and severity of pulmonary complications also corresponded better with the spirometric diagnosis , which was made using all spirometric parameters and not only vital capacity ( VC ) and 1-s forced expiratory volume ( FEV1). We found that the percentage of primary respiratory complications increased with deterioration of the preoperative spirometric values . To provide a prognostic model combining both the advantages of using only a few parameters ( FEV1, VC ) and appropriate risk assessment , we propose a modification of the Miller scheme consisting of five risk classes . The analysis of the respiratory therapy regimen was unsatisfactory because of discrepancies between the predicted pulmonary risk , the use of respiratory therapy , and the occurrence of pulmonary complications . Conclusions . For minimising perioperative pulmonary complications , respiratory care ( prophylaxis and therapy ) adequate for the functional risk of the patient is necessary . We assume that intensive pre- and postoperative respiratory care and therapy in patients with underlying reductions in ventilatory function can help to avoid or reduce respiratory complications . The modification of Miller's scheme proposed after evaluating the postoperative course of our patients provides a differentiated prognostic model that allows the establishment of an appropriate and economical therapeutic regimen of perioperative pulmonary care ." ], "offsets": [ [ 0, 3257 ] ] } ]

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[ { "id": "DerAnaesthesist.40430082.eng.abstr-passage-0", "type": "abstract", "text": [ "An 81-year-old patient had prolonged competitive neuromuscular blockade with train-of-four ratios of 0.1 and 0.5 , respectively , after two successive anaesthesia procedures ( enflurane-N2O/O2; vecuronium-succinylcholine-sequence ) for transurethral prostate resection . Although antagonism with neostigmine was promptly successful after the first , 65-min period of anaesthesia ( 1.5 mg vecuronium for precurarization , 100 mg succinylcholine for intubation , 3 mg vecuronium ) , repetitive and chronologically staggered administration of neostigmine after the second , 30-min period of anaesthesia ( 1 mg vecuronium for precurarization , 100 mg succinylcholine for intubation ) had hardly any effect , so that the patient had to be ventilated mechanically for a total of 4.5 h . Laboratory analysis revealed homozygous , atypical , plasma cholinesterase ( 790 U/l ; dibucaine number 23 ; genotype E ! [ CDATA [ |lefbop|a ! [ CDATA [ |clobop||opnbop|1 ! [ CDATA [ |clobop|E ! [ CDATA [ |lefbop|a ! [ CDATA [ |clobop||opnbop|1 ! [ CDATA [ |clobop|). This retrospectively confirmed a succinylcholine-induced phase II block in both instances , as had already been suspected following the second anaesthetic procedure . The degree of block transformation , and thus the available time , are decisive in explaining the diverse effects of antagonism here . It must be assumed that a complete phase II block developed after the first succinylcholine exposure owing to the longer duration of anaesthesia ; the purely competitive component ( train-of-four ratio 0.1 ) was easily antagonized by neostigmine . At the time of the attempted antagonism after the second , shorter period of anaesthesia , however , block transformation was still incomplete ( train-of-four ratio 0.5 ) . The administration of neostigmine therefore rather intensified the depolarization segment of the mixed block , so that repeated attempts at antagonism then inhibited any further block transformation ." ], "offsets": [ [ 0, 1973 ] ] } ]

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[ { "id": "DerAnaesthesist.40430087.eng.abstr-passage-0", "type": "abstract", "text": [ "Postoperative intestinal atonia is a complication which is likely to occur in patients predisposed for constipation and in patients after intra-abdominal operations . The postoperative delay of bowel movement , however , is often also related to the type of anaesthesia being used . In order to evaluate the magnitude of an anaesthetic-induced postoperative delay of bowel movement , two types of intravenous-based anaesthesia using fentanyl/midazolam ( 1 mg/25 mg ; dosage 0.1 ml/kg/h ) , and ketamine/midazolam ( 250 mg/25 mg ; dosage 0.1 ml/kg/h ) respectively were compared with a volatile anaesthetic technique ( enflurane ; mean concentration 1.5 vol%). Methods . In three groups of patients ( each n=15) undergoing elective surgery of the lower extremities , induction of anaesthesia was accomplished with methohexital ( 1 - 1.5 mg ) followed by succinylcholine ( 1.5 mg/kg ) to facilitate intubation . For the maintenance of muscle relaxation vecuronium bromide was used . All patients were given droperidol to prevent postoperative emesis , and they were artifically ventilated with N2O/O2 ( 60 : 40 ) to normal end-expiratory CO2 concentrations . No anticholinergic agents were used at the end of operation since they are known to interfere with bowel motility . In order to determine gastro-intestinal motility , the H2 exhalation test was used . For this purpose 40 g lactulose in 100 ml of water was given to all patients via a gastral tube shortly before extubation . Lactulose is broken down by bacteria once it enters the colon , and H2 is released , taken up by the vascular system and exhaled . Postoperatively , patients were asked to exhale into a 20-ml syringe every 10 min . The content was analysed for hydrogen ( ppm ) , using an electrochemical sensor ( GMI exhaled hydrogen monitor ) . From the time of lactulose instillation to a threefold increase in endexpiratory hydrogen concentration ( compared to the preoperative value ) , gastro-coecal transit time was computed . Results . All three groups of patients were comparable in age , height and body weight . Also , the duration of operation was comparable in all three groups . Mean gastro-coecal transit time was 204 ( +/- 19.6 SD ) min following enflurane , 302 ( +/- 32.8 SD ) min following fentanyl/-midazolam and 210 ( +/- 28.8 SD ) min following ketamine/midazolam anaesthesia . The gastro-intestinal inhibition after the opioid-based anaesthetic technique was significantly prolonged ( p 0.001 , Kruskal-Wallis test ) . There was no significance between patients after ketamine-based anaesthesia and those who had the volatile anaesthetic . Discussion and conclusion . When using intravenous anaesthesia with an opioid , gastro-intestinal inhibition , especially in patients prone to have constipation , is likely to develop postoperatively . In classical neuroleptanaesthesia and in analgosedation in the ICU , the simultaneous use of the butyrophenone droperidol seems to counteract the inhibition of opioid-related gastrointestinal motility . In cases of opioid-related gastrointestinal atonia a gastrokinetic compound may be necessary to overcome this effect on intestinal motility ." ], "offsets": [ [ 0, 3174 ] ] } ]

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[ { "id": "DerAnaesthesist.40430092.eng.abstr-passage-0", "type": "abstract", "text": [ "Clinically-used ketamine is a racemic mixture of two isomers , S- ( + ) - and R- ( - ) -ketamine . Previous investigations showed the anaesthetic potency of S- ( + ) -ketamine to be three times higher than that of R- ( - ) -ketamine . It was the aim of this study to compare the effects of S- ( + ) -ketamine and racemic ketamine on endocrine and cardiovascular parameters , recovery , and side effects in geriatric patients during total intravenous anaesthesia ( TIVA ) for orthopaedic surgery . Methods . Forty patients over 60 years of age scheduled for elective hip or knee replacement were investigated in a double-blind , randomised design . For induction of TIVA , patients received 0.1 mg midazolam , 0.5 mg atropine , 1 mg/kg S ( + ) -ketamine or 2 mg/kg racemic ketamine , respectively , 2 mg vecuronium , and 1.5 mg/kg suxamethonium . After intubation and relaxation with a total dose of 0.1 mg/kg vecuronium , a continuous infusion of 2 mg/kg per hour S- ( + ) - or 4 mg/kg per hour racemic ketamine was administered throughout surgery . Blood samples were taken through a central venous catheter at seven time-points , before induction as well during and after surgery , until the 1st postoperative morning for analysis of adrenaline , noradrenaline ( by high-pressure liquid chromatography with electrochemical detection ) , anti-diuretic hormone ( ADH ) , adrenocorticotropic hormone ( ACTH ) , cortisol ( by radioimmunoassay ) , glucose , and lactate . In addition , systolic arterial pressure ( SAP ) , heart rate ( HR ) , and arterial oxygen saturation were measured , and the time intervals between the end of ketamine infusion and the return of consciousness and orientation were protocolled . The incidence and assessment of dreams and other side effects were reported by the patients . Results . Biometric data of the groups were comparable , the mean age of both groups being 68 years . Plasma adrenaline , noradrenaline , ADH , ACTH , cortisol , and glucose as well as SAP and HR increased significantly ( P 0.05 ) during the course of anaesthesia . The influence on lactate levels was not significant . There were no differences between S- ( + ) - and racemic ketamine with respect to these parameters . Three patients in the ketamine-racemate group showed severe arterial hypertension and were withdrawn from the study . Recovery clearly improved after administration of S- ( + ) -ketamine compared to the racemate . Simple orders were followed after 2.0 +/- 3.4 versus 4.9 +/- 6.8 min ( P=0.07), orientation with respect to person returned after 5.7 +/- 4.0 versus 14.6 +/- 10.0 min ( P 0.001 ) and spatial orientation after 8.2 +/- 5.4 versus 17.4 +/- 9.7 min ( P 0.001 ) . After racemic ketamine , 1 patient remembered a negative dream and 1 patient a positive dream . In the S- ( + ) -group , 1 positive dream was reported . No intraoperative awareness was reported , and all patients would accept the same anaesthesia again . Conclusions . Increases in cardiovascular parameters and insufficient reduction of the stress response with respect to ADH , ACTH , and cortisol seem to require a more potent hypnotic element during TIVA with ketamine . With regard to endocrine and cardiovascular parameters , the pharmacodynamic effects of racemic and S- ( + ) -ketamine were comparable . Because of the significant improvement in recovery and the reduced quantitative drug load , S- ( + ) -ketamine offers a clinical advantage compared with currently used racemic ketamine ." ], "offsets": [ [ 0, 3500 ] ] } ]

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"type": "umlsterm", "text": [ "times" ], "offsets": [ [ 188, 193 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040223" } ] }, { "id": "DerAnaesthesist.40430092.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "-ketamine" ], "offsets": [ [ 223, 232 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0022614" } ] }, { "id": "DerAnaesthesist.40430092.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "aim" ], "offsets": [ [ 246, 249 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0108800" } ] }, { "id": "DerAnaesthesist.40430092.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "-ketamine" ], "offsets": [ [ 299, 308 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0022614" } ] }, { "id": "DerAnaesthesist.40430092.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "ketamine" ], "offsets": [ [ 321, 329 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0022614" } ] }, { "id": "DerAnaesthesist.40430092.eng.abstr-s3-t4", "type": "umlsterm", "text": [ "geriatric" ], "offsets": [ [ 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[ { "id": "DerAnaesthesist.40430101.eng.abstr-passage-0", "type": "abstract", "text": [ "Mucociliary clearance represents an important protective mechanism of the upper and lower respiratory tracts whereby inhaled particles and micro-organisms are removed from the tracheobronchial system . In intubated intensive care unit ( ICU ) patients , impaired ciliary function and mucus transport are associated with pulmonary complications [ 9 ] . Some authors have shown that theophylline increases mucus transport in healthy subjects and patients with chronic bronchitis [ 8 , 16 , 31 , 36 ] . However , other investigators have found unconvincing or conflicting results [ 4 , 20 , 25 ] . Therefore , we studied the influence of theophylline on bronchial mucus transport velocity ( BTV ) in ventilated ICU patients . Methods . The study was approved by the ethics committee of our hospital . In a placebo-controlled double-blind study , the effect of therapeutic serum concentrations ( 10 - 20 µg/ml) of theophylline on BTV in ventilated patients in a surgical ICU was investigated . Group 1 ( n=10) served as controls and received placebo . The patients of group 2 ( n=10) were given intravenous infusions of 5 mg/kg body weight theophylline over 20 min , followed by 1 mg/kg per hour . Before administration of theophylline and 1 h after starting the infusion BTV , serum theophylline concentrations , and arterial blood gases were measured . Heart rate and blood pressure were registered every 5 min . In an additional study , the effect of theophylline on BTV at subtherapeutic serum concentrations ( 5 µg/ml) was investigated . BTV was measured with a small volume ( 0.05 - 0.08 ml ) of albumin microspheres labeled with technetium-99m, which was deposited on the dorsal surface at the lower ends of the right and left main bronchi via a catheter placed in the inner channel of a fibre-optic bronchoscope . The movement of the microspheres towards the trachea was visualised and recorded using a scintillation camera [ 10 ] . Results . The theophylline treatment induced a significant improvement in BTV from 3.8 to 7.6 mm/min in the left main bronchus and from 0.5 to 5.4 mm/min in the right , while placebo was inactive . The increase in BTV , however , was associated with an increase in heart rate ; in 3 patients the theophylline infusion had to be stopped because of severe tachycardia . Blood gases and blood pressures did not change . Theophylline at subtherapeutic concentrations had no effect on either BTV or heart rate . Conclusions . Theophylline at therapeutic concentrations improves bronchial mucus transport in intubated ICU patients . The increase in BTV may be associated with severe tachycardia , and therefore routine application cannot be recommended ." ], "offsets": [ [ 0, 2685 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.40430107.eng.abstr-passage-0", "type": "abstract", "text": [ "The hospital nursing staff represents a distinct group of cardiopulmonary resuscitation ( CPR ) providers . Differences in the success rates of resuscitation attempts inside or outside the hospital seem to be attributable to the skill of the various rescuers . Whereas the definite success rate for prehospital resuscitation is 7% , the corresponding rate for in-hospital settings is 15% . Methods . During 53 CPR refresher courses offered to nursing staff members , their individual skills and competence in CPR procedures were examined according to the standards and guidelines of the German Medical Association ( Bundesaerztekammer ) . The efficacy of cardiac massage and artificial ventilation performed by each nurse was recorded . Quality criteria were defined , grouped and analysed statistically by the Chi-square test . Results . Only 6.6% of the nursing staff were found to have good skills in artificial ventilation . The main faults observed were insufficient tilting of the head ( 24% ) and failure to prevent leakage from the insufflation airway ( 35% ) . For 42.8% it proved impossible to insufflate a minimum ventilatory tidal volume of 400 ml . The attempts at resuscitation made by 58.6% were completely inadequate . Although 14.1% of the nurses carried out effective cardiac massage , the majority of the test group ( 44.7% ) failed to do so . For 29.4% the appropriate position of their own upper body to allow adequate chest compression remained elusive . In 41.4% of the compression cycles , the rescuer's hands lost contact with the sternum . The compression period proved too long in relation to the decompression period in 21.4% . Only 4 individuals ( 0.9% ) were able to perform all standard CPR procedures as recommended by the guidelines and 71.8% failed to perform effective CPR manoeuvers . The test results did not differ with respect to the nurses ' educational or professional status , clinical CPR experience or work area within the hospital . Conclusion . Cardiopulmonary resuscitation skills of hospital nurses are inadequate , mainly because of lack of manual dexterity . Obviously the special skills learned in CPR courses are lost after a relatively short time . These results , however , do not suggest completely inadequate handling of CPR procedures in the hospital setting . Indeed an increasing rate of successful resuscitations inside the hospital ( up to 27% ) has been reported in the literature . In consequence of our findings , refresher courses in specific CPR techniques must be demanded , which should be made obligatory for nursing staff every 2 years . Qualified nursing personnel routinely trained in CPR and supported by effective hospital logistics is essential if the life-saving benefits of modern CPR are to be provided to our patients ." ], "offsets": [ [ 0, 2798 ] ] } ]

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[ { "id": "DerAnaesthesist.40430115.eng.abstr-passage-0", "type": "abstract", "text": [ "Intrinsic positive end-expiratory pressure ( PEEPi ) occurring during mechanical ventilation depends on expiratory time constants , expiratory volume and expiration time as well as on external flow resistance ( tubes , valves , etc. ) . It is not routinely determined in mechanically ventilated patients , but it is necessary to optimize respirator settings . The aim of the present study was the validation of an automated PEEPi determination method implemented in the respirator EVITA ( Draegerwerke , Luebeck ) in mechanically ventilated patients with acute lung failure . Patients . The method was validated in ten sedated , myorelaxed patients with respiratory insufficiency of different etiologies ( five with restrictive , and five with obstructive pulmonary disease ) . PEEPi was determined using the volume constant ventilatory mode at ZEEP or at an external PEEP of 5 as well as 10 cm H2O. Method . PEEPi was first determined with the automated method implemented in the EVITA ( five measurements at each end-expiratory pressure level ; PEEPEvita ) . Steady-state was attained between each measurement . These values were compared to the results obtained with end-expiratory occlusion ( external , computer-controlled valve in the inspiratory limb of the circuit ) at the respective pressure levels ( PEEPEEO ) . The average of five measurements at each PEEP level with each method was defined as PEEPi for the particular ventilatory situation . Gas flow was measured at the proximal end of the endotracheal tube with a heated pneumotachometer ( Fleisch no . 2 , Fleisch , Lausanne , Switzerland ) and a differential pressure transducer . Tracheal pressure was determined in the same position with a further differential pressure transducer ( Dr. Fenyves & Gut , Basel , Switzerland ) . After A/D conversion , data were sampled with a frequency of 20 Hz and processed on an IBM compatible PC . Software for data collection and processing as well as for control of the occlusion valve was self-programmed . For the statistical analysis we used the Mann-Whitney U-test or Wilcoxon signed-ranks test ; a P value less than 0.05 was considered significant . Results . At the given respiratory setting and without PEEP patients with obstructive lung disease had a higher PEEPi ( median : 6.4 cm H2O; range : 5.0 - 9.6 cm H2O) than those with restrictive pulmonary disease ( median : 2.3 cm H2O; range : 0.8 - 3.0 cm H2O) ( P 0.05 ) . Increasing external PEEP to 5 or 10 cm H2O significantly decreased the pressure difference between PEEPi and external PEEP ( P 0.05 ) , but was unable to eliminate it completely . There was no statistically significant difference between PEEPEEO and PEEPEvita ( P=0.43; Wilcoxon signed-ranks tests ) . Regression analysis showed a highly significant correlation between PEEPEEO and PEEPEvita values ( r=0.985, P 0.001 ; y=1.03x-0.18). Discussion . PEEPi occurs during ventilation in patients with obstructive and restrictive lung disease . The difference between external end-expiratory pressure and PEEPi decreases with increasing external PEEP . However , PEEPi may increase with increasing external PEEP in some instances . The reason for this may be that the PEEPi determined at the proximal end of the endotracheal tube represents only a mean value of different PEEPi values of various lung regions . Increasing external PEEP only partially alters this mean value due to an effect on PEEPi values lower than external PEEP . The PEEPi values measured by the EVITA respirator compared with classical end-expiratory occlusion with an external valve were nearly identical . Unfortunately , PEEPi measurement of the EVITA can only" ], "offsets": [ [ 0, 3668 ] ] } ]

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[ { "id": "DerAnaesthesist.40430121.eng.abstr-passage-0", "type": "abstract", "text": [ "Fournier's gangrene is a necrotising soft-tissue infection of the scrotum and perineal region caused by gram-negative and gram-positive Enterobacteriaceae . The disease is characterised by its unique appearance , its speed of onset , and its high mortality . Case report . A 26-year-old male presented to the emergency room complaining of a painful , tremendously swollen scrotum and penis ( Fig . 1 ) that had developed within the past 24 h . Later , slurred speech , pallor , and hypotension were recognised , leading to the patient's admission to the intensive care unit . Suspecting a severe internal haemorrhage , vigorous volume therapy was started using crystalloids and colloids until blood and fresh frozen plasma were available . One hour later , septic shock was presumed and therapy augmented by IV antibiotics , tracheal intubation , and mechanical ventilation . Despite all efforts , the patients condition deteriorated rapidly and he died a few hours later due to multiple organ failure in septic shock . Postmortem , a perforated external hemorrhoidal node was found to be the primary focus of sepsis . Microbiologic cultures revealed Escherichia coli in blood and tissue samples . Discussion . Fournier's gangrene is a rare disease ; nevertheless , its clinical picture has to be recognised immediately in order to provide appropriate treatment in time . It occurs predominantly in males after minor trauma , colorectal or urological disease , and perineal or abdominal surgery . Fournier's gangrene usually begins with itching and pain in the scrotal region followed by swelling and dark-blueish discolouration of the scrotum and penis , occasionally including the lower abdominal wall . Fever and chills are usually present . The illness progresses to severe prostration and septic shock with a mortality of 20% - 50% . Tissue cultures mostly reveal E. coli , gram-positive enterococci , Pseudomonas , Proteus , and various anaerobes . The treatment should include immediate radical surgical debridement , IV administration of broad-spectrum antibiotics , and cardiopulmonary support . Conclusion . The dramatic course of Fournier's gangrene requires early recognition , extensive surgical debridement , as well as intensive care treatment in order to prevent irreversible septic shock ." ], "offsets": [ [ 0, 2306 ] ] } ]

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] } ]

[]

[]

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[ { "id": "DerAnaesthesist.40430159.eng.abstr-passage-0", "type": "abstract", "text": [ "Early mental and psychomotor recovery was studied in 67 patients undergoing colorectal surgery under continuous epidural anaesthesia and light general anaesthesia using propofol , halothane , and midazolam/fentanyl . The study was approved by the local ethics commitee . All patients received epidural anaesthesia with 0.25% bupivacaine and were then randomly allocated to one of three groups . In group I ( halothane ) , light general anaesthesia was induced with thiopental 3 - 5 mg/kg and maintained with halothane . The propofol group ( II ) received 2 mg/kg for induction and a mean continuous infusion of 1.7 mg/kg - h . In group III ( Mi/Fe ) , midazolam and fentanyl were used for induction and maintenance . All patients were intubated , received non-depolarising muscle relaxants , and were manually ventilated with nitrous oxide-oxygen ( 2 : 1.2 ) . For postoperative analgesia , 0.05 mg/kg morphine was administrated epidurally 30 min before the end of the operation ; 30 , 60 , 90 , and 120 min after arriving in the recovery room , vigilance was assessed using a modified Steward score , the Trieger test , the ability to recall a column of numbers ( KAI test ) , and symbol counting ( CI test ) . Heart rate , blood pressure , arterial oxygen saturation , and blood gases were recorded . Results . The three groups were comparable with regard to age , sex , ASA classification , and duration of anaesthesia and operation ( Table 3 ) . There was no difference between the groups in performance of the recovery tests ( Figs . 2 - 5 ) , blood pressure , heart rate , arterial blood gas analysis ( Fig . 6 ) , or oxygen saturation . Comparing pre- and postoperative values , we found severe psychomotor and mental impairment in all groups . pCO2 was slightly elevated in all groups , but only 3 patients in the propofol group and 6 in the midazolam/fentanyl group developed hypercapnia above 50 mm Hg. Patients receiving propofol or midazolam/fentanyl had significantly less postoperative nausea and vomiting than those receiving halothane ( Table 5 ) . Conclusion . It is concluded that propofol offers no advantage over halothane or midazolam/fentanyl where early postoperative recovery is concerned . Intraoperatively , all three techniques provided good anaesthesia . Propofol and midazolam/fentanyl caused less postoperative nausea and vomiting than halothane anaesthesia ." ], "offsets": [ [ 0, 2389 ] ] } ]

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[ { "id": "DerAnaesthesist.40430168.eng.abstr-passage-0", "type": "abstract", "text": [ "In the present study , a retrospective statistical analysis of laboratory data , clinical data , and perioperative blood requirements from 300 primary orthotopic liver transplantations ( OLT ) is described . Methods . OLT was performed using established surgical techniques and total IV anaesthesia . Volume was substituted with red blood cells ( RBC ) and fresh frozen plasma ( FFP ) according to haemodynamic data , haemoglobin , and diuresis . Platelet counts , prothrombin time , activated partial thromboplastin time ( aPTT ) , thrombin time , fibrinogen , and antithrombin III were registered but not used as indications for transfusions . Statistics were performed using regression analysis and analysis of variance . Results . The mean intraoperative fluid requirement was 793 ml balanced salt solution , 7.1 units RBC , and 8.4 units FFP ; pooled random donor platelets were given only once . During 24 h postoperatively , an average of 1.8 units RBC and 4.6 units FFP had to be transfused . Currently , 278 of the 300 patients ( 92.7% ) are alive . There was no significant correlation between clotting data and intraoperative blood use ; for postoperative transfusion rates , the preoperative aPTT and postoperative platelet counts had a significant correlation . Reviewing the basic diseases of the patients , there were significant differences in coagulation status , but no differences in transfusion rates . Conclusion . According to the data presented , indications for transfusions in OLT according to clotting data are not valid , since these data do not correlate with the blood requirement . In addition , strategies for pretreatment of patients such as preoperative plasmapheresis are no longer justified with respect to possible side effects ." ], "offsets": [ [ 0, 1765 ] ] } ]

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[ { "id": "DerAnaesthesist.40430178.eng.abstr-passage-0", "type": "abstract", "text": [ "Patients with end-stage liver disease frequently develop combined coagulopathies due to increased procoagulant and fibrinolytic turnover as well as thrombocytopenia . The onset of clinical symptoms of a haemorrhagic diathesis requires balanced substitution of coagulation factors , since fresh frozen plasma alone does not always maintain a sufficient haemostatic potential in these patients . This substitution commonly follows standard rules based on the assumption that 0.5 - 1 IU of a coagulation factor or inhibitor concentrate given per kg body weight will increase its endogenous activity by 1% . We set out to investigate the validity of this standard regime in patients with end-stage liver disease scheduled for orthotopic liver transplantation . Patients and methods . Fifty-one adult patients were prospectively studied . In 37 patients with antithrombin III ( AT III ) activity 70% , an AT III preparation ( Kybernin , Behring , Marburg , Germany ) was given preoperatively ( mean dose 2616 +/- 207 IU ) following standard calculations in order to increase endogenous activity to 80% . Twenty-seven of the patients had chronic hepatic failure ( CHF group ) with histologically proven cirrhosis and 10 had acute hepatic failure ( AHF group ) . Blood samples were drawn prior to a 15-min infusion of AT III concentrate and 30 min thereafter . In 14 patients with prothrombin time ( PT ) 40% , AT III levels had been corrected earlier during the clinical course to achieve activities > 70% . Prothrombin complex ( PPSB , Beriplex , Behring , Marburg , Germany ) was substituted ( mean dose 2304 +/- 289 IU ) to increase procoagulant activity to PT > 60% . Blood samples were drawn in the same fashion as in the AT III group . The amounts of AT III and PPSB concentrates ( AT III , [ IU/kg ] ; PPSB [ IU/kg ] ) required to increase AT III activity and PT , respectively , by 1% were calculated . Results . Standard calculations for AT III substitution indicated AT III recovery in all 37 patients who received AT III concentrate . However , there was a statistically significant difference between patients with CLF and ALF . In patients with CLF , AT III was found to be 0.8 IU/kg ( +/- 0.1 SEM ) and in those with ALF it was 1.5 IU/kg ( +/- 0.1 SEM ) ( P 0.05 , t-test ) . In patients treated with PPSB concentrate , PPSB was 1.6 U/kg ( +/- 0.2 SEM ) for both CLF and ALF groups . Conclusions . In patients with end stage liver disease standard rules for substitution with AT III-concentrate are adequate only for patients with CLF . In patients with ALF higher AT III doses are required to achieve the expected effect on endogenous AT III activity . Procoagulant activity , as reflected by PT , can be increased by 1% when 1.6 IU/kg PPSB concentrate is given . However , this study shows the effects of coagulation concentrates only 30 min after administration . An increased volume of distribution and increased turnover may explain the poor recovery of AT III activity in the ALF group , indicating that the dose of coagulation concentrate should be estimated against the background of the patient's clinical symptoms and diagnosis ." ], "offsets": [ [ 0, 3147 ] ] } ]

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[ { "id": "DerAnaesthesist.40430183.eng.abstr-passage-0", "type": "abstract", "text": [ "A 45-year-old, healthy , well-trained man climbed within 12 hours from 300 m above sea level to a shelter at 2500 m in the Tyrolean Alps . During the following 3 days he undertook ski tours to the surrounding mountains up to 3356 m . On the 4th day he suddenly suffered from headache , coughing and very severe dyspnoea even at rest , accompanied by loss of appetite and the feeling of suffocation . The following day he was rescued by a helicopter and taken to hospital . At the time of admission the patient was severely hypoxaemic ( capillary PO2=25.7 mm Hg ) , and the chest X-ray revealed signs of bilateral alveolar pulmonary edema localised predominantly in the right lung . High-altitude pulmonary edema ( HAPE ) was diagnosed because of the typical clinical course . Pulmonary gas exchange normalised within hours , and complete restitution was achieved within 2 days . The chest X-ray was normal on the 4th day after admission . HAPE is a non-cardiogenic pulmonary edema which develops in healthy individuals usually above 3000 m . Among the predisposing factors are rapid ascent , severe physical effort , diminished hypoxic ventilatory response and abnormal fluid balance . The treatment of choice is descent to a lower altitude , administration of oxygen and of nifedipine and expiratory positive airway pressure ." ], "offsets": [ [ 0, 1327 ] ] } ]

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[ { "id": "DerAnaesthesist.40430187.eng.abstr-passage-0", "type": "abstract", "text": [ "There is no doubt that a single emergency phone number is desirable , but in contrast to other countries , in Germany different emergency phone numbers and dispatching centers exist for the fire brigade ( FB ) , the emergency medical service system ( EMS ) , and the general practitioners ' emergency service ( GPS ) . Due to this fact , valuable time is often wasted by connecting or transferring emergency calls from one dispatching center to another . The purpose of this study was to analyse all calls received by the different dispatching centers in the city and county area of Mainz with respect to total number , fraction of emergency calls , and specificity . Further , the total number of calls potentially referring to a hypothetic single dispatching center with a general emergency phone number ( 112 ) was calculated . During a 4-month period , all telephone calls were registered and related to day , time , and origin of the call ( city or county ) and classified as non-urgent or emergency calls , calls appropriate to the dispatching center dialed , emergency calls to be transferred , or unspecific calls . A total of 80 987 calls were received ( city area 84.3% , county area 15.7% ) , most of them directed to the FB of Mainz ( 33 086 ) . The EMS dispatching center received 31 286 calls , the five GPS-centers 15 256 calls ; 1359 emergency calls that were directed to the police or FB needed transfer to the EMS . During weekdays the EMS and FB received the most calls , with a reduced frequency on Saturdays and Sundays ( Table 2 ) . Nevertheless , the highest total numbers of calls were received on Saturdays due to multiple calls directed to the GPS . The FB had the highest specificity of calls ; more than 50% of the calls to the GPS were unspecific ( Fig . 1 ) . Of all calls , 4.37% were classified as emergency calls ; two-thirds of these came from the area of Mainz during the daytime . During off-duty hours of the GPS in the city , 51% of the emergency calls reached the EMS directly ; 49% had to be connected by the police or FB . During duty hours of the GPS , the fraction of calls directed to the EMS decreased significantly to 35% . During duty hours of the GPS centers in the county area , only 14% of the urgent emergency calls reached the EMS dispatcher directly ( Fig . 2 ) . Compared to the multiple-center mode , a hypothetic single dispatching center for all systems would probably be followed by a slight increase in total number of calls due to the fact that the GPS numbers would be answered 24 h a day , but there would be only minimal differences in the total number received on most days ; only on Sundays would a decrease be expected . The EMS area of Mainz , with a total of 13 different telephone numbers for 7 dispatching centers , can be regarded as typical of the German situation . The high number of emergency calls to be transferred ( up to 86% under special circumstances ) demonstrated that this weak point in the German EMS system must be eliminated by introducing a single emergency number . This should occur when a Europe-wide three-digit number \" 112 \" will be instituted , probably in 1995. Additionally , the continued existence of 5- or 10-digit telephone numbers for non-urgent calls may be useful for allowing non-verbal differentiation of calls . In any case , all telephone numbers , including the latter calls , have to enter one dispatching center . The main advantage of a single dispatching center would be avoidance of the time-consuming transfer of emergency calls from one dispatching center to the other ." ], "offsets": [ [ 0, 3586 ] ] } ]

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[ { "id": "DerAnaesthesist.40430194.eng.abstr-passage-0", "type": "abstract", "text": [ "It is a strange contradiction that increasingly sophisticated anaesthesia machines are developed meeting all requirements for rebreathing techniques and the highest safety standards , but the usual anaesthetic management is still based on the use of fresh gas flows that preclude substantial rebreathing . The advantages of rebreathing can only be realised if low-flow anaesthesia techniques are adopted . Increasing acceptance of these methods is due to the availability of comprehensive anaesthetic gas monitoring . Different techniques of low-flow anaesthesia , the characteristic features , technical requirements , and considerations concerning their performance and contraindications are discussed . This paper presents a topic that is left unmentioned by most anaesthesia textbooks . The use of new inhalational anaesthetics such as desflurane that require comparatively high concentrations , or even xenon , will motivate to sparing use . Increasingly stringent health and safety regulations as well as sharpened ecological awareness will prompt anaesthetists to minimise all anaesthetic gas emission according to the possibilities of available equipment . Last but not least , the demand for economical working methods will be an argument for applying low-flow anaesthesia techniques ." ], "offsets": [ [ 0, 1294 ] ] } ]

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[ { "id": "DerAnaesthesist.40430223.eng.abstr-passage-0", "type": "abstract", "text": [ "In 1977 a new anaesthesiology preoperative evaluation clinic was started for evaluation of all elective surgical patients for their fitness to undergo anaesthesia . Physical examination , medical history and anaesthetic risk assessment are assessed in a standardized manner with the aid of computer menus . Comprehensive laboratory tests included electrocardiography , lung function assessment ( vital capacity and forced exspiratory volume with 1 s ) , chest X-ray , and arterial blood gas analysis and blood chemistry analysis with an SMA-22 ( System Multi Analyzer ) . At the conclusion of the preoperative evaluation , patients are classified according to ASA physical status , Goldman Cardiac Risk Index and an exercise classification such as NYHA . Only elective surgical patients are evaluated in this clinic . Within the last 15 years more than 75 000 patients have been seen in our preoperative clinic , 91.8% of whom were cleared for surgery and anaesthesia after the initial evaluation . There were 1132 patients who needed preoperative treatment first . Only 4.4% were discharged without operation because too many risk factors for perioperative complications were present . We found that comprehensive preoperative evaluation in this clinic was more efficient than bedside evaluation and reduced examination time for the patient . In 1983 and 1985 we published two prospective/retrospective studies on the improvement of perioperative morbidity and mortality of selected patients undergoing non-cardiac surgery . We found that perioperative complications and adverse outcome correlated with preoperative data and physical examination . The main source of perioperative morbidity and mortality was the cardiovascular system , followed by nephrologic diseases , correlating exactly with preoperative BUN and plasma creatinine . These studies also underlined the value of the ASA physical status to predict perioperative outcome . Since 1988 all patients ' data have been processed automatically by a computer system designed by clinic staff . Precise data evaluation , statistical analyses and selective studies of over 24 000 patients can be performed easily . The cost of one examination in the anaesthesia clinic is OeS 140 ( DM 17 ) . The price of the reagents for blood chemistry , blood gas analysis and the chest X-ray is OeS 95 ( DM 12 ) . If preoperative tests were discontinued the laboratory staff could not be much reduced , because preoperative tests do not account for more than 10% of the workload and the system must work over 24 h . In total , therefore , examination of one patient costs OeS 235 ( DM 30 ) . Compared with the total costs of the surgical procedure , this part is one of the smallest items . Even the anaesthetic management starting from intravenous induction with propofol or ketamine , followed by orotracheal intubation and inhalation anaesthesia with isoflurane or sevoflurane , costs more than this preoperative evaluation . This preanaesthetic examination procedure is easy to learn . Surgical specialties now routinely schedule patients for preoperative evaluation at the clinic . We feel that performing this comprehensive physical assessment reinforces basic concepts in anaesthesiology for the house doctors . All medical departments create specialists in each part of their sector . We think that anaesthetists should also optimize preoperative evaluation by concentrated well-organized practices ." ], "offsets": [ [ 0, 3453 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.40430229.eng.abstr-passage-0", "type": "abstract", "text": [ "Despite a widespread approach to explain the molecular mechanisms of anaesthetic agents , the complex state of \" general anaesthesia \" is still not completely understood . Voltage-activated sodium channels from human brain cortex served as a model membrane protein to investigate anaesthetic drug-protein interactions using a novel electrophysiological voltage-clamp technique . Sodium channels are already well-characterized important integral membrane proteins responsible for the generation of the fast-propagated action potential and thus are vital components for neuronal signal integration and cell communication . In order to elucidate the molecular interactions of intravenous anaesthetics with single human brain sodium channels , representative compounds of four different clinical intravenous anaesthetic groups were used to correlate different types of clinical anaesthesia with differential anaesthetic effects on the molecular level . Methods . Single sodium channels from human brain cortex were incorporated into artificial phospholipid bilayers and studied under our standard experimental conditions ( Electrolyte solution : 500 mM NaCl , 100 mM HEPES , pH 7.4 , Temp . 22 - 25 °C) with an electrophysiological voltage-clamp technique . In the presence of a channel activator ( 1 µM batrachotoxin ) single-channel characteristics ( fractional open time , single-channel conductance and amplitude , steady-state activation behaviour ) were characterized for control conditions and in the presence of various doses of four different anaesthetic agents ( pentobarbital , propofal , ketamine , midazolam ) . Results . During control measurements the investigated human brain sodium channels showed stable and reproducible characteristics on the range expected for batrachotoxin-modified sodium channels in bilayers . After completion of the control measurement the effects of the four different general anaesthetics pentobarbital , propofol , ketamine and midazolam were investigated on the same control sodium channels . All four substances demonstrated a blocking effect of sodium channel conductance ( pentobarbital : K50: concentration for 50% block of the maximal conductance block : 0.60 mM ; blockmax : maximal conductance block ( % ) : 100% ; propofol : K50: 0.02 mM , blockmax : 28% ; ketamine : K50: 1.1 mM , blockmax : 71% ; midazolam : K50: 0.52 mM , blockmax : 100% ) . Furthermore , a destabilization of the steady-state activation process could be demonstrated . These effects were dose dependent , but only pentobarbital and propofol demonstrated these effects at or near clinically relevant serum concentrations . Discussion . At the clinical level , \" general anaesthesia \" is a highly complex phenomenon . Similarly , anaesthetics may demonstrate a multimechanistic mode of action also at the molecular level . In this study all four investigated anaesthetic compounds interacted with at least two primary sodium channel functions , leading to a voltage-independent reduction of the fractional channel open time and an interaction with the steady-state activation behaviour , respectively . The effects of pentobarbital and propofol were detectable at concentrations within the range of serum concentrations achieved during clinical anaesthesia , whereas ketamine and midazolam demonstrated qualitatively similar effects exceeding this range 10- to 50-fold . Thus , the human brain sodium channel might serve as a molecular target only for pentobarbital and propofol . This suggests that different types of clinical anaesthesia may correlate with differential actions of anaesthetics on the molecular level ." ], "offsets": [ [ 0, 3640 ] ] } ]

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"db_name": "UMLS", "db_id": "C0496899" } ] }, { "id": "DerAnaesthesist.40430229.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "cortex" ], "offsets": [ [ 223, 229 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001613" } ] }, { "id": "DerAnaesthesist.40430229.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "membrane" ], "offsets": [ [ 248, 256 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0025255" } ] }, { "id": "DerAnaesthesist.40430229.eng.abstr-s2-t6", "type": "umlsterm", "text": [ "protein" ], "offsets": [ [ 257, 264 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033684" } ] }, { "id": "DerAnaesthesist.40430229.eng.abstr-s2-t7", "type": "umlsterm", "text": [ "anaesthetic" ], "offsets": [ [ 280, 291 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002932" } ] }, { "id": "DerAnaesthesist.40430229.eng.abstr-s2-t8", "type": "umlsterm", "text": [ "interactions" ], "offsets": [ [ 305, 317 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0037420" } ] }, { 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[]

[]

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[ { "id": "DerAnaesthesist.40430235.eng.abstr-passage-0", "type": "abstract", "text": [ "Abdominal mesenteric traction ( MT ) results in decreased mean arterial pressure ( MAP ) , systemic vascular resistance ( SVR ) and increased cardiac output ( CO ) [ 24 , 25 , 28 ] . This response is induced by a considerable release of prostacyclin ( PGI2) [ 12 , 26 , 27 ] . Precipitous falls in systemic arterial pressure related to central and/or autonomic nervous reflex arcs also have been described during operations on the upper abdominal viscera [ 14 , 22 , 29 , 30 ] . Those hypotensive responses to visceral traction appear to be transmitted along afferent fibres contained within the splanchnic nerves [ 17 ] . We investigated the influence of supplementary thoracic epidural anaesthesia on mesenteric traction response during major abdominal surgery . Methods . With the approval of the Human Investigation Review Board we studied 40 patients scheduled for major abdominal surgery ( infrarenal aortic , gastrointestinal and pancreatic surgery ) according to a prospective , randomized double-blinded protocol . Patients were randomized to two different anaesthetic regimens . Patients in group 1 received general anaesthesia ( GA n=20) with 0.1 - 0.15 mg/kg midazolam and 10 µg/kg fentanyl prior to skin incision . Maintenance included 65% nitric oxide in oxygen and 0.1 mg increments of fentanyl as required . Group 2 patients ( EA n=20) underwent a combined technique of dose-reduced general anaesthesia and supplementary continuous , thoracic epidural anaesthesia ( bupivacaine 0.25% , sensory blockade T4 to L1-3). In both anaesthesia groups ibuprofen ( 400 mg i.v. ) or a placebo equivalent was administered 15 min before the induction of anaesthesia . MT was applied in a uniform fashion . Baseline values preceded the incision of the peritoneum . Further assessments followed 5 , 15 and 30 min after MT . The plasma concentrations of 6-keto-PGF1 ( stable metabolite of PGI2), TXB2 ( stable metabolite of thromboxan ) , PGF2, KH2-PGF2 ( stable metabolite of PGF2) were determined by radioimmunoassay . At all assessments we recorded systolic and diastolic blood pressure , heart rate and measured arterial blood gases . Statistical analyses were performed using three-factor ANOVA for repeated measurements after log ( x ) transformation . A P-value of less than 0.05 was considered significant when the Bonferroni-Holm adjustment was applied . Results . Patients with supplementary epidural anaesthesia demonstrated lower systolic ( P=0.0001) and diastolic ( P=0.006) blood pressure than those in the GA group . Nevertheless , in untreated patients in the EA and GA group there was a significant decrease of about 20 - 30% in systolic and diastolic blood pressure ( P=0.0001) after mesenteric traction . Irrespective of the anaesthetic procedure , paO2 ( P=0.0001) decreased after mesenteric traction in the placebo group . The control patients in the GA group exhibited a more pronounced increase in heart rate after MT . After traction on the mesentery a significant 20- to 30-fold increase in 6-keto-PGF1 plasma concentrations occurred in the placebo group : GA group 1950/58 ( 5 min ) , 1574/59 ( 15 min ) 858/66 ( 30 min ) ng/l , P 0.0001 ; EA group : 2002/106 ( 5 min ) , 2955/107 ( 15 min ) 1807/70 ( 30 min ) ng/l , P 0.0001 , for placebo vs ibuprofen . There was no statistically significant difference between the two anaesthetic procedures used . In ibuprofen-pretreated patients haemodynamics and paO2 values were stable , while 6-keto-PGF1 plasma concentrations remained within the normal range . Conclusion . Our data clearly indicate that the mesenteric traction response consists in relevant haemodynamic alterations and a significant decrease of paO2. Stable haemodynamics and paO2 following cyclooxygenase inhibition" ], "offsets": [ [ 0, 3754 ] ] } ]

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[ { "id": "DerAnaesthesist.40430257.eng.abstr-passage-0", "type": "abstract", "text": [ "Documentation of physician-staffed ambulance runs traditionally focuses on information transfer between the prehospital care provider and the receiving hospital . To use this information as a tool for research and quality assurance programs , the German Interdisciplinary Association of Critical Care Medicine developed in a consensus process a protocol for nationwide use . Protocol development was based on the question of what information can be obtained reliably in the emergency medical service ( EMS ) environment and what questions should be answered by data analysis . The protocol content was evaluated in several pilot studies and focuses on incidents and interventions that occur with reasonable frequency . It was taken into account that due to this approach , not all information that can possibly be obtained during the ambulance run can be documented . For data collection , the concepts of manual processing versus optical scanning are evaluated . The data analysis can serve as a basic tool for screening structure and process quality of EMS systems on a local as well as a nationwide level . During this process , areas for improvement as well as for clinical research are identified ." ], "offsets": [ [ 0, 1203 ] ] } ]

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[ { "id": "DerAnaesthesist.40430262.eng.abstr-passage-0", "type": "abstract", "text": [ "Background . Stenotic processes of the tracheobronchial system may lead to dyspnoea that can become lift-threatening . To restore sufficient function of the blocked airway , a silicone stent can be inserted . The anaesthesia techniques used for this intervention so far have been complicated . The object of this study was to determine whether the superimposed high-frequency jet ventilation ( SHFJV ) via the jet laryngoscope originally designed for microlaryngeal surgery can be utilised for endoluminal stent insertion . Methods . In 12 patients with acute respiratory insufficiency ( ASA 3 - 5 ) due to stenosis of the tracheobronchial system , an endoluminal silicone stent was inserted through the jet laryngoscope while the patient was ventilated using SHFJV . Results . A significant rise in paO2 readings prior to the jet ventilation and subsequent measurements was observed . The CO2 elimination was good ( average paCO2 31.5 +/- 7.5 - 53.1 +/- 14 mm Hg ) . Variably high paCO2 readings during stent insertion were related to the respective surgical phases . At the end of the surgical manipulation , all patients had sufficient spontaneous ventilation . Conclusions . First clinical applications of the jet laryngoscope combined with superimposed jet ventilation for stent insertion demonstrated satisfactory results . Not only were the patients ventilated throughout the procedure , but CO2 elimination was also satisfactory . Superimposed jet ventilation provides a sufficient tidal volume with low ventilation pressures , and therefore oxygenation and CO2 elimination are unproblematic . SHFJV enables the anaesthetist to ventilate the patient nearly continuously with minimal phases of apnoea . The only apnoea phases , as with any other method , occur during surgical manipulation while inserting the stent and thus blocking the airway . We believe that the jet laryngoscope with SHFJV presents a distinct advantage for both anaesthetist and surgeon when inserting stents in the tracheobronchial system ." ], "offsets": [ [ 0, 2020 ] ] } ]

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[ { "id": "DerAnaesthesist.40430270.eng.abstr-passage-0", "type": "abstract", "text": [ "Various new muscle relaxants are available : atracurium , rocuronium and vecuronium all have an intermediate duration of action , whereas doxacurium and pipecuronium are long-acting and mivacurium is a short-acting nondepolarizing muscle relaxant . The duration of action of atracurium and mivacurium is determined by their degradation , which makes them unique among the nondepolarizing muscle relaxants in this respect . The time of onset is shortest with rocuronium , while vecuronium is probably the muscle relaxant with the fewest undesirable side-effects . In clinical practice , muscle relaxants of short and intermediate duration of action should be preferred , since such agents carry the least risk of residual neuromuscular block postoperatively . Because recovery from them is slow , long-acting agents should preferentially be used only when postoperative mechanical ventilation is intended . The use of a peripheral nerve stimulator is the only reliable guide to appropriate administration of muscle relaxants ." ], "offsets": [ [ 0, 1025 ] ] } ]

[ { "id": "DerAnaesthesist.40430270.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "muscle" ], "offsets": [ [ 12, 18 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s1-t2", "type": "umlsterm", "text": [ "atracurium" ], "offsets": [ [ 45, 55 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004234" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s1-t3", "type": "umlsterm", "text": [ "rocuronium" ], "offsets": [ [ 58, 68 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0209337" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s1-t4", "type": "umlsterm", "text": [ "vecuronium" ], "offsets": [ [ 73, 83 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242531" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s1-t5", "type": "umlsterm", "text": [ "doxacurium" ], "offsets": [ [ 138, 148 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0058716" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s1-t6", "type": "umlsterm", "text": [ "pipecuronium" ], "offsets": [ [ 153, 165 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0071102" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s1-t7", "type": "umlsterm", "text": [ "mivacurium" ], "offsets": [ [ 186, 196 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0066621" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s1-t8", "type": "umlsterm", "text": [ "muscle" ], "offsets": [ [ 231, 237 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "atracurium" ], "offsets": [ [ 275, 285 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004234" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "mivacurium" ], "offsets": [ [ 290, 300 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0066621" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "degradation" ], "offsets": [ [ 324, 335 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0243125" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "muscle" ], "offsets": [ [ 388, 394 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "time" ], "offsets": [ [ 427, 431 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040223" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "rocuronium" ], "offsets": [ [ 458, 468 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0209337" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "vecuronium" ], "offsets": [ [ 477, 487 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242531" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s3-t4", "type": "umlsterm", "text": [ "muscle" ], "offsets": [ [ 504, 510 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s4-t1", "type": "umlsterm", "text": [ "muscle" ], "offsets": [ [ 586, 592 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s4-t2", "type": "umlsterm", "text": [ "risk" ], "offsets": [ [ 704, 708 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0035647" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s4-t3", "type": "umlsterm", "text": [ "risk of" ], "offsets": [ [ 704, 711 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0035647" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s4-t4", "type": "umlsterm", "text": [ "neuromuscular block" ], "offsets": [ [ 721, 740 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0235062" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s5-t1", "type": "umlsterm", "text": [ "postoperative" ], "offsets": [ [ 855, 868 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0032790" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s5-t2", "type": "umlsterm", "text": [ "ventilation" ], "offsets": [ [ 880, 891 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042491" }, { "db_name": "UMLS", "db_id": "C0035203" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s5-t3", "type": "umlsterm", "text": [ "mechanical ventilation" ], "offsets": [ [ 869, 891 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042494" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s6-t1", "type": "umlsterm", "text": [ "use" ], "offsets": [ [ 910, 913 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042153" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s6-t2", "type": "umlsterm", "text": [ "nerve" ], "offsets": [ [ 930, 935 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027769" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s6-t3", "type": "umlsterm", "text": [ "administration" ], "offsets": [ [ 989, 1003 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001554" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s6-t4", "type": "umlsterm", "text": [ "muscle" ], "offsets": [ [ 1007, 1013 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.40430270.eng.abstr-s6-t5", "type": "umlsterm", "text": [ "peripheral nerve" ], "offsets": [ [ 919, 935 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0031119" } ] } ]

[]

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[ { "id": "DerAnaesthesist.40430283.eng.abstr-passage-0", "type": "abstract", "text": [ "The classification of neuromuscular diseases with regard to the use of muscle relaxants is based on the localisation of the particular abnormality . Three types of syndromes can be differentiated : ( 1 ) denervation states ; ( 2 ) disturbances of neuromuscular transmission ; and ( 3 ) intracellular disease . Succinylcholine should be avoided in all types of denervation syndrome due to the possibility of life-threatening hyperkalaemia . The time frame during which succinylcholine must be avoided following a traumatic denervation or burn begins 24 h after the event . The exact period of risk is unknown , but a duration of 6 months can be considered the absolute minimum . Patients may display increased sensitivity to non-depolarising muscle relaxants following damage to the second motoneuron ( e.g. , amyotrophic lateral sclerosis ) , whereas in diseases of the first motoneuron ( e.g. , cerebral apoplexy ) , increased resistance to muscle relaxants may be observed in the affected parts of the body . In diseases of the neuromuscular junction ( myasthenia gravis ) there is increased sensitivity to non-depolarising muscle relaxants . No complications have been described following the use of succinylcholine in these patients , however , the use of reversal agents may lead to prolongation of the effect of succinylcholine . Patients with a primary myopathy may display increased sensitivity to non-depolarising muscle relaxants . The use of drugs with acetylcholine-like actions ( succinylcholine , reversal agents ) should be avoided due to the danger of triggering muscle spasms in patients with myotonic disease and the risk of rhabdomyolysis in patients with dystrophic muscle disease . Irrespective of the type of muscle disease present , titration of the dose of muscle relaxant should always be done using a nerve stimulator . The doses required do not correlate with the clinical manifestations of the disease . The muscle relaxants of choice are those non-depolarising agents with the shortest possible duration of action , at present either atracurium or vecuronium . Reversal of prolonged neuromuscular blockade in patients with increased sensitivity to non-depolarising muscle relaxants should be avoided , and controlled ventilation should be continued until spontaneous recovery has occurred ." ], "offsets": [ [ 0, 2319 ] ] } ]

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"db_id": "C0000769" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s1-t6", "type": "umlsterm", "text": [ "neuromuscular diseases" ], "offsets": [ [ 22, 44 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027868" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "syndromes" ], "offsets": [ [ 164, 173 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039082" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "denervation" ], "offsets": [ [ 204, 215 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0011307" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "transmission" ], "offsets": [ [ 261, 273 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040722" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "disease" ], "offsets": [ [ 300, 307 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012634" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "Succinylcholine" ], "offsets": [ [ 310, 325 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038627" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "denervation" ], "offsets": [ [ 360, 371 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0011307" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "syndrome" ], "offsets": [ [ 372, 380 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039082" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s3-t4", "type": "umlsterm", "text": [ "hyperkalaemia" ], "offsets": [ [ 424, 437 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0020461" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s4-t1", "type": "umlsterm", "text": [ "time" ], "offsets": [ [ 444, 448 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040223" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s4-t2", "type": "umlsterm", "text": [ "succinylcholine" ], "offsets": [ [ 468, 483 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038627" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s4-t3", "type": "umlsterm", "text": [ "denervation" ], "offsets": [ [ 522, 533 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0011307" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s5-t1", "type": "umlsterm", "text": [ "exact" ], "offsets": [ [ 576, 581 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0059927" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s5-t2", "type": "umlsterm", "text": [ "period" ], "offsets": [ [ 582, 588 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0025344" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s5-t3", "type": "umlsterm", "text": [ "risk" ], "offsets": [ [ 592, 596 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0035647" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s6-t1", "type": "umlsterm", "text": [ "Patients" ], "offsets": 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{ "id": "DerAnaesthesist.40430283.eng.abstr-s6-t12", "type": "umlsterm", "text": [ "non-depolarising muscle relaxants" ], "offsets": [ [ 724, 757 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0010464" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s6-t13", "type": "umlsterm", "text": [ "amyotrophic lateral sclerosis" ], "offsets": [ [ 809, 838 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002736" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s7-t1", "type": "umlsterm", "text": [ "diseases" ], "offsets": [ [ 1014, 1022 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012634" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s7-t2", "type": "umlsterm", "text": [ "sensitivity" ], "offsets": [ [ 1094, 1105 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0036667" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s7-t3", "type": "umlsterm", "text": [ "muscle" ], "offsets": [ [ 1126, 1132 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s7-t4", "type": "umlsterm", "text": [ "neuromuscular junction" ], "offsets": [ [ 1030, 1052 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027869" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s7-t5", "type": "umlsterm", "text": [ "myasthenia gravis" ], "offsets": [ [ 1055, 1072 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026896" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s7-t6", "type": "umlsterm", "text": [ "non-depolarising muscle relaxants" ], "offsets": [ [ 1109, 1142 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0010464" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s8-t1", "type": "umlsterm", "text": [ "complications" ], "offsets": [ [ 1148, 1161 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009566" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s8-t2", "type": "umlsterm", "text": [ "use" ], "offsets": [ [ 1196, 1199 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042153" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s8-t3", "type": "umlsterm", "text": [ "succinylcholine" ], "offsets": [ [ 1203, 1218 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038627" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s8-t4", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 1228, 1236 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s8-t5", "type": "umlsterm", "text": [ "use" ], "offsets": [ [ 1253, 1256 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042153" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s8-t6", "type": "umlsterm", "text": [ "succinylcholine" ], "offsets": [ [ 1318, 1333 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038627" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s9-t1", "type": "umlsterm", "text": [ "Patients" ], "offsets": [ [ 1336, 1344 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s9-t2", "type": "umlsterm", "text": [ "myopathy" ], "offsets": [ [ 1360, 1368 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026848" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s9-t3", "type": "umlsterm", "text": [ "sensitivity" ], "offsets": [ [ 1391, 1402 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0036667" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s9-t4", "type": "umlsterm", "text": [ "muscle" ], "offsets": [ [ 1423, 1429 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s9-t5", "type": "umlsterm", "text": [ "non-depolarising muscle relaxants" ], "offsets": [ [ 1406, 1439 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0010464" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t1", "type": "umlsterm", "text": [ "use" ], "offsets": [ [ 1446, 1449 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042153" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t2", "type": "umlsterm", "text": [ "drugs" ], "offsets": [ [ 1453, 1458 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013227" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t3", "type": "umlsterm", "text": [ "acetylcholine-like" ], "offsets": [ [ 1464, 1482 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001041" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t4", "type": "umlsterm", "text": [ "succinylcholine" ], "offsets": [ [ 1493, 1508 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038627" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t5", "type": "umlsterm", "text": [ "muscle" ], "offsets": [ [ 1579, 1585 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t6", "type": "umlsterm", "text": [ "spasms" ], "offsets": [ [ 1586, 1592 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0037763" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t7", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 1596, 1604 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t8", "type": "umlsterm", "text": [ "disease" ], "offsets": [ [ 1619, 1626 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012634" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t9", "type": "umlsterm", "text": [ "risk" ], "offsets": [ [ 1635, 1639 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0035647" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t10", "type": "umlsterm", "text": [ "rhabdomyolysis" ], "offsets": [ [ 1643, 1657 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0035410" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t11", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 1661, 1669 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t12", "type": "umlsterm", "text": [ "muscle" ], "offsets": [ [ 1686, 1692 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t13", "type": "umlsterm", "text": [ "disease" ], "offsets": [ [ 1693, 1700 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012634" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t14", "type": "umlsterm", "text": [ "muscle spasms" ], "offsets": [ [ 1579, 1592 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0037763" }, { "db_name": "UMLS", "db_id": "C0026838" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t15", "type": "umlsterm", "text": [ "risk of" ], "offsets": [ [ 1635, 1642 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0035647" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s10-t16", "type": "umlsterm", "text": [ "muscle disease" ], "offsets": [ [ 1686, 1700 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026848" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s11-t1", "type": "umlsterm", "text": [ "muscle" ], "offsets": [ [ 1731, 1737 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s11-t2", "type": "umlsterm", "text": [ "disease" ], "offsets": [ [ 1738, 1745 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012634" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s11-t3", "type": "umlsterm", "text": [ "titration" ], "offsets": [ [ 1756, 1765 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0162621" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s11-t4", "type": "umlsterm", "text": [ "muscle" ], "offsets": [ [ 1781, 1787 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s11-t5", "type": "umlsterm", "text": [ "nerve" ], "offsets": [ [ 1827, 1832 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027769" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s11-t6", "type": "umlsterm", "text": [ "muscle disease" ], "offsets": [ [ 1731, 1745 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026848" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s12-t1", "type": "umlsterm", "text": [ "disease" ], "offsets": [ [ 1922, 1929 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012634" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s13-t1", "type": "umlsterm", "text": [ "muscle" ], "offsets": [ [ 1936, 1942 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s13-t2", "type": "umlsterm", "text": [ "choice" ], "offsets": [ [ 1956, 1962 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0008300" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s13-t3", "type": "umlsterm", "text": [ "atracurium" ], "offsets": [ [ 2063, 2073 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004234" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s13-t4", "type": "umlsterm", "text": [ "vecuronium" ], "offsets": [ [ 2077, 2087 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242531" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s14-t1", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 2138, 2146 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s14-t2", "type": "umlsterm", "text": [ "sensitivity" ], "offsets": [ [ 2162, 2173 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0036667" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s14-t3", "type": "umlsterm", "text": [ "muscle" ], "offsets": [ [ 2194, 2200 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.40430283.eng.abstr-s14-t4", "type": "umlsterm", "text": [ "ventilation" ], "offsets": [ [ 2246, 2257 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042491" }, { "db_name": "UMLS", "db_id": "C0035203" } ] 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[]

[]

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[ { "id": "DerAnaesthesist.40430289.eng.abstr-passage-0", "type": "abstract", "text": [ "There is a high incidence of intraoperative awareness during cardiac surgery . Mid-latency auditory evoked potentials ( MLAEP ) reflect the primary cortical processing of auditory stimuli . In the present study , we investigated MLAEP and explicit and implicit memory for information presented during cardiac anaesthesia . Patients and methods . Institutional approval and informed consent was obtained in 30 patients scheduled for elective cardiac surgery . Anaesthesia was induced in group I ( n=10) with flunitrazepam/fentanyl ( 0.01 mg/kg ) and maintained with flunitrazepam/fentanyl ( 1.2 mg/h ) . The patients in group II ( n=10) received etomidate ( 0.25 mg/kg ) and fentanyl ( 0.005 mg/kg ) for induction and isoflurane ( 0.6 - 1.2 vol%)/fentanyl ( 1.2 mg/h ) for maintenance of general anaesthesia . Group III ( n=10) served as a control and patients were anaesthetized as in I or II . After sternotomy an audiotape that included an implicit memory task was presented to the patients in groups I and II . The story of Robinson Crusoe was told , and it was suggested to the patients that they remember Robinson Crusoe when asked what they associated with the word Friday 3 - 5 days postoperatively . Auditory evoked potentials were recorded awake and during general anaesthesia before and after the audiotape presentation on vertex ( positive ) and mastoids on both sides ( negative ) . Auditory clicks were presented binaurally at 70 dBnHL at a rate of 9.3 Hz. Using the electrodiagnostic system Pathfinder I ( Nicolet ) , 1000 successive stimulus responses were averaged over a 100 ms poststimulus interval and analyzed off-line . Latencies of the peak V , Na , Pa were measured . V belongs to the brainstem-generated potentials , which demonstrates that auditory stimuli were correctly transduced . Na , Pa are generated in the primary auditory cortex of the temporal lobe and are the electrophysiological correlate of the primary cortical processing of the auditory stimuli . Results . None of the patients had an explicit memory of intraoperative events . Five patients in group I , one patient in group II , and no patients in group III showed implicit memory of the intraoperative tape message . They remembered Robinson Crusoe spontaneously when they were asked their associations with Friday . In the awake state AEP peak latencies were in the normal range . During general anaesthesia in group I , the peaks Na , Pa did not increase in latency or decrease in amplitude before and after the audiotape presentation . The primary cortical complex Na/Pa could be identified as in the awake state . In contrast , in group II Na , Pa showed a marked increase in latency and a decrease in amplitude or were completely suppressed . Conclusions . During general anaesthesia auditory information can be processed and remembered postoperatively by an implicit memory function , when the electrophysiological conditions of primary cortical stimuli processing is preserved . Implicit memory can be observed more often when high-dose opioid analgesia is combined with receptor-binding agents like the benzodiazepines than under non-specific anaesthetics like isoflurane . Non-specific anaesthetics seem to provide a more effective suppression of auditory stimuli processing than receptor-specific agents ." ], "offsets": [ [ 0, 3309 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.40430298.eng.abstr-passage-0", "type": "abstract", "text": [ "Recent studies and reviews continue to report a high mortality associated with the acute respiratory distress syndrome ( ARDS ) , which involves a severe inflammatory reaction within the whole lung that is frequently associated with multiple-organ failure . Important factors contributing to the poor results in severe ARDS are the aggressive procedures required to maintain sufficient arterial oxygenation , such as mechanical ventilation with high inspiratory pressures and high inspired oxygen concentrations ( FiO2) which themselves contribute to the progression of the disease . As no specific therapy that reduces or prevents the general inflammatory reaction is known , current therapy is limited to procedures that minimize peak inspiratory pressures and FiO2. Therefore , pressure- and volume-limited ventilation modes with positive end-expiratory pressure , controlled hypercapnia , differential lung ventilation when appropriate , positioning ( particularly prone ) , and aggressive dehydration are used . Should these procedures fail to improve arterial gas exchange , the patients may be additionally treated by veno-venous extracorporeal gas exchange . To reduce the risk of severe haemorrhagic complications due to high levels of systemic heparinization , systems internally coated with covalently bound heparin , which allow a lower level of systemic anticoagulation , should be used . From April 1989 to August 1993 , 89 patients were transferred to our intensive care unit for treatment of severe ARDS ; 52 were treated by combining the described conventional methods without artificial gas exchange ( survival rate 88% ) and 37 additionally underwent artificial gas exchange ( survival rate 57% ) . The overall survival rate was 75% . On the basis of these experiences , we conclude that this step-by-step approach may improve survival in patients with severe ARDS ." ], "offsets": [ [ 0, 1885 ] ] } ]

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[ { "id": "DerAnaesthesist.40430309.eng.abstr-passage-0", "type": "abstract", "text": [ "A strong consensus was reached for several changes in the guidelines for cardiopulmonary resuscitation ( CPR ) and emergency cardiac care ( ECC ) in the 1992 conference on CPR and ECC held by the Emergency Cardiac Care Committee of the American Heart Association . These new recommendations , together with differing recommendations of the European Resuscitation Council , are described . An unresponsive person with spontaneous respirations should be placed in the recovery position if no cervical trauma is suspected . Compared with endotracheal intubation , other airway-protecting devices such as combination esophageal-tracheal tubes are of minor acceptance . During ventilation , the time for filling the lungs is increased to 1.5 - 2 s to decrease the likelihood of gastric insufflation . Delivery of IV drugs can be enhanced by an IV flush of sodium chloride . In endotracheal drug administration , higher doses and drug dilution are recommended in infants and children up to 6 years of age , the value of intraosseous drug administration is emphasized . For pulseless adult victims , the intitial dosage of epinephrine of 1 mg I.V. remains unchanged . For repeat doses , high-dose epinephrine up to 0.1 mg/kg is classified as of uncertain but possible efficacy . For lidocaine , the recommended I.V. dosage is 1.5 mg/kg . Sodium bicarbonate and calcium are not routinely recommended for resuscitation . For atropine , the maximum dose is 0.04 mg/kg . If hypomagnesaemia is present in recurrent and refractory ventricular fibrillation , it should be corrected by administration of 1 to 2 mg magnesium sulfate I.V. Thrombolytic agents are classified as useful and effective in acute myocardial infarction and should be administered as early as possible . Glucose-containing fluids are discouraged for resuscitative efforts ." ], "offsets": [ [ 0, 1831 ] ] } ]

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[ { "id": "DerAnaesthesist.40430316.eng.abstr-passage-0", "type": "abstract", "text": [ "Postoperative pain relief can be achieved by several methods , including the use of systemic opioids and regional anaesthesia with intrathecal or epidural opioids or local anaesthetics . On-demand analgesia using a PCA ( patient-controlled analgesia ) system is regarded as the ideal option for systemic opioid analgesia . While PCA devices are not yet commonly used in all recovery units , the use of repetitive boluses on demand is still the most frequent form of administration in postoperative pain therapy . The objective of the present study was to show if continuous infusion of the opioid tramadol could produce better analgesia than repetitive administration of boluses . Method . In a study under double-blind conditions 135 ASA I and II patients were assigned at random to group I ( infusion group ) or group B ( bolus group ) when they first requested pain treatment after abdominal surgery . The patients in group I received an initial intravenous loading dose of 100 mg tramadol , followed by an infusion of 12 mg/h tramadol for 24 h ; if necessary , repeated boluses of 50 mg tramadol were given . In group B the patients received a placebo infusion instead of the tramadol infusion ; otherwise , the procedure was the same . Pain relief was monitored by means of a VAS ( visual analogue scale ) up to 6 h after surgery . We investigated the retrograde assessment of analgesia by the patients after 6 h , how often repetitive boluses were required , and the amount of analgesics administered in 6 and 24 h . Results . The pain relief was assessed as excellent or good by 76.5% of group I and 65.6% of group B ; 19.1% of group I and 26.9% of group B assessed the analgesic effect as satisfactory ; 4.4% of group I and 7.5% of group B complained of insufficient analgesia . In group I 69.2% requested only one or no repetitive bolus , compared with 40.3% in group B , while two or more boluses were demanded by 30.8% in group I and 59.7% in group B. The average analgesic consumption after 6 h was 223.5 +/- 53.7 mg tramadol in group I and 176.6 +/- 63.1 mg tramadol in group B , respectively . After 24 h it was 449.5 +/- 66.0 mg tramadol in group I and 201.6 +/- 83.9 mg tramadol in group B. While the consumption during the first 6 h was comparable , from then on the consumption in group I increased significantly . Side effects were reported by 25% in both groups . They were clinically irrelevant and did not necessitate termination of the clinical trial in any case . During the study period pulse and blood pressure remained within the normal range and did not show any significant changes . Conclusion . The fact that the patients in group I requested far fewer repetitive boluses than those in group B and the assessment by the patients led to the conclusion that treatment in the infusion group is better than that in the bolus group . Concerns that a significantly higher consumption of analgesics would cause unwanted side-effects have proven unfounded . Six hours after surgery , when analgesia was evaluated by the patients , there was no significant difference between the two groups . Not until the maintenance infusion had been administered for a further 18 h , was the tramadol consumption within the infusion group significantly higher . Thus , we should consider continuing unreduced administration of the maintenance infusion 6 h after operation ." ], "offsets": [ [ 0, 3382 ] ] } ]

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[ { "id": "DerAnaesthesist.40430333.eng.abstr-passage-0", "type": "abstract", "text": [ "There are two types of diabetes mellitus . Type I , insulin-dependent diabetes ( IDDM ) , which becomes manifest before the age of 40 , is the result of an absolute deficiency of insulin . Type II , the non-insulin-dependent diabetes ( NIDDM ) , develops in the elderly and is caused by a relative insulin deficiency . Patients with type-I diabetes are prone to the development of ketoacidosis , while type II causes hyperglycaemic , hyperosmolar , nonketotic coma . Apart from these acute metabolic alterations , the long-term complications of diabetes are of concern to the anaesthesiologist . Hypertension , coronary artery disease , renal insufficiency and autonomic neuropathy are common and can result in myocardial ischaemia , cardiovascular instability and gastroparesis , with an increased risk of aspiration . Limited movement of the atlanto-occipital joint can cause difficult intubation . To avoid perioperative metabolic catastrophy , blood glucose concentration should be kept between 6.7 and 10 mmol - l-1 ( 120 - 180 mg - dl-1). Hypoglycaemia can result in neurological damage , whereas hyperglycaemia causes impaired wound healing and susceptibility to infections and worsens ischaemic damage to the myocardium and brain . Perioperative diabetes management depends on the severity of the surgical procedure and the type of diabetes . All type-I diabetics , whatever operation being performed , need insulin . The intravenous route is recommended as it allows better adjustment . After determination of the fasting blood glucose level , insulin is given at a dosage of 0.5 - 1 U - h-1 ( at gluc 11.1 mmol - l-1), 1.5 - 2 U - h-1 ( at gluc 11.1 - 16.7 mmol - l-1) or 3 U - h-1 ( at gluc > 16.7 mmol - l-1). In addition , 5 - 10 g glucose - h-1 is given . In type-II diabetes the oral antidiabetic drug is withheld . During minor surgery the blood glucose concentration is monitored frequently , and if necessary insulin ( with gluc > 13.9 mmol - l-1) or glucose is given . In most cases of major surgery insulin therapy will be necessary . Administration should follow the guidelines listed for type-I diabetes . Whether the intravenous or the subcutaneous route is used for insulin , repeated glucose determinations are mandatory . If ketoacidosis develops the volume depletion is treated with normal saline . For hyperglycaemia and acidosis insulin ( 3 - 6 U - h-1) with 10 - 20 mmol - h-1 potassium phosphate is given . Bicarbonate is only indicated when the serum pH is lower than 7.1. It must be borne in mind that perioperative management of diabetes does not end with postanaesthesia care ." ], "offsets": [ [ 0, 2612 ] ] } ]

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"normalized": [ { "db_name": "UMLS", "db_id": "C0001792" }, { "db_name": "UMLS", "db_id": "C0001811" } ] }, { "id": "DerAnaesthesist.40430333.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "deficiency" ], "offsets": [ [ 165, 175 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0011155" } ] }, { "id": "DerAnaesthesist.40430333.eng.abstr-s2-t6", "type": "umlsterm", "text": [ "insulin" ], "offsets": [ [ 179, 186 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021641" } ] }, { "id": "DerAnaesthesist.40430333.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "diabetes" ], "offsets": [ [ 225, 233 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0011847" }, { "db_name": "UMLS", "db_id": "C0011849" } ] }, { "id": "DerAnaesthesist.40430333.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "NIDDM" ], "offsets": [ [ 236, 241 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0011860" } ] }, { "id": "DerAnaesthesist.40430333.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "elderly" ], 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[]

[]

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[ { "id": "DerAnaesthesist.40430355.eng.abstr-passage-0", "type": "abstract", "text": [ "The frequency of postspinal headaches after accidental puncture of the subarachnoid space with 16 - 18 G Tuohy needles is reported at 59 - 85% . A case of postspinal headache syndrome persisting over a period of 6 weeks following epidural anaesthesia during labour is described . The treatment is discussed . Case report . A 30-year-old women had severe postspinal headache for 6 weeks after epidural anaesthesia during labour . Conservative therapy for 3 days and 4 days of bedrest followed by cristalloid infusions during a 3-week hospital stay and a subsequent 3-week period of bedrest at home did not lead to lasting pain relief . Intracranial haematoma and other abnormal processes were excluded by CCT . A pathologic EEG was not confirmed by cranial MRT . A lumbar epidural blood patch of 15 ml of autologous blood was performed at L3/4. The patient stayed in bed for 12 h . After 3 h free of pain the patient complained of recurring headache . After a further 48 h of bedrest she had recovered . Because of lumbar pain 4 days after the epidural blood patch a MRT was performed , which showed the blood at L4 to S3 in the epidural space . Discussion . The diagnosis of a cerebrospinal fluid leakage was based on the history and the main symptom of postspinal headache : the pain onset in the supine position . Such possible treatments as diminishing subarachnoidal pressure by bedrest , increasing cerebrospinal fluid production by infusions , increasing epidural pressure by epidural infusions and closing the cerebrospinal fluid leakage by epidural blood patch are discussed . The average success rate with the epidural blood patch is 93% . Volumes ranging from 5 to 20 ml are discussed for the autologous blood . We chose 15 ml of blood , to take account of the possibility that blood might settle in the wide sacral space . We were able to document the position of the blood patch as L4 to S3 on MR tomography ( the injection site was L3/4). Most patients are free of headache 1 h after epidural blood patch . Our patient had to be confined to bed for another 48 h because of recurring headache . The blood patch alone was not immediately sufficient to prevent all further cerebrospinal fluid leakage . Probably more than one subarachnoidal puncture had been made during the difficult epidural anesthetic procedure . On the other hand , the leak was probably only diminished because of the blood patch descending down to the wide sacral space . The combination of the large-volume blood patch , which diminished the leakage , and conservative treatment , which narrowed the transdural pressure difference , was successful : the 6-week postspinal headache was cured . Conclusion . Prolonged postspinal headache should be treated by epidural blood patch . The use of over 10 ml cannot be generally recommended , although in this case most of the blood patch of 15 ml was localized caudally . Careful monitoring for side effects is necessary with blood volumes larger than 10 ml . If there is no immediate relief , conservative therapy with 24 - 48 h of bedrest is recommended . If the headache persists a second blood patch should be performed , with the volume and the probable caudal spreading of the first taken into account ." ], "offsets": [ [ 0, 3237 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.40430359.eng.abstr-passage-0", "type": "abstract", "text": [ "A new closed tracheo-bronchial suction system was evaluated . With this device the patient need not be disconnected from the ventilator during suctioning , and can thus have a continuous supply of oxygen . The closed suction system is attached to the patient's endotracheal tube and ventilator Y-piece . The catheter , which is enveloped by a plastic sheet , can remain connected to the patient for as long as 24 h ( Fig . 1 ) . Materials and methods . In the medical and surgical intensive care unit of Alt/Neuoetting General District Hospital , 39 trials on 16 mechanically ventilated patients receiving more than 8 cm H2O positive end-expiratory pressure ( PEEP ) and/or more than 60% FiO2 were performed . Each subject was suctioned using the open and closed methods . Arterial blood gases were obtained through an indwelling catheter before suctioning and then 1 , 5 , and 15 min after suctioning . Open suctioning : After 2 min preoxygenation with 100% oxygen the patient was disconnected from the ventilator , the suction catheter was inserted and the subject suctioned for a maximum of 15 s , then manually ventilated four times and reconnected . Closed suctioning : After preoxygenation the patient was suctioned without disconnection by means of the closed suction system . Statistical analysis was done by the two-tailed t-test on individual paired differences or by Student's t-test . P values of less than 0.05 were accepted as significant . Results . Patients were subdivided according to the PEEP level used ( less or more than 8 cm H2O) and analysed separately . One minute after suctioning ( T1) arterial pO2 was found to increase significantly for the open-system method when PEEP ventilation was =8 cm H2O ( Table 1 ) and for the closed system method when PEEP ventilation was both =8 cm H2O ( Table 1 ) and > 8 cm H2O ( Table 2 ) . Five ( T5) and 15 ( T15) min after suctioning , pO2 dropped significantly compared to baseline values in the open-system method when PEEP was > 8 cm H2O ( Table 2 ) . PO2 values 15 min after closed suctioning with PEEP > 8 cm H2O were significantly higher than those after open suctioning ( Table 2 ) . After the pO2 differences were formed between baseline and values 1 , 5 , and 15 min after suctioning , significant differences between open- and closed-system suctioning were found for PEEP > 8 cm H2O at T1, T5, and T15 ( Table 2 , Fig . 3 ) . Discussion . The increase in pO2 as a positive effect of preoxygenation with 100% oxygen before suctioning was less marked for open-system suctioning with PEEP > 8 cm H2O because FiO2, measured at the ventilator Y-piece , was abruptly reduced after disconnection and simultaneously PEEP was lost . As a consequence , pO2 values fell significantly 5 and 15 min after suctioning in this situation , whereas for all the other conditions pO2 reached baseline as well as slightly higher values . Patients with severe respiratory insufficiency need continuous positive airway pressure to keep unstable alveoli patent . Every maneuvre that reduces intra-alveolar pressure may precipitate alveolar collapse . However , in the diseased lung closed alveoli may not re-expand at once when pressure is re-established . Therefore , closed-system suctioning may help to prevent prolonged deterioration of oxygenation in patients with severe respiratory failure ." ], "offsets": [ [ 0, 3348 ] ] } ]

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[ { "id": "DerAnaesthesist.40430364.eng.abstr-passage-0", "type": "abstract", "text": [ "Conventional treatment of the adult respiratory distress syndrome ( ARDS ) includes pressure-limited ventilation , permissive hypercapnia , posture changes , aggressive dehydration , selective lung ventilation , and extracorporeal gas exchange . New strategies such as nitric oxide inhalation , the implantation of an intravenous membrane oxygenator ( IVOX ) , and surfactant replacement are currently under evaluation . Nitric oxide ( NO ) is an important endothelium-derived relaxing factor that is rapidly inactivated by binding to haemoglobin . Inhaling this substance has been shown to induce selective vasodilatation of ventilated lung regions . Thus , inhaled NO reduces pulmonary hypertension , increases right heart ejection fraction , and improves arterial oxygenation by redistributing blood flow away from areas with intrapulmonary shunts to areas with a normal ventilation/perfusion ratio . Dose-response analysis has revealed that effective doses for improvement of oxygenation are lower than for reduction of mean pulmonary artery pressure . The use of a miniaturised membrane lung , IVOX , for intracaval oxygen and carbon dioxide exchange is a new approach to augment gas exchange . The IVOX is inserted via an introducer into the femoral vein and is designed for placement in the full length of the vena cava . Initial experiences with this device show that the currently used prototype provides a maximum of one-third of basal gas exchange . Therefore , a more efficient device will be needed to significantly reduce high inspired oxygen concentrations and airway pressures . Moreover , there exists evidence that IVOX causes caval obstruction . Lung surfactant recovered in BAL from patients with ARDS demonstrates that fractional contents of phosphatidylcholine and phosphatidylglycerol are reduced , and that the total concentration of apoproteins is decreased . Furthermore , the surfactant surface tension-lowering activity is abnormal . Thus , administration of exogenous surfactant may have therapeutic benefits . However , the optimal surfactant preparation , the optimal amount required to restore lung surfactant activity , and the optimal method to deliver it to patients with ARDS are unknown and currently under evaluation ." ], "offsets": [ [ 0, 2256 ] ] } ]

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[ { "id": "DerAnaesthesist.40430376.eng.abstr-passage-0", "type": "abstract", "text": [ "Trauma scores in emergency medicine quantitatively characterise the severity of trauma victims ' injuries and physiologic derangements . They are used to detect and assess patients and have applications in guiding patient care and early therapeutic decisions . In the pre-clinical setting , an effective trauma index meets the following criteria : - It is highly reliable with regard to identifying high- and low-risk patients . - It has high face-validity . - It has high inter- and intra-rater reliability . - It is easy to use and allows rapid , accurate measurements . The most widely accepted injury severity index is probably the Injury Severity Score ( ISS ) . It is calculated as the sum of the squares of the three most severely injured body regions , and was originally developed as a means to standardise the description of injuries sustained in motor vehicle accidents . The Trauma Score ( TS ) represents the gold standard of physiologic scoring of injury severity . It summarises the numerical assessments of the central nervous and cardiopulmonary system functions . The recently developed Mainz Emergency Evaluation Score ( MEES ) is based upon numerical specification of the vital signs , including a pain scale , and has been designed as a dynamic score . Nevertheless , limitations of the established trauma score systems have been described . Mortality and patient outcome do not strictly correlate with injury severity scoring . In addition , intubated or paralysed patients were excluded from outcome studies since the scoring systems lacked options for evaluation of pathophysiological conditions after therapeutic interventions . Thus , therapeutic efficacy could hardly be assessed , and subsequent scoring during time periods was impossible . The accurate definition of comprehensive evaluation of a trauma victim is challenging , for example , \" pain \" as chosen in the MEES must be regarded as a highly desirable piece of information although its rating may prove difficult , especially when classifying unconscious patients . Further criticisms of the above-mentioned trauma indices could include omission of the trauma victim's age , gender , pre-injury health status , or the influence of alcohol or additional medication . Moreover , questioning the interrater reliability of injury severity scoring , a recent study revealed bias in assigning values to trauma patients : trained raters classified injury severity with significantly higher indices than less experienced researchers . If trauma indices in pre-hospital emergency medicine were relied upon as the only means of evaluating a trauma patient and guiding therapeutic approaches , significant numbers of trauma victims requiring major interventions would be missed . Resuscitative treatment regimens must not be based solely upon indices , since , e.g. , in states of shock injury scores do not correlate with fluid resuscitative requirements . Furthermore , a qualitative assignment of single vital-function parameters as crucial indices for a patient's condition never reflects the broad range of a patient's profile . Many multiple-trauma patients do benefit from controlled ventilation in clinical experience even though pulse oximetry values are within the physiological range , and the administration of analgesics or even pre-hospital anaesthesia has often proved advantageous for trauma patients in the field . Providing the opportunity of subsequent patient evaluation and the efficacy of acute care , the MEES has been developed as a dynamic scoring system . This design is extremely desirable and must be regarded as an indispensible criterion for future scoring systems . In view of the peculiarities of field emergency medicine , pre-hospital indices do have limitations . The parameters \" unknown patient \" , time pressure , unprecise measurements , lack of diagnostic facilities , incomplete evaluation , and limited statistical power cannot be eliminated . Accurate prediction of outcome within early time-frames is therefore not possible ." ], "offsets": [ [ 0, 4047 ] ] } ]

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[ { "id": "DerAnaesthesist.40430385.eng.abstr-passage-0", "type": "abstract", "text": [ "Despite major advances in knowledge and development of efficient techniques for pain control , many patients on surgical wards suffer from modest to severe pain following surgery or trauma . Therefore , in the University Hospital of Kiel , Germany , an anaesthesiology-based acute pain service ( APS ) was started in 1985 to improve this situation . Organization of an APS . The anaesthesiologist in training who manages the recovery unit serves as an APS for surgical wards and is supervised by a consultant . The anaesthesists on call are responsible after regular working hours . The activities of the APS are as follows : 1. Induction of sufficient postoperative analgesia in the recovery unit for all surgical patients . 2. Clinical rounds on all patients receiving epidural analgesia ( EA ) , other forms of regional analgesia , or patient-controlled analgesia ( PCA ) every morning and throughout the day if necessary . 3. Additional consultations for postoperative pain management for other patients on request . 4. Assessment and documentation of the clinical status of the patient , quality of analgesia , and side effects . 5. Writing orders for further treatment . 6. Continuing consultations and informal education for ward nurses , physiotherapists , and surgical staff ; formal medical training for ward nurses in postoperative pain management . Activity of the APS . From 1985 to 1992 , 1947 patients on normal wards were treated ( EA : 1736 , PCA : 183 ) . Epidural analgesia was performed using a standard protocol with bupivacaine 0.175% - 0.25% infused continuously with top-ups if needed ( mean 240 mg/day , range 75 - 600 mg ; median duration 7 days , range 1 - 53 , Table 1 ) . Demand for further treatment was proved by day-to-day withdrawal . Since the introduction of an APS , complications of EA such as hypotension ( 1985/1986 : 5.1% ; 1987/1992 : 0.5% , Table 3 ) and insufficient analgesia due to dislocation or other technical complications could be reduced significantly ( Table 3 ) . Dermal infections were seen in 2.6% of patients , with a significantly higher incidence in patients with arteriosclerotic diseases ( 4.1% ) . Epidural opioids were used in only 46 selected cases on surgical wards . Nevertheless , 2 cases of marked respiratory depression occurred . The overall risk of complications during postoperative EA could be reduced from 1 : 11 cases in the first 2 years to 1 : 20 in the last 6 years since introducing the APS . For other regional procedures ( e.g. , interpleural analgesia ) no complications were recorded . PCA was performed using a standard protocol with tramadol or piritramide without background infusion ( Table 6 ) . The loading dose was titrated in the recovery unit . The median duration of PCA was 4 days ( range 1 - 23 ) ; the median dose of piritramide was 45 mg/day ( range 3 - 226 mg ) . Two cases of somnolence and respiratory depression occurred . In this period there were 8 potential life-threatening complications due to postoperative pain therapy ; 4 occurred during standard surgical pain management ( 3 cases of severe respiratory depression after i.m. and i.v. piritramide ( unsuccessfull resuscitation ) , tramadol , and buprenorphine ; 1 small child with multiorgan failure after paracetamol intoxication ) . In those cases the APS was not involved . Conclusions . There are insufficient data for comparison of the incidence of complications following standard management of postoperative pain relief without an APS , i.e. , i.m. injections of opioids on request , but severe and sometimes lethal complications have been reported . Since the majority of patients used EA or PCA for several days , it is again emphasised that these techniques should not be restricted to high-dependency areas such as intensive care or recovery units . The introduction of an APS is an adequate approach to more efficient and safer pain management on surgical wards . This requires standard protocols ( Table 7 ) , standardised monitoring and trained ward nurses ." ], "offsets": [ [ 0, 4030 ] ] } ]

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[ { "id": "DerAnaesthesist.40430398.eng.abstr-passage-0", "type": "abstract", "text": [ "Massive intraoperative embolism is a life-threatening condition that may lead to immediate death . Important for the survival of the patient are rapid diagnosis and prompt surgical embolectomy . Case report . Nineteen days after a traffic accident , a 67-year-old patient who had complex ligamentous injuries was operated upon on both knees during general anaesthesia . The operation progressed uneventfully for the first 30 min when the patient's systolic blood pressure became slightly unstable and decreased to 85 mm Hg despite administration of ephedrine and infusion of hetastarch . This was followed 30 min later by an immediate drop to values that were undectable on an oscilloscope . The pulse oximeter no longer detected a signal at the finger-tip and the end-tidal CO2 decreased to 1 kPa ( 7.5 mm Hg ) . To confirm the diagnosis of an acute pulmonary embolism , we performed transoesophageal echocardiography ( TEE ) and found a large amount of free-floating material in the right atrium , a dilated and hypokinetic right ventricle , and a collapsed left ventricle ( Fig . 1 a ) . Embolectomy was immediately started using the inflow-occlusion technique supported by cardiopulmonary bypass ( CPB ) . All emboli were removed from the right atrium and pulmonary artery ( Fig . 1 b ) . During closure of the sternotomy , heart function was monitored by TEE and we again noted large emboli in the right atrium ( Fig . 1 c ) . To remove these , we reinstated CPB and then placed an inferior vena cava filter . The final TEE control showed free heart chambers with good contractility ( Fig . 1 d ) . The postoperative course of the patient was without complications , and he left the hospital 41 days after the operation without sequelae from the massive pulmonary embolism . Conclusion . Intraoperative diagnosis of acute pulmonary embolism with shock is difficult . Clinical signs are unspecific and are rarely present during general anaesthesia . ECG changes may occur only later . As a result of the persistent shock , the pulse oximeter no longer works properly and the decrease in end-tidal CO2 may be explained by other reasons such as low cardiac output from a myocardial infarction . In this situation , TEE is a very useful method for quickly confirming the diagnosis of massive pulmonary embolism . In addition , we have shown that TEE is effective in detecting new emboli after an embolectomy . We conclude that TEE is a life-saving diagnostic tool that is useful for confirming acute pulmonary embolism and controlling the efficacy of embolectomy ." ], "offsets": [ [ 0, 2565 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.40430405.eng.abstr-passage-0", "type": "abstract", "text": [ "Raised intracranial pressure is the final common path to brain damage and brain death from a variety of intracranial conditions . Since the introduction of continuous monitoring of intracranial pressure into neurosurgical practice , much work has been undertaken which has advanced our knowledge of intracranial pressure and its management . The treatment of raised intracranial pressure should begin as soon as possible . The position of the head and neck should be checked to ensure that there is not an excessive degree of flexion or rotation . The airway should also be checked for obstruction and the patient observed to ensure that he is not making respiratory efforts against the respirator . The body temperature should not be above normal . Blood gases or other parameters of the adequacy of ventilation should be assessed and any abnormalities corrected . The sedation/analgesia regimen should be checked to ensure that it is sufficient and the patient is not experiencing pain . The serum sodium should be checked to ensure that hyponatraemia is not the cause of the intracranial hypertension . If intracranial hypertension persists despite the meticulous applications of these measures , then more specific therapy is required . This essentially reduces to a choice between osmotic agents , hypnotic drugs and drainage of cerebrospinal fluid ." ], "offsets": [ [ 0, 1355 ] ] } ]

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[ { "id": "DerAnaesthesist.40430431.eng.abstr-passage-0", "type": "abstract", "text": [ "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 ) 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 -bands , while in groups AP and APP the increase was most pronounced in the and bands . In group M , there was a linear increase in 1 power up to 310% , while in the 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 1 ( 220% ) and 2 ( 130% ) . Increases in both -bands were most pronounced with frontal electrodes . While group M showed an increase in power ( 150% ) , together with moderate suppression in ( 1 50% , 2 40% ) , nordazepam caused only a slight increase ." ], "offsets": [ [ 0, 3749 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.40430441.eng.abstr-passage-0", "type": "abstract", "text": [ "Non-invasive blood pressure measurements by the auscultatory method do not provide reliable , reproducible blood pressure values in many neonates because the Korottkoff sounds are often very difficult to detect . This resulted in the development of many alternative indirect methods . Devices utilizing the Doppler ultrasound technique have not found wide acceptance . Since the introduction of automated oscillometric blood pressure monitors , arterial blood pressure has been increasingly brought into discussion as an indicator of the circulatory state . This is the first study to investigate the similarity and reproducibility of the data obtained with five oscillometric devices for measurement of blood pressure in neonates . Materials and methods . Since investigations on the technical performance are not practical in the clinical setting of a neonatal or pediatric ward , we used two simulators , the CuffLink ( Dynatech , Nevada , USA ) and a device developed by the PTB ( Physikalisch-Technische Bundesanstalt ) . While the latter uses oscillations originally obtained from neonates , the CuffLink uses artificial and therefore ideal signals for the blood pressure monitors . The signals used for the PTB simulator were obtained from three neonates with an average age of 2 months and a weight of 3.5 kg , 4.4 kg , and 7.8 kg . The following blood pressure monitors were studied : Hoyer/Colin , BP-1001; Datex , Cardiocap II ; SpaceLabs , model no . 90426 ; Hewlett-Packard , NBP M1008A ; Critikon , Dinamap 1846. Before the measurements were started , the cuff pressure display of each monitor was checked according to a verification procedure . Although the 4 mm Hg margin of error was not exceeded , the results were corrected . Results . The results of the measurements show significant differences between the blood pressure monitors from the various manufacturers , with the differences for the ideal signals of the CuffLink-Simulator being less pronounced than those for the PTB simulator . Direct comparison of results is therefore often impossible . The standard deviation , taken from 20 measurements per monitor and simulation , is below 4 mm Hg for both simulators . We can therefore conclude that the reproducibility of data is satisfactory and the emerging trend is reliable . Discussion . The difference between the results of the PTB simulator and the CuffLink are probably due to the method of evaluation and the identification of artifacts of each blood pressure monitor . This is also confirmed by the studies of Mieke et al. The manufacturers should provide devices that display comparative results and improve the algorithms for detection of artefacts , increasing the accuracy of their blood pressure monitors . This could be done with the help of simulators . Considering the pathophysiological characteristics of neonates and infants , the systematic differences between the five monitors have to be regarded as serious ." ], "offsets": [ [ 0, 2958 ] ] } ]

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[ { "id": "DerAnaesthesist.40430454.eng.abstr-passage-0", "type": "abstract", "text": [ "As early as 1974 , Brian advocated the prone position for ventilated patients [ 5 ] . He suggested that this position might enhance ventilation of the dorsal parts of the lungs , thereby improving oxygenation . These considerations have been confirmed by several experimental and clinical studies [ 1 , 6 , 13 , 17 ] . Better secretion removal , decreased intrapulmonary shunting , and an increased FRC are thought to be responsible for the observed improvement of oxygenation . However , the prone position never became very popular in the clinical treatment of the adult respiratory distress syndrome ( ARDS ) . Routine performance of thoracic CT scans in ARDS patients demonstrated preferential distribution of pathological densities in the dependent lung areas . The prone position therefore could possibly benefit these patients , as shown by two recent studies [ 8 , 11 ] . The aim of our study was to evaluate the influence of repeatedly turning the patient to the prone position on gas exchange and thoracic CT findings in multiple-trauma patients . Methods . Seven ventilated intensive care patients with severe ARDS ( Murray Score > 2.5 [ 9 ] , Quotient > 0.7 [ 4 ] , mean airway pressure > 18 cm H2O, thoracic CT scan showing dorsal atelectases ) were included in the study . Patients were turned from the supine to the prone position at 12-h intervals using an air-cushion bed ( Mediscus , Austria ) . Redistribution of dystelectatic or atelectatic dependent lung areas was verified by means of repeated thoracic CT scans ( Figs . 1 , 8 ) . Results . The patients were intermittently turned for 6.5 +/- 1.1 days . The course of gas exchange is shown in Figs . 2 and 3. Initially , improvement of the respiratory quotient could only be achieved during prone positioning , from the 2nd day in the supine position as well . Intrapulmonary shunting showed a similar trend ( Figs . 4 and 5 ) . No significant changes in cardiovascular parameters could be observed . Control thoracic CT scans showed uniform reduction of atelectases in dependent lung areas ( Figs . 1 and 8 ) . The inspiratory fraction of oxygen could be reduced significantly as of the 2nd day ( Fig . 7 ) . Constant levels of positive end-expiratory pressure and tidal volume were associated with decreasing mean and plateau airway pressures ( Fig . 6 ) . Discussion . Repeatedly turning the patient to the prone position produced long-lasting improvement of arterial oxygenation , which persists up to the end of the weaning process . This is in good accordance with other studies [ 1 , 2 , 6 , 8 , 11 , 13 , 17 ] , however , this is the first study to report an observation period of more than 6 days of repeatedly turning the patient . These positive effects on gas exchange can be attributed to sudden improvement of the ventilation-perfusion ratio within the lung areas that become dependent after turning to the prone position . Due to reduced hydrostatic pressure [ 11 ] and relative hyperventilation [ 7 , 16 ] , previously collapsed alveoli are recruited in the lung areas that become non-dependent after turning to the prone position ." ], "offsets": [ [ 0, 3120 ] ] } ]

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[ { "id": "DerAnaesthesist.40430463.eng.abstr-passage-0", "type": "abstract", "text": [ "A 25-year-old woman with Kartagener's syndrome was admitted to hospital for laparoscopy because of sterility . Kartagener's syndrome is a rare disorder involving the combination of situs inversus , bronchiectasis and sinusitis . A dynein deficiency leads to ciliary dyskinesia . When general anaesthesia is to be induced in a patient with Kartagener's syndrome the following points must be borne in mind : ascertainment of the preoperative pulmonary status , antibiotic coverage , recognition of dextrocardia , necessity for aseptic techniques because of the possibility of abnormal neutrophil chemotaxis . Anticholinergic and antitussive medications are relatively contraindicated , as are nasal tubes . In the present case an intubation anaesthesia with thiopental , nitrous oxide , enflurane and succinylcholine was carried out ; cefoxitin was administered for antibiotic treatment , and the patient made an uneventful recovery ." ], "offsets": [ [ 0, 932 ] ] } ]

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[ { "id": "DerAnaesthesist.40430466.eng.abstr-passage-0", "type": "abstract", "text": [ "We report on two patients with subcutaneous carbon dioxide ( CO2) emphysema that developed during laparoscopic surgery with CO2 pneumoperitoneum ( PP ) , in whom pulmonary elimination of CO2 ( ECO2, Servo ventilator with integrated CO2 analyzer 930 , Siemens ) was continuously monitored . Patient 1 was a 61-year-old man with laparoscopic herniotomy . ECO2 immediately before PP was 120 ml/minxm2 and increased rapidly after 45 min PP to a maximum value of 340 ml/minxm2. At that time , minute ventilation had been increased from 7 to 11 l/min and PaCO2 had risen from 35 to 57 mm Hg. At the end of the procedure the patient showed excessive subcutaneous emphysema . Patient 2 was a 71-year-old woman in whom diagnostic laparoscopy was performed for staging of a pancreatic tumor . ECO2 immediately before PP was 140 ml/minxm2, increasing dramatically after 45 min PP to a maximum value of 529 ml/minxm2 ( Fig . 1 ) . At that time minute ventilation had been increased from 6.2 to 12.5 l/min and PaCO2 had risen from 40 to 77 mm Hg. PP was terminated and the patient was found to have extreme subcutaneous emphysema . She was mechanically ventilated for a further 40 min to normalize PaCO2 and ECO2. It seems reasonable to suppose that an increase in ECO2 by more than 100% of control during CO2-PP is an early sign of CO2 emphysema . In this situation hypercapnia is potentially life-threatening . Evidently , reabsorption of CO2 from loose connective tissue is far more rapid and effective than CO2 resorption from the peritoneal cavity . The incidence of CO2 emphysema during laparoscopic surgery is said to be in the range of 0.3 - 3% , but even higher incidences may be found when it is carefully looked for . Continuous observation of ECO2 is non-invasive and relatively inexpensive and may give new insights into pathophysiological changes during CO2-PP in the future ." ], "offsets": [ [ 0, 1877 ] ] } ]

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[ { "id": "DerAnaesthesist.40430494.eng.abstr-passage-0", "type": "abstract", "text": [ "Modern medicine has succeeded in achieving enormous technical developments . One recent highlight has been the introduction of postmortem organ transplantation . At the same time , serious objections have been raised concerning the radical changes in the cultural conception of the inviolable body . One major objection arises from the conflict of considering a brain-dead person as dead . The presence of brain death is a prerequisite for post-mortem organ donation , because only during this phase of dying does the individual quality as dead while the organs , other than the brain , remain viable . The objection implies scepticism as to the physician's ability to distinguish a dead from a living person . On the other hand , even the critics must rely on the physician's ability to discriminate , e.g. , when to discontinue resuscitation . The medical community has not found reasons to restrict the definition of irreversible coma 25 years after its first formulation . It must be clearly recognised that reasons other than medical ones can be decisive for refusing organ donation . One ethical problem is the therapeutic benefit of organ transplantation . The beneficiary of the treatment is not the donor , but another person , the recipient . The concept of human dignity does not allow the use of a person fur purposes other than the ones he/she consents to , as Immanuel Kant stated . Although the human corpse is not a person in the full sense , even if it is protected by the thought of respect for the former person , the life-interest of the organ recipient had to be considered legitimate . The resulting conflict between the respect for the donor and the life-interest of the recipient should be balanced by seeking the donor's consent as far as possible . The proposed information model seems adequate at the moment . A common report of both churches in Germany in 1990 supported postmortem organ transplantation . The report dealt with the medical problems and harmonized them with the Christian value of solidarity . The ethical alternatives to organ transplantation , however , are not mentioned . Within this limitation , the report seems to adequately express the aim to strengthen individual competence and plead for fair perception of the neighbour's life-interest ." ], "offsets": [ [ 0, 2292 ] ] } ]

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[ { "id": "DerAnaesthesist.40430500.eng.abstr-passage-0", "type": "abstract", "text": [ "Ondansetron , a selective 5-HT3 receptor antagonist , has recently been shown , in a dose of 8 mg , to be superior to 1.25 mg droperidol in preventing postoperative vomiting . There are indications that a dose of 4 mg of ondansetron may be just as effective in reducing postoperative nausea and vomiting as a dose of 8 mg [ 16 ] . The aim of this study was to evaluate the efficacy and the adverse effects of 4 mg ondansetron in the prevention of postoperative nausea and vomiting compared to droperidol in patients undergoing surgery with inhalation anaesthesia supplemented with alfentanil . Methods . Following institutional approval , 40 ASA physical status I and II women scheduled for minor gynaecological surgery gave informed consent to participate in this randomized , double-blind comparative study . Five minutes before induction of general anaesthesia , 20 patients received a single intravenous ( IV ) dose of 4 mg of ondansetron and the remaining 20 received 1.25 mg droperidol IV . Anaesthesia was induced with 2.1 - 4 mg/kg of thiopental and 0.1 mg of alfentanil IV and maintained with 65% nitrous oxide and 1.5% - 3% enflurane in oxygen . On pain stimuli another 0.2 - 0.4 mg of alfentanil was given . Total effective antiemetic response was defined as the absence of nausea and vomiting for 24 h postoperatively . The incidence of nausea , vomiting and the number of patients showing total antiemetic response as well as the incidence of adverse effects were compared with the chi2 test and P 0.05 was considered significant . Results . Patients were similar with respect to age , height , body weight and total anaesthetic agents received . Duration of anaesthesia and the time until awakening was not significantly different among groups . Postoperatively 7 out of 20 patients given 4 mg of ondansetron and 3 out of 20 patients with droperidol vomited ( n.s. ) . The incidence of nausea was 11 out of 20 in the ondansetron group , and 4 out of 20 in the droperidol group ( P 0.05 ) . Sixteen patients in the droperidol group and 8 patients in the ondansetron group showed a total effective antiemetic response ( P 0.05 ) . Postoperative sedation and well-being scores did not differ significantly among groups . Conclusion . Our results show that for the prevention of postoperative nausea and vomiting 4 mg of ondansetron was inferior to 1.25 mg of droperidol . The drugs were given intravenously prior to general anaesthesia for minor gynaecological surgery with nitrous oxide and enflurane in oxygen supplemented with small boluses of alfentanil ." ], "offsets": [ [ 0, 2570 ] ] } ]

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"DerAnaesthesist.40430500.eng.abstr-s1-t6", "type": "umlsterm", "text": [ "5-HT3 receptor" ], "offsets": [ [ 26, 40 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0295352" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s1-t7", "type": "umlsterm", "text": [ "postoperative vomiting" ], "offsets": [ [ 151, 173 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0520905" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "ondansetron" ], "offsets": [ [ 221, 232 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0061851" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "postoperative" ], "offsets": [ [ 270, 283 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0032790" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "nausea" ], "offsets": [ [ 284, 290 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027497" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "vomiting" ], "offsets": [ [ 295, 303 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042963" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "postoperative nausea" ], "offsets": [ [ 270, 290 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0520904" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "aim" ], "offsets": [ [ 335, 338 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0108800" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "ondansetron" ], "offsets": [ [ 414, 425 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0061851" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "prevention" ], "offsets": [ [ 433, 443 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0687732" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s3-t4", 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1500, 1504 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0076174" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s10-t8", "type": "umlsterm", "text": [ "adverse effects" ], "offsets": [ [ 1456, 1471 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001688" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s12-t1", "type": "umlsterm", "text": [ "Patients" ], "offsets": [ [ 1555, 1563 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s12-t2", "type": "umlsterm", "text": [ "age" ], "offsets": [ [ 1593, 1596 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001792" }, { "db_name": "UMLS", "db_id": "C0001811" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s12-t3", "type": "umlsterm", "text": [ "weight" ], "offsets": [ [ 1613, 1619 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005910" }, { "db_name": "UMLS", "db_id": "C0043100" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s12-t4", "type": 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"offsets": [ [ 1839, 1847 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s14-t4", "type": "umlsterm", "text": [ "droperidol" ], "offsets": [ [ 1853, 1863 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013136" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s15-t1", "type": "umlsterm", "text": [ "incidence" ], "offsets": [ [ 1887, 1896 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0220856" }, { "db_name": "UMLS", "db_id": "C0021149" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s15-t2", "type": "umlsterm", "text": [ "nausea" ], "offsets": [ [ 1900, 1906 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027497" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s15-t3", "type": "umlsterm", "text": [ "ondansetron" ], "offsets": [ [ 1931, 1942 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0061851" } ] }, { "id": "DerAnaesthesist.40430500.eng.abstr-s15-t4", "type": "umlsterm", "text": [ 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[ { "id": "DerAnaesthesist.40430504.eng.abstr-passage-0", "type": "abstract", "text": [ "Introduction . Ondansetron is more effective than a placebo in treating postoperative nausea and vomiting ( PONV ) , but it has not been proved to be superior to established antiemetics for prophylaxis or therapy . We compared ondansetron vs droperidol for the treatment of PONV . Methods . Our prospective , randomized double-blind study was performed between 15 October 1992 and July 1993 ; it included 271 gynaecological ASA I - III inpatients who had been operated on under general anaesthesia with intubation . Patients were excluded if : there was no informed consent ; it was an ambulatory or emergency operation ; the patient was pregnant or breast feeding ; allergies were being treated with antihistamines ; drug addiction was present or convulsions or Parkinson's disease ; any pre- or intraoperative antiemetic medication had been administered . All patients wishing an antiemetic and/or suffering from at least one emetic episode during the first 24 h postoperatively received either 8 mg ondansetron or 1.25 mg droperidol from identical 4 ml ampoules intravenously . The verbal nausea score ( 1=none, 2=mild, 3=moderate, 4=severe) was recorded every 30 min for 4 h , then before and 2 h after each antiemetic dose . All emetic episodes and the interval between administration and effect were also noted . Patients were interviewed 36 - 48 h postoperatively on subjective effects , side-effects and individual acceptance . After oral premedication with diazepam , anaesthesia was induced with thiopental , in a few cases with etomidate or propofol . Relaxation was achieved with pancuronium or atracurium and , when indicated , with succinylcholine . Muscular relaxation was antagonized with neostigmin and glycopyrrolate . Gastric content was aspirated once after intubation . Anaesthesia was maintained with nitrous oxide/oxygen , enflurane , halothane or isoflurane and fentanyl up to 0.3 mg . Statistical evaluation was performed by the unpaired Student's t-test and the Mann-Whitney U test . Categoric variables were examined by the 2 test . Significance was defined as P 0.05. Results . Of 271 patients , 100 ( 37% ) experienced PONV . The groups were statistically comparable with respect to demographic data , type and duration of operation , emesis record , perioperative uterotonic medication . Twenty patients in the ondansetron group and 27 in the droperidol group received the first antiemetic within 2 h , the other patients up to 17 h after extubation . Nausea scores and emetic episodes were identical before antiemetic medication . The reduction of these parameters after medication was similar . Complete response over 6 h was 60% in the ondansetron and 68% in the droperidol group . In both groups the first medication failed in 4 cases during the initial 2 h . Twenty of the ondansetron and 16 of the droperidol patients needed a second dose ; among these 2 and 4 , respectively , a third ampoule . No rescue medication was necessary over 24 h and a mean of 1.4 ampoules was administered in both groups . Onset and quality of emetic action were identical in both groups . It was not possible to evaluate 25 interviews due to linguistic or amnestic problems . Multiple side-effects were noted frequently . Injection pain was reported significantly more often in the droperidol , pruritus in the ondansetron group . Ninety-three percent of the ondansetron and 85% of the droperidol patients opted for the same drug for future PONV treatment . Conclusions . Ondansetron ( 8 mg ) and droperidol ( 1.25 mg ) proved to be equally effective when used as a postoperative antiemetic . Both drugs showed similar side-effects . Due to differences in methods it was difficult to compare our results to those obtained in other studies ." ], "offsets": [ [ 0, 3756 ] ] } ]

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"type": "umlsterm", "text": [ "PONV" ], "offsets": [ [ 108, 112 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0520909" } ] }, { "id": "DerAnaesthesist.40430504.eng.abstr-s2-t7", "type": "umlsterm", "text": [ "antiemetics" ], "offsets": [ [ 174, 185 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003297" } ] }, { "id": "DerAnaesthesist.40430504.eng.abstr-s2-t8", "type": "umlsterm", "text": [ "prophylaxis" ], "offsets": [ [ 190, 201 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033107" } ] }, { "id": "DerAnaesthesist.40430504.eng.abstr-s2-t9", "type": "umlsterm", "text": [ "therapy" ], "offsets": [ [ 205, 212 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0087111" }, { "db_name": "UMLS", "db_id": "C0039798" } ] }, { "id": "DerAnaesthesist.40430504.eng.abstr-s2-t10", "type": "umlsterm", "text": [ "postoperative nausea" ], "offsets": [ [ 72, 92 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0520904" } ] }, { "id": "DerAnaesthesist.40430504.eng.abstr-s3-t1", 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[ { "id": "DerAnaesthesist.40430521.eng.abstr-passage-0", "type": "abstract", "text": [ "In most ventilators used in anaesthesia tidal volume delivered during mechanical ventilation is different from the tidal volume preset at the respirator on the basis of respirator and circuit compliance and gas compression during inspiration . The error in ventilation due to the compressed volume is especially significant clinically when the tidal volume is very small or when the airway pressure is very high . In newborns and neonates in particular , decreasing lung compliance during a surgical procedure may contribute to marked hypoventilation . We therefore investigated ventilation in newborn piglets during decreasing lung compliance induced by tension pneumothorax . We used the anaesthesia ventilator CICERO ( Draeger , Luebeck , Germany ) and the SERVO 900 C ventilator ( Siemens-Elema , Sweden ) . Materials and methods . Two anaesthesia ventilators , the CICERO ( group I , n=8) and the SERVO ventilators ( group II , n=8) were investigated following randomized selection in a group of 16 newborn piglets ( Table 1 ) . After normoventilation for 60 min a tension pneumothorax at +10 mbar was induced . After 15 min the pneumothorax was increased to +20 mbar and maintained at this level for the rest of the study . When hypercapnia ( PaCO2>45 mm Hg ) resulted , the respiratory rate was increased by +10/min after 15 min with pneumothorax at +20 mbar . When hypercapnia continued , the respiratory rate was increased again 25 min and if necessary also 35 min after the induction of pneumothorax at 20 mbar . After normoventilation for 60 min ( T1) ( Table 2 ) , after 15 min with pneumothorax at +10 mbar ( T2) and after 15 min ( T3), 25 min ( T4), 35 min ( T5) and 45 min ( T6) with pneumothorax at +20 mbar the following parameters were obtained : central venous ( CVP ) and mean arterial pressure ( MAP ) , heart rate ( HR ) , arterial ( PaCO2 and end-tidal CO2 tension ( PetCO2 ) , peak inspiratory pressure ( PIP ) , respiratory frequency ( RF ) and expiratory tidal ( Vtex ) and minute volume ( VE ) . Results . In group I the pneumothorax resulted in a significantly smaller increase in PaCO2 ( 43.3 +/- 6.2 mm Hg ) than in group II ( Fig . 1 ) , and hypercapnia was present in only 3 piglets . Vtex ( Fig . 2 ) , VE ( Fig . 3 ) and PIP ( Fig . 5 ) increased significantly , with significantly higher values than in group II , while PetCO2 ( Fig . 6 ) decreased significantly . In group II the pneumothorax was attributed to a significant increase in PaCO2 and a marked hypercapnia in all piglets ( PaCO2 61.2 +/- 5.9 mm Hg ) ( Fig . 1 ) . Vtex ( Fig . 2 ) and VE ( Fig . 3 ) remained unchanged , while PIP ( Fig . 5 ) and PetCO2 ( Fig . 6 ) increased . Following the increase in RF ( Fig . 4 ) in all piglets , Vtex and VE increased and PaCO2 and PetCO2 decreased . Conclusions . During ventilation of neonates with the SERVO ventilator a decrease in lung compliance will cause hypoventilation and hypercapnia . This is reflected by an increase in peak inspiratory pressure and can be corrected by increasing the respiratory rate . In contrast , the CICERO is able to preserve ventilation by an internal correction for gas compression , but it does not guarantee normoventilation in all cases . In neither group does the end-tidal PCO2 reflect the true ventilation during decreasing lung compliance , so that arterial blood gas analysis seems to be mandatory for the diagnosis of hypercapnia in such situations ." ], "offsets": [ [ 0, 3435 ] ] } ]

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[ { "id": "DerAnaesthesist.40430528.eng.abstr-passage-0", "type": "abstract", "text": [ "The aims of the study were : ( 1 ) to predict reversal time from intensive atracurium blockade ; and ( 2 ) to determine the optimal time of neostigmine administration during recovery from atracurium blockade , i.e. , the time at which the administration of neostigmine results in the shortest total recovery time ( time from administration of last supplemental dose of atracurium to train-of-four [ TOF ] ratio 0.70 ) , and at the same time results in the shortest time from administration of neostigmine to TOF ratio 0.70. Method . The spontaneous and neostigmine-facilitated recovery in 52 healthy women anaesthetised with thiopentone , fentanyl , droperidol , and nitrous oxide was followed . Post-tetanic count ( PTC ) of TOF stimulation of the ulnar nerve and mechanomyography were used for monitoring neuromuscular transmission . The neuromuscular blockade was induced with atracurium 0.6 mg/kg and supplemental doses of 0.15 mg/kg were given when the first twitch response in the TOF ( TH1) had recovered to 20% . Neostigmine 0.036 mg/kg body weight was given at different levels of neuromuscular blockade to 37 of the patients . Results . Multiple regression analyses including pre-reversal time ( time from administration of the last atracurium dose to neostigmine administration ) , PTC , weight , and age of the patients suggest that pre-reversal time is the best predictor of reversal time : reversal time=27.3 min- ( 0.89xpre-reversal time [ min ] ; ( SEE=6.0 min ) . If pre-reversal time is unknown , PTC can be used : reversal time=24 min- ( 4.5xln PTC ) at time of reversal ) ; ( SEE=6.8 min ) . Total recovery time was 47 min ( SEM=2.0 min , n=15) in the patients allowed to recover spontaneously , and 29 min ( SEM=1.2 min , n=29) in the patients reversed by neostigmine ; the difference of 18 min ( SE diff 2.0 min ) was significant ( P 0.0005 ) . The level of blockade indicated by PTC ( 1 - 24 ) at the time of reversal had no influence on the total recovery time . The spontaneous recovery times from reappearance of TH1 and TH1=10% to TOF ratio 0.70 were 29.2 min ( SEM=1.7 min ) and 24.4 min ( SEM=2.6 min ) , respectively . Discussion . The results suggest that pre-reversal time is the strongest predictor of reversal time when neostigmine is administered during intense atracurium blockade . To achieve the optimal time-saving effect , neostigmine must be given 18 min ( the time saved by giving neostigmine ) plus 7 to 11 min ( needed for neostigmine to reach its peak effect ) , giving a total of 25 to 29 min before TOF ratio 0.70. As TH1 is between 1% and 10% 25 to 29 min before TOF ratio 0.70 is reached during spontaneous recovery , the optimal level of neuromuscular blockade for neostigmine administration in atracurium blockade is when TH1 is between 1% and 10% . Conclusion . Reversal time can be predicted as 27.3 min- ( 0.89xpre-reversal time ( min ) , and the optimal time of neostigmine administration in atracurium blockade appears to be when TH1 is 1% - 10% ." ], "offsets": [ [ 0, 3003 ] ] } ]

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[ { "id": "DerAnaesthesist.40430534.eng.abstr-passage-0", "type": "abstract", "text": [ "Because the brain is highly vulnerable to damage from even a brief imbalance of oxygen delivery and demand , intraoperative disturbances of local oxygen supply must be avoided . Until now , there has been no method allowing fast and reliable intraoperative measurement of the local oxygen supply in the human brain . Intraoperative investigations were therefore performed using the Erlangen micro-lightguide spectrophotometer . Methods . Intraoperative investigations of local intracapillary haemoglobin saturation ( SO2) were performed during neurosurgical interventions using the Erlangen micro-lightguide spectrophotometer ( EMPHO ) . Measurements were performed in eight patients ( age 31 - 67 years ) during neurosurgical interventions . Three received thiopentone anaesthesia , and three received propofol . In two patients thiopentone anaesthesia was later changed to propofol . The EMPHO enables rapid , non-invasive measurement of local intracapillary SO2. White light from a Xenon-arc lamp is transmitted by a 250-µm micro-lightguide to the tissue . The remitted ( reflected ) light is led by 6 micro-lightguides surrounding the illuminating one to a rotating band-pass interference filter disk . Light in the range of 502 to 630 nm is detected with a photomultiplier . In this range haemoglobin shows an SO2-dependent spectrum , which is then analysed . Because the measurements are performed with micro-lightguides , high spatial resolution is attained . Representative measurements can be performed in a very short period of time ( approx . 60 s ) ; thus , the EMPHO enables rapid monitoring of local SO2 in the brain . Results . The effect of propofol and thiopentone anaesthesia on the distribution of local intracapillary haemoglobin saturation was investigated during neurosurgical interventions . The arterial PCO2 was similar in both groups ( 31 +/- 0.7 and 31 +/- 0.5 mm Hg , respectively ) . There were also no differences in arterial blood pressure . The FiO2 was 0.28 +/- 0.04 in the thiopentone group and 0.30 +/- 0.1 in the propofol group . In all patients receiving propofol anaesthesia higher local SO2 values were found , even if the patients first received thiopentone ( values in parenthesis ) . The mean local SO2 amounted to 65.4% ( 57.3% ) in the propofol group and 38.8% ( 45.2% ) in the thiopentone group . The number of values below 25% SO2 was 5.6% ( 5.8% ) in the propofol group and 18.7% ( 19.1% ) in the thiopentone group ." ], "offsets": [ [ 0, 2463 ] ] } ]

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[ { "id": "DerAnaesthesist.40430547.eng.abstr-passage-0", "type": "abstract", "text": [ "The analgetic efficacy of intraoperative infiltration with bupivacaine 0.5% or saline of the skin incisions for the endoscopic trocars was examined in 30 female patients following operative endoscopic pelviscopy in a double-blind study . Infiltration of the peritoneum , abdominal wall , and subcutaneously was performed by endoscopic view before skin suture . There were no significant differences between the two groups in age , duration of surgery , operative technique , intensity of preoperative acute and chronic pain , or state of anxiety . Postoperative pain assessment was performed using a numeric rating scale ( NRS ) hourly within the first 8 h and after 24 h postoperatively . After 8 h patients were asked for the localisation and description of the worst pain . Cumulative tramadol doses were calculated for 3 , 8 and 24 h using patient-controlled analgesia ( PCA ) . Pain intensity within the first 8 h postoperatively did not differ between the bupivacaine and placebo groups ( Fig . 1 ) . The mean NRS after bupivacaine infiltration was 4.6 ( +/- 2.4 ) in the 1st - 3rd h and 3.4 ( +/- 1.8 ) after 6 - 8 h ( placebo : 4.8 ( +/- 2 ) and 2.4 ( +/- 1.7 ) ) . In both groups most patients reported lower ( 40% ) or upper ( 12% ) abdominal visceral pain as their worst pain . Pain due to skin incision was noted less , but in equal numbers in both groups . Of the patients in the bupivacaine group 77% and in the control group 80% started with PCA due to increasing pain scores within 60 to 120 min . The numbers of tramadol demands and given doses did not differ ( Fig . 2 ) . Therefore , intraoperative infiltration of the abdominal wall and skin with bupivacaine cannot be recommended for postoperative pain therapy after pelviscopy . Pain involving visceral afferents seems to play the major role following abdominal endoscopic surgery . In addition , the study supports recent reports showing that even after minimal invasive surgery most patients need opioids in the early postoperative period ." ], "offsets": [ [ 0, 2014 ] ] } ]

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"C0030201" } ] }, { "id": "DerAnaesthesist.40430547.eng.abstr-s15-t8", "type": "umlsterm", "text": [ "pain therapy" ], "offsets": [ [ 1719, 1731 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002766" } ] }, { "id": "DerAnaesthesist.40430547.eng.abstr-s16-t1", "type": "umlsterm", "text": [ "Pain" ], "offsets": [ [ 1751, 1755 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030193" } ] }, { "id": "DerAnaesthesist.40430547.eng.abstr-s16-t2", "type": "umlsterm", "text": [ "role" ], "offsets": [ [ 1809, 1813 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0035820" } ] }, { "id": "DerAnaesthesist.40430547.eng.abstr-s16-t3", "type": "umlsterm", "text": [ "surgery" ], "offsets": [ [ 1845, 1852 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038894" }, { "db_name": "UMLS", "db_id": "C0038895" } ] }, { "id": "DerAnaesthesist.40430547.eng.abstr-s16-t4", "type": "umlsterm", "text": [ "visceral afferents" ], "offsets": [ [ 1766, 1784 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0206309" } ] }, { "id": "DerAnaesthesist.40430547.eng.abstr-s16-t5", "type": "umlsterm", "text": [ "endoscopic surgery" ], "offsets": [ [ 1834, 1852 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0282493" } ] }, { "id": "DerAnaesthesist.40430547.eng.abstr-s17-t1", "type": "umlsterm", "text": [ "surgery" ], "offsets": [ [ 1944, 1951 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038894" }, { "db_name": "UMLS", "db_id": "C0038895" } ] }, { "id": "DerAnaesthesist.40430547.eng.abstr-s17-t2", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 1957, 1965 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.40430547.eng.abstr-s17-t3", "type": "umlsterm", "text": [ "opioids" ], "offsets": [ [ 1971, 1978 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242402" } ] }, { "id": "DerAnaesthesist.40430547.eng.abstr-s17-t4", "type": "umlsterm", "text": [ "postoperative" ], "offsets": [ [ 1992, 2005 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0032790" } ] }, { "id": "DerAnaesthesist.40430547.eng.abstr-s17-t5", "type": "umlsterm", "text": [ "period" ], "offsets": [ [ 2006, 2012 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0025344" } ] }, { "id": "DerAnaesthesist.40430547.eng.abstr-s17-t6", "type": "umlsterm", "text": [ "postoperative period" ], "offsets": [ [ 1992, 2012 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0032790" } ] } ]

[]

[]

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[ { "id": "DerAnaesthesist.40430553.eng.abstr-passage-0", "type": "abstract", "text": [ "Case report . A 34-year-old male ( 190 cm/100 kg ) was scheduled for surgery of the nasal septum . He had had uneventful anaesthesia for appendicectomy 14 years earlier : following 600 mg thiopentone , 180 mg suxamethonium and up to 2 vol . % halothane for 20 min had been used and no symptoms of malignant hyperthermia ( MH ) were recorded . Following oral premedication with 2 mg flunitrazepam at 7.00 a.m. anaesthesia was induced with a priming dose of atracurium at 8.45 a.m. followed by 0.2 mg fentanyl , 500 mg thiopentone , and 100 mg suxamethonium . Endotracheal intubation was accomplished easily [ 9 ] , and the patient was ventilated manually in a semi-closed circle system until spontaneous ventilation resumed . Enflurane ( 1.5% for 5 min , 1.0% for 10 min , and 0.8% until the diagnosis of MH was suspected ) was given in 33% O2/66% N2O. Seventy minutes after induction it was noted that the spontaneous respiratory rate and minute volume had risen continuously from 10/min and 6 l/min , respectively , to 20/min and 12 l/min . Attempts at deepening anaesthesia with repeated doses of fentanyl up to a total dose of 0.95 mg failed to reduce the hyperventilation . In spite of a high fresh gas flow of 6 l/min and assisted manual ventilation , the FIO2 started to fall from 0.34 to 0.28 at 10:20 a.m. The O2/N2O ratio was changed to 1 : 1 , but the FIO2 remained at 0.3. MH was suspected , enflurane was discontinued , and an arterial blood gas analysis was done ( Table 2 ) . When marked acidosis and hypercarbia were found , dantrolene 2.5 mg/kg was given , the operation was terminated , and the patient's trachea was extubated and he was monitored closely in the intensive care unit for 24 h . Vital signs were stable ( Table 3 ) and no further complications were observed . The patient did not mention pain or uneasiness postoperatively . About 6 months later , a muscle biopsy was done according to the European MH Protocol [ 5 ] and the patient was found to be MHEh . Discussion . In this case five main reasons for the hypercarbia and mixed acidosis must be considered ( Table 1 ) . Firstly , hypoventilation does not seem to be reasonable as the patient was ventilated with 8 to 12 l/min , which is within the range of 80 - 120 mg/kg - min . Secondly , we can exclude shock and hypoperfusion because the patient had a normal blood pressure and heart rate ( within 65 - 90 beats/min ) , his fingertips and skin were well perfused , his body temperature was 37 °C, and there was no sign of muscle rigidity . Thirdly , a defect of the CO2 adsorber as well as CO2 admixture to the N2O and O2 ventilation gases can cause hypercarbia . We use two absorbers in sequence of which one is changed every day , and found neither a change in colour of the indicator nor an abnormally raised temperature of the absorbers [ 11 ] . A postoperative check of the ventilator showed no defect in the O2/N2O supply and a correctly functioning anaesthesia apparatus . A malfunction of both CO2 absorbers resulting in intraoperative hypercarbia could not explain a postoperative mixed acidosis lasting for more than 6 h . Anaesthesias performed at the same time using soda lime from the same canisters were totally uneventful . Conclusion . It is concluded that the hypercarbia and mixed acidosis were caused by hypermetabolism . A thorough postoperative examination by an internist did not reveal any thyroid , pulmonary , endocrine , or circulatory reason for our intra- and postoperative findings . Iatrogenic factors like superficial anaesthesia or systemic side effects of adrenaline admixture to local anaesthetics can cause hypermetabolism without striking clinical signs , but they do not cause mixed acidosis lasting longer than 6 h ( Table 2 ) . The most suitable explanation in this case is an abortive form of MH ." ], "offsets": [ [ 0, 3825 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.40430557.eng.abstr-passage-0", "type": "abstract", "text": [ "Malignant hyperthermia ( MH ) is a rare , life-threatening pharmacogenetic disease . The genetic incidence is estimated to be 1 : 10 000. In predisposed individuals , MH is triggered by volatile anaesthetics and/or depolarizing muscle relaxants by an abnormal increase of intracellular calcium concentration in skeletal muscle cells . The clinical presentation may vary from abortive MH to the fulminant MH crisis . Early diagnosis , the use of electrocardiography and capnography for anaesthetic monitoring , immediate cessation of trigger agents and dantrolene treatment are essential components of an effective MH therapy . In some MH families , a genetic alteration of the ryanodine receptor gene ( a calcium channel of the sarcoplasmic reticulum ) on chromosome 19 has been identified as the potential cause of MH susceptibility . Recent molecular biological findings support the view of MH being a heterogenetic disease . At present , the diagnosis in potentially MH-susceptible individuals is still made using the in vitro halothane and caffeine muscle contracture test ." ], "offsets": [ [ 0, 1078 ] ] } ]

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[ { "id": "DerAnaesthesist.40430573.eng.abstr-passage-0", "type": "abstract", "text": [ "Total intravenous anaesthesia ( TIVA ) is increasingly used in short-stay surgery such as laparoscopic cholecystectomy . TIVA may provide fast recovery of psychomotor function , thus being of benefit to both the patient's behaviour and postoperative management . The purpose of this prospective study was to compare postoperative recovery from TIVA using propofol or methohexitone as the hypnotic component and balanced anaesthesia with isoflurane . Patients and methods . After giving informed consent and approval by the ethical committee of our hospital , 51 patients ( ASA I , II ) were investigated in a prospective study . Patients were randomised to receive either isoflurane , methohexitone , or propofol . Perioperative management with regard to premedication , intraoperative analgesia , relaxation , ventilation , and postoperative analgesia was carried out identically for all groups . Postoperative vigilance , pain , and nausea scores were assessed 15 , 30 , 60 , 120 , and 360 min after extubation with a visual analogue scale ( VAS ) . At the same points , psychomotor recovery was investigated with the following assays : sedation as shown in Table 1 ; orientation with ten questions as to person , time , and location ; memory as expressed by the patient's ability to repeat five words ; a calculation test with five subtractions of the number 7 beginning from 100 ; and word generation by the number of words with an initial \" m \" given within 1 min and with animal names . Data were analysed with Kruskal Wallis ' test for multiple comparisons between the groups and with Friedman's test for repeated measurements . All values are given as medians ( interquartile range ) or ranges . Results . There was no difference between the groups ' physical condition ( Table 2 ) . All intraoperative parameters compared well between groups ; the management of anaesthesia was smoother with isoflurane than with the other anaesthetics . Psychomotor recovery was somewhat faster in the propofol group than the methohexitone group , as indicated by sedation score , orientation , memory and calculation tests ( Table 4 ) , word generation tests ( Fig . 4 ) , and subjective vigilance score ( Fig . 3 ) . The difference in recovery time between the propofol and isoflurane groups was minimal and without any significance or relevance . The incidence of postoperative nausea was significantly lower after balanced anaesthesia with isoflurane ( 24% , P 0.05 ) as compared to TIVA with either propofol ( 53% ) or methohexitone ( 41% ) . However , there were only minor differences between the groups ; the ability to cooperate and be mobilised was not limited . Discussion . Each of the three techniques used in this study is suitable for anaesthesia in patients undergoing laparoscopic cholecystectomy . Since fast recovery of vigilance and psychomotor function is very important in outpatient surgery , opioid-supplemented propofol anaesthesia is well established . Inhalation anaesthesia with isoflurane in air/oxygen without adding nitrous oxide compares well to propofol TIVA for laparoscopic surgery ." ], "offsets": [ [ 0, 3111 ] ] } ]

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[ { "id": "DerAnaesthesist.40430582.eng.abstr-passage-0", "type": "abstract", "text": [ "Preoperative detection of a patent foramen ovale ( PFO ) may be achieved employing either transthoracic echocardiography ( TTE ) with the Valsalva manoeuvre in the awake patient or trans-oesophageal echocardiography ( TEE ) in the anaesthesised patient . Our study was undertaken to validate these methods with regard to their efficacy in identifying patients at risk for paradoxical air embolism ( PAE ) . Methods . In 67 patients ranging from 28 to 70 years of age , TEE was performed utilising the Valsalva manoeuvre prior to surgery . The patients were informed about all procedures and agreed to take part in the study . After induction of anaesthesia the patients were evaluated with TEE in the supine and sitting positions . At end-inspiration 10 ml agitated gelatine solution ( Gelafundin ) was injected through a central venous catheter into the right atrium after airway pressure of 20 cm H2O had been maintained for 5 s. The injected bolus was observed throughout the ventilatory cycle , with special attention being given to early expiration and systole . A right-to-left shunt was assumed if five echo targets were observed in the left atrium . Results . The prevalence of PFO detected by TTE/Valsalva was 9% . The diagnosis was confirmed by TEE in 2 patients in the supine and 1 in the sitting position . An echocardiogram in these patients showed bulging of the septum to the left , which was not seen in those patients in whom PFO was detected only by TTE . Discussion . The reason for the lower incidence of PFO detected by TEE during airway pressure 20 cm H2O may have been an insufficient increase of pressure in the right atrium with a negative right-to-left atrial pressure gradient . A standardised ventilation manoeuvre with supra-atmospheric airway pressure of 20 cm H2O is not sufficient . Bulging of the intra-atrial septum from right to left during airway pressure is a possible indication of the efficacy of the manoeuvre , regardless of the influence of the breathing pattern ." ], "offsets": [ [ 0, 2006 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.40430594.eng.abstr-passage-0", "type": "abstract", "text": [ "Total intravenous anaesthesia ( TIVA ) using a combination of a hypnotic and an analgesic agent is gaining increasing popularity as an alternative to balanced anaesthesia with volatile anaesthetics for abdominal surgery . Among the required characteristics of the drugs used in this technique are a good correlation between dose , plasma concentrations , and effect as well as rapid elimination from the circulation , allowing close control of anaesthetic depth . Two hypnotic drugs with similar pharmacokinetic and pharmacodynamic profiles are propofol and methohexitone , both of which can be employed as a component of a TIVA technique . Two TIVA combinations utilising either of these drugs with alfentanil were tested against isoflurane-nitrous oxide in a balanced regimen . Methods . Twenty-seven healthy women undergoing hysterectomy for non-malignant diseases participated in the study after having given written consent . They were randomly allocated to receive either isoflurane ( Iso ) , methohexital-alfentanil ( M-A ) , or propofol-alfentanil ( P-A ) . Blood samples for determination of cortisol , prolactin , catecholamines , glucose , lactate , non-esterified fatty acids , and pharmacon concentrations were drawn repeatedly from before induction until 360 min after surgery . Anaesthesia was induced in group Iso with fentanyl 0.1 mg and M 1.5 mg - kg-1 and maintained with Iso-N2O. In the TIVA groups M or P was given in a two-step infusion to load peripheral compartments and then maintain plasma concentrations within the hypnotic range . A was given as a continuous infusion in an identical dose ( 0.1 mg - kg-1 initial , 0.125 mg - kg-1 - h-1 maintenance ) in both groups . If signs of insufficient depth of anaesthesia occurred ( heart rate or systolic blood pressure > 25% above baseline ) , then first A ( 0.5 - 1 mg ) , and if that was ineffective , then 50 mg hypnotic was administered . The A infusion was stopped 30 min before the end of surgery , and Iso or the hypnotic was stopped at skin closure . Recovery time was the time until the patients were able to give their birth date after stopping the Iso or hypnotic . Results . The three groups were comparable with regard to age , weight , and duration of surgery . The total doses of M and P were 1,357 +/- 125 mg ( mean +/- SEM ) and 1,315 +/- 121 mg , respectively , and the total A doses were 20.7 +/- 2.5 mg ( M-A ) and 23.4 +/- 3.5 ( P-A ) . The peak plasma concentrations were P 10.6 +/- 1.5 µg - ml-1 and M 12.4 +/- 2.6 µg - ml-1. At the end of surgery the P concentrations were in the projected range while those of M were somewhat lower than expected ( P3.7 +/- 0.4 µg - ml-1; M 3.5 +/- 0.6 µg - ml-1). Three patients each in the P-A and M-A groups required supplementary A injections . Five patients in the P-A group required additional bolus injections of the hypnotic as compared to 2 in the M-A group . The median recovery times were Iso 15 min , M-A 50 min , and P-A 25 min ( P 0.05 ) . The incidence of shivering was Iso 3/9 , M-A 5/9 , and P-A 0/9 ( P 0.05 ) ; vomiting occurred with equal frequency in all groups ( Iso 33% , M-A 33% , P-A 22% ) . The patients were somewhat more restless in group M-A . Systolic blood pressure dropped in a similar manner in all groups after induction of anaesthesia ( Iso -31% , M-A -37% , P-A -36% ) but recovered during surgery . The intraoperative response of cortisol ( Iso +216% , M-A +92% , P-A +43% ) and catecholamines ( noradrenaline Iso +56% , M-A +30% , P-A -21% ) was lower in the TIVA groups , whereas prolactin increased after induction in all groups . Plasma concentrations of glucose , lactate , and fatty acids were lower in the TIVA groups than in the Iso group intraoperatively , but increased to comparable postoperative levels ." ], "offsets": [ [ 0, 3783 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.40430605.eng.abstr-passage-0", "type": "abstract", "text": [ "Etomidate is a hypnotic with only minor effects on haemodynamics . Although its rapid elimination kinetics would suggest its use in total intravenous anaesthesia ( TIVA ) and sedation , its administration in higher doses or for a prolonged period has been discouraged due to its inhibitory effects on corticosteroid synthesis . Newer evidence that the suppression of cortisol synthesis might not be total requires a re-evaluation of this drug as a component of a TIVA technique . The effects of high-dose etomidate with fentanyl on spontaneous and stimulated corticosteroid levels as a measure of the magnitude and duration of adrenocortical suppression , as well as on plasma concentrations of adrenocorticotropic hormone ( ACTH ) -endorphin , and catecholamines during cardiac surgery were investigated in a prospective , randomised study and compared to those following the administration of midazolam-fentanyl . Patients and methods . Nineteen patients undergoing myocardial revascularisation were assigned to two groups : group 1 : etomidate-fentanyl ( n=9) and group 2 : midazolam-fentanyl ( n=10). Anaesthesia was induced with fentanyl 0.5 mg and either etomidate 0.3 mg/kg or midazolam 0.2 mg/kg . Relaxation was achieved with pancuronium 0.1 mg/kg . Anaesthesia was maintained during extracorporeal circulation ( ECC ) with an infusion of etomidate ( 0.36 mg - kg-1 - h-1) or midazolam ( 0.16 mg - kg-1 - h-1) and fentanyl ( 10 µg - kg-1 - h-1. Blood samples were drawn before induction , before ECC , and 1 , 6 , and 20 h after surgery . Cortisol secretion was stimulated with 0.25 mg ACTH1 - 24 IV at 6 and 20 h postoperatively . Results . The total drug doses were etomidate 87 +/- 3 mg and midazolam 46 +/- 2 mg . Plasma cortisol concentrations decreased in the etomidate group from 20 ( 10 - 31 ) to 10 ( 6 - 31 ) µg - dl-1 ( median and range ) before ECC , but had returned to baseline at 1 h and were significantly increased at 6 h [ 29 ( 15 - 47 ) µg - dl-1] and 20 h [ 46 ( 29 - 62 ) µg - dl-1]. There was no difference between the groups except at 20 h , when cortisol levels were higher in the etomidate group . The stimulated cortisol increase was markedly impaired in this group at both measuring points . ACTH and -endorphin were markedly increased in the etomidate group and ACTH concentrations were eight times greater than the corresponding values in the midazolam group after surgery ( ACTH 141 vs. 18 pmol - l-1). Plasma catecholamine concentrations increased significantly in both groups . Noradrenaline concentrations were greater in the etomidate group at 6 h after surgery . Two patients in the midazolam group and none in the etomidate group required circulatory support with exogenous catecholamines . Discussion . It is concluded that the stress of cardiac surgery can overcome the block in cortisol synthesis caused by the administration of high-dose etomidate by substantially increasing ACTH secretion . The administration of high-dose etomidate was not associated with cardiovascular instability . The use of etomidate as a component of TIVA can therefore not be ruled out on the grounds of insufficient cortisol secretion ." ], "offsets": [ [ 0, 3163 ] ] } ]

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[ { "id": "DerAnaesthesist.40430614.eng.abstr-passage-0", "type": "abstract", "text": [ "More than 50% of all congential haemangiomas are located on the head and neck . Because most orofacial haemangiomas exhibit the tendency to grow rapidly , they are often treated by embolisation and excision . Case report . The case of a 5-year-old patient is presented , who was admitted to the hospital for embolisation and immediate surgery of a haemangioma of the right side of the face and upper lip . After the injection of 2 ml fibrin glue she suddenly developed hypotension , tachycardia , a low oxygen saturation , and a low end-tidal carbon dioxide partial pressure . There was no failure of the breathing circuit and no airway obstruction could be found . Most likely these symptoms were due to transport of the fibrin glue from the haemangioma into pulmonary vessels . The therapy included the administration of heparin and antihypotensive drugs . After stabilisation , the patient was transferred to the intensive care unit for 1 day without further complications . Conclusion . Pulmonary embolism after injection of fibrin glue into an orofacial haemangioma has not previously been reported , but it should be considered that systemic complications can occur after injecting substances for embolisation into vessel-rich tissues ." ], "offsets": [ [ 0, 1242 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.40430618.eng.abstr-passage-0", "type": "abstract", "text": [ "Securing the airway following surgery can be a problem in certain patients . Preparation , therefore , should include a plan for safe reintubation , if necessary . We report two patients with a difficult airway ( recurrent thyroid carcinoma , inoperable carcinoma of the hypopharynx ) who were at a high risk for intubation under general anaesthesia . In addition , one of the patients suffered from an acute abdomen and ileus . We used a guidewire placed into the trachea via a fiberscope to facilitate fiberoptic reintubation ." ], "offsets": [ [ 0, 529 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.40430642.eng.abstr-passage-0", "type": "abstract", "text": [ "Continuous monitoring of blood gases and pH could add substantially to patient safety . During the last decade , efforts have been made to develop continuous optochemical blood gas sensors . The initial evaluation of such fibreoptic-based systems showed major patient-interface problems [ 11 ] . We evaluated a new intra-arterial blood gas monitoring system ( PB3300 , Puritan-Bennett , Carlsbad CA ) under routine clinical conditions . Methods . After institutional review board approval and with written informed consent , 38 sensors were tested in 25 patients with acute respiratory failure ( e.g. , the acute respiratory distress syndrome , complications after lung transplantation ) . Two conventional bench-top blood gas analysers ( ABL 520 and ABL 300 , Radiometer , Copenhagen ) served as criterion standards . The mean differences ( bias ) and standard deviations ( SD ) of the differences ( precision ) were calculated according to the method of Bland and Altman [ 2 ] . In addition , linear regression analysis and correlation coefficients were calculated . The quality of blood pressure tracings was assessed using a grading system . Results . The median sensor lifetime was 81.3 h ; 869 blood samples ( median 14 per sensor ) were analysed for the comparison of continuous and conventional blood gas analysis . The ranges for measured parameters were : pH : 6.92 to 7.55 ; PCO2: 20 to 83 torr ; PO2: 31 to 518 torr . The mean differences ( SD ) were : pH : -0 . 03 ( 0.03 ) or -0 . 4 ( 0.4 ) % ; PCO2: -2 . 6 ( 4.1 ) torr or -6 . 9 ( 10.9 ) % ; PO2: -3 . 4 ( 10.5 ) torr or -2 . 9 ( 7.0 ) % . The results of linear regression analysis and the correlation coefficients are depicted in Table 2. The mean grade of blood pressure tracings was satisfactory for the clinical setting . Conclusions . The continuous blood gas monitor is sufficiently accurate and precise for clinical use . Bias and precision are better than those known from former studies evaluating fibreoptic blood gas monitors under experimental conditions [ 7 ] . Cost-effectiveness was not an issue of this study ." ], "offsets": [ [ 0, 2092 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.40430648.eng.abstr-passage-0", "type": "abstract", "text": [ "Hypothermia ( Tcore 36 °C) can be observed in 60% - 80% of all admissions to the post-anaesthetic recovery unit . Effective warming devices may accelerate rewarming , improve patient comfort , and suppress shivering thermogenesis . This study was designed to compare the efficiency of warming devices in extubated postoperative patients and their effect on postoperative oxygen uptake ( V. O2). Methods . Thirty-five ASA I and II patients after laparoscopic hernioplastic repair with core temperatures 36 °C were randomly assigned to either postoperative nursing under a radiant heater ( group R , n=11, Aragona Thermal Ceilings CTC X , Aragona Medical AB , Taeby , Sweden ) , a forced air system ( group L , n=12, Bair Hugger , Augustine Medical Inc. , Eden Prairie , Minnesota , USA ) , or a normal cotton hospital blanket ( group K , n=12). Anaesthesia was conducted totally intravenously with propofol , alfentanil , and vecuronium . Mean body temperature and total body heat were calculated from urinary bladder temperature and four subcutaneous temperature measurements . The rate of thermogenesis was calculated from continuous measurement of V. O2 ( Datex Deltatrac Metabolic Monitor , Datex Instrumentarium Corp. , Helsinki , Finland ) . Heat balance was derived from the increase in total body heat minus body heat production . Heart rate and noninvasive blood pressure were measured by the Cardiocap ( Datex Instrumentarium Corp. , Helsinki , Finland ) . All data were transferred to an IBM-compatible computer at 60-s intervals . Measurements were stopped when core temperature reached 37 °C. The rate of change was calculated for each variable for the period 15 min after the beginning of rewarming to attainment of 37 °C. Data are presented as median , minima , and maxima ( min - > max ) ; the Mann-Whitney U test was used to test for significance of group differences . Results . All groups were comparable for body weight , height , age , and amount of postoperative infusions . Temperatures at admission were 35.2 ( 33.4 - > 35.9 ) , 34.7 ( 34.3 - > 35.8 ) , and 35.4 ( 34.3 - > 35.9 ) °C for groups R , B , and K , respectively . No significant differences in the rate of central rewarming could be found for these groups with 0.81 ( 0.41 - > 1.32 ) , 0.76 ( 0.40 - > 1.07 ) , and 0.70 ( 0.37 - > 1.13 ) °C/h ( Fig . 1 ) . The mean V. O2 of 3.41 ( 3.07 - > 3.73 ) , 3.55 ( 2.78 - > 4.06 ) , and 3.79 ( 2.51 - > 7.00 ) ml/kg/min also did not differ significantly ( Fig . 3 ) . Significant differences between groups R and B [ 4.39 ( 3.74 - > 6.19 ) and 4.30 ( 3.46 - > 6.67 ) ml/kg/min ] and K [ 5.92 ( 3.79 - > 10.64 ) ml/kg/min ] were found for V. O2 maxima during the course of investigation ( Fig . 4 ) . The heat balance revealed significant differences among treatment and control groups with -88 ( -266 - > +30 ) , -41 ( -212 - > +12 ) , and -191 ( -265 - > -86 ) kJ/h for groups R , B , and K. We additionally calculated the heat balance as a quotient , which showed 0.70 ( 0.22 - > 1.07 ) , 0.86 ( 0.44 - > 1.04 ) , and 0.49 ( 0.31 - > 0.79 ) for groups R , B , and K ( Fig . 4 ) . The mean rate-pressure product of all groups did not differ significantly during the period of investigation . Conclusions . Neither external heat supply by radiant heat nor by a forced warm air system significantly reduced rewarming time in extubated , awake patients . As measured by heat balance , both active treatments saved about 20% more body heat production than in the control group . Continuing peripheral vasoconstriction may be the reason for the low efficiency of heat transfer . Thermal treatment did reduce the peak load ( max . V. O2) on the oxygen transport systems , though shivering was treated by pethidine if it occurred . External rewarming did not reduce the average load ( mean V. O2)." ], "offsets": [ [ 0, 3818 ] ] } ]

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[ { "id": "DerAnaesthesist.40430658.eng.abstr-passage-0", "type": "abstract", "text": [ "Automated measurements of respiratory gas exchange recently became available for the determination of oxygen uptake ( V. O2) in critically ill patients . Whereas these metabolic gas monitoring systems ( MBM ) are assumed to measure total body V. O2, the reversed Fick method in principle excludes intrapulmonary V. O2. Previous clinical reports comparing V. O2 measured by the reversed Fick principle ( V. O2 Fick ) with V. O2 measured by MBM ( V. O2 MBM ) found that V. O2 MBM was significantly greater than V. O2 Fick . It was suggested that these differences between methods represent V. O2 of pulmonary and bronchial tissue , as intrapulmonary V. O2 had been estimated to account for 15% of total body V. O2 in dogs with experimental pneumonia . The objective of this study was to compare V. O2 Fick with V. O2 MBM in patients with and without pneumonia and to assess the reproducibility of both methods in critically ill patients . Method . With institutional approval nine critically ill patients with acute pneumonia were studied under controlled mechanical ventilation . The diagnosis of pneumonia was based on respective changes of chest X-rays , body temperature > 38 °C, and WBC counts > 12,000/mm3. Inspiratory oxygen fractions ( FIO2) ranged from 0.3 to 0.6 ; all patients routinely received opioids and hypnotics . Complete muscle relaxation was achieved during the periods of measurement to avoid sudden changes in V. O2 due to shivering or involuntary movements . Arterial and pulmonary-arterial blood samples were drawn simultaneously after aspiration of the sevenfold catheter dead space . Measurements of haemoglobin concentration ( Hb ) , fractional oxygen saturation ( SO2), and O2 partial pressure ( PO2) were performed by use of a calibrated haemoximeter and blood gas analyser , respectively ; 2x5 thermodilution measurements of cardiac output ( CO ) were spread randomly over the respiratory cycle for each determination of V. O2 Fick . To minimise systematic errors of CO measurements , the CO computer was calibrated in an extracorporeal model using an electromagnetic flowmeter . Calculations of V. O2 Fick were based on an oxygen binding capacity of 1.39 ml/g Hb . Simultaneous measurements of V. O2 MBM were obtained by use of a Datex Deltatrac MBM that had been validated in vitro with a gas dilution model of respiratory gas exchange . Calibration of the MBM was performed prior to each measurement . Gas supply of the respirator was provided by an external high-precision mixing device to reduce errors in V. O2 measurements that may arise from short-term oscillations in FIO2. All patients with pneumonia were studied on three consecutive days ; thus , measurements from 27 days could be analysed . On each day two sets of measurements were performed at an interval of 60 min to assess the reproducibility of differences between methods . During each set of measurements duplicate blood samples were drawn twice , before and after thermodilution measurements of CO , to evaluate the short-term repeatability of V. O2 Fick . The beginning and the end of each set of measurements were marked in the computer record of the MBM to assess the respective repeatability of V. O2 MBM . Fifty control measurements were performed in ten patients undergoing major neurosurgical procedures . None of these patients exhibited signs of pulmonary infection . Except for the number of repeated measures , all V. O2 measurements were obtained in the same way as in the study group ." ], "offsets": [ [ 0, 3499 ] ] } ]

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[ { "id": "DerAnaesthesist.40430667.eng.abstr-passage-0", "type": "abstract", "text": [ "The advantages of the addition of low-dose sufentanil to local anaesthetics in epidural analgesia during labour ( improvement of analgesia , reduction of total dose of local anaesthetic , reduction of rate of instrumental delivery outweigh ) far the disadvantages ( pruritus , sedation , potential maternal and neonatal respiratory depression ) . In over 8000 cases , the addition of incremental sufentanil ( 7.5 µg) up to 30 µg has not caused any negative effects on newborns , and hence , the addition of sufentanil is justified ; it may even be indicated . Sufentanil has not yet been registered for epidural analgesia in Germany , in contrast to other countries . In considering whether this fact may prohibit its use , two aspects should be discussed : therapy and clinical experiments . The difference lies in the purpose rather than in the method of administration . Ethical and legal requirements for clinical tests are anchored in the declaration of Helsinki and the code of the medical profession . The legal background for therapy is represented in the proviso of the German Civil and Criminal Codes as well as the code of conduct on professional liability of the physician . Pain during labour is no absolute indication for the addition of sufentanil , but there are considerable arguments for its superiority in comparison to other standard procedures : the side effects and complications are very limited . Justification of this method is relatively easy in view of the fact that sufentanil has already been registered for peridural analgesia in obstetrics in many other countries . Last but not least , the patient must give informed consent before any procedure can be performed ." ], "offsets": [ [ 0, 1696 ] ] } ]

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[ { "id": "DerAnaesthesist.40430674.eng.abstr-passage-0", "type": "abstract", "text": [ "Cannulation of the axillary vein is claimed to be an effective and relatively safe access to the central venous ( CV ) system [ 2 , 4 , 5 , 8 ] . However , anatomical landmarks recommended for venous location ( Muskulus pectoralis minor , processus coracoideus ) are probably hard to identify in the majority of intensive care ( ICU ) patients . This investigation evaluated unidirectional 8 MHz Doppler ultrasound ( US ) in locating the axillary vein . Success rates and complications of this CV access in ICU patients is analysed . Methods . The experimental design was approved by the local ethical committee ( RUB ) . In 50 patients from our ICU cannulation of the axillary vein was attempted ; all were in need of a CV line . Other CV puncture sites ( except for the subclavian vein ) were associated with contraindications . Patients were placed in a 15 ° Trendelenburg position ( 15 exceptions ) ; the arm was abducted to 45 ° [ 5 , 8 ] . The course of the axillary vein was located by Doppler US and marked on the skin with a felt pen . Prior to puncture , US intensity was judged by a score ranging from 0 to 4. After skin desinfection , sterile draping , and local anaesthesia , puncture of the axillary vein was attempted . The puncture kit Leader-Cath 11515 ( Vygon , Aachen , FRG ) was used . When venous blood could be aspirated , the Seldinger guide-wire was inserted and the definite catheter placed . The experimental design allowed up to ten punctures , slightly modified in angle and direction of the needle , if puncture of the axillary vein or guide-wire placement failed . The cannulation attempt was classified as unsuccessful in the following cases : malposition , axillary vein not encountered by the puncture needle , guide-wire placement unsuccessful , or if identification and cannulation of the vein lasted more than 20 min . The puncture attempts were evaluated in respect to success rate , time , relation of US intensity to puncture attempts and CV pressure , complications , and malposition . Results . Of the 50 attempted CV catheters , 43 were placed successfully . In 2 cases the axillary vein could not be encountered by the puncture needle . Guide-wire placement did not succeed in 4 patients . One catheter was malpositioned in the ipsilateral internal jugular vein . Four inadvertent punctures of the axillary artery remained without sequelae after compression . No further puncture-related complications were observed . With high US intensity score the number of puncture attempts necessary for successful vein cannulation was lower . On the other hand , complications and puncture failure seemed to be more frequent in patients with lower US intensity scores . Discussion . CV access via the axillary vein had a satisfying success rate ( 43/50 ) and proved to be a safe procedure in our ICU patients despite higher risk factors compared to a healthy population . Although ethical reasons did not allow a randomised comparison with the standard technique , location of the axillary vein by Doppler US is likely to improve cannulation results and reduce complications induced by \" blind \" needle probing . With a low US intensity score , the rate of successful punctures is lower and complication rates increase . In some patients , e.g. , those with extended tumour operations involving the head and neck , CV access via the axillary vein may be of high clinical value ." ], "offsets": [ [ 0, 3411 ] ] } ]

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"type": "umlsterm", "text": [ "minor" ], "offsets": [ [ 231, 236 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026193" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "hard" ], "offsets": [ [ 276, 280 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018599" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "care" ], "offsets": [ [ 322, 326 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0150499" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s2-t6", "type": "umlsterm", "text": [ "ICU" ], "offsets": [ [ 329, 332 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021708" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s2-t7", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 335, 343 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s2-t8", "type": "umlsterm", "text": [ "intensive care" ], "offsets": [ [ 312, 326 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0085559" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "ultrasound" ], "offsets": [ [ 404, 414 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0220934" }, { "db_name": "UMLS", "db_id": "C0041618" }, { "db_name": "UMLS", "db_id": "C0041621" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "vein" ], "offsets": [ [ 447, 451 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042449" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "Doppler ultrasound" ], "offsets": [ [ 396, 414 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0162481" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s3-t4", "type": "umlsterm", "text": [ "axillary vein" ], "offsets": [ [ 438, 451 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004456" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s4-t1", "type": "umlsterm", "text": [ "complications" ], "offsets": [ [ 472, 485 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009566" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s4-t2", "type": "umlsterm", "text": [ "ICU" ], "offsets": [ [ 507, 510 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021708" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s4-t3", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 511, 519 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s5-t1", "type": "umlsterm", "text": [ "Methods" ], "offsets": [ [ 534, 541 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0025663" }, { "db_name": "UMLS", "db_id": "C0025664" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s6-t1", "type": "umlsterm", "text": [ "RUB" ], "offsets": [ [ 614, 617 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0206788" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s6-t2", "type": "umlsterm", "text": [ "experimental design" ], "offsets": [ [ 548, 567 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0015320" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s7-t1", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 628, 636 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s7-t2", "type": "umlsterm", "text": [ "ICU" ], "offsets": [ [ 646, 649 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021708" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s7-t3", "type": "umlsterm", "text": [ "cannulation" ], "offsets": [ [ 650, 661 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0917707" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s7-t4", "type": "umlsterm", "text": [ "vein" ], "offsets": [ [ 678, 682 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042449" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s7-t5", "type": "umlsterm", "text": [ "need" ], "offsets": [ [ 711, 715 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027552" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s7-t6", "type": "umlsterm", "text": [ "line" ], "offsets": [ [ 724, 728 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0677502" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s7-t7", "type": "umlsterm", "text": [ "axillary vein" ], "offsets": [ [ 669, 682 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004456" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s8-t1", "type": "umlsterm", "text": [ "puncture" ], "offsets": [ [ 740, 748 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0034117" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s8-t2", "type": "umlsterm", "text": [ "vein" ], "offsets": [ [ 783, 787 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042449" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s8-t3", "type": "umlsterm", "text": [ "contraindications" ], "offsets": [ [ 811, 828 ] ], "normalized": [ { "db_name": "UMLS", "db_id": 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"type": "umlsterm", "text": [ "vein" ], "offsets": [ [ 1214, 1218 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042449" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s11-t5", "type": "umlsterm", "text": [ "local anaesthesia" ], "offsets": [ [ 1169, 1186 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002934" }, { "db_name": "UMLS", "db_id": "C0002921" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s11-t6", "type": "umlsterm", "text": [ "axillary vein" ], "offsets": [ [ 1205, 1218 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004456" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s12-t1", "type": "umlsterm", "text": [ "puncture" ], "offsets": [ [ 1239, 1247 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0034117" } ] }, { "id": "DerAnaesthesist.40430674.eng.abstr-s13-t1", "type": "umlsterm", "text": [ "blood" ], "offsets": [ [ 1318, 1323 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005767" }, { "db_name": "UMLS", "db_id": "C0005768" }, { 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[]

[]

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[ { "id": "DerAnaesthesist.40430683.eng.abstr-passage-0", "type": "abstract", "text": [ "Knowledge of normal and impaired pulmonary gas exchange is essential to the anaesthesiologist . Analysis of an arterial blood sample allows evaluation of whether or not pulmonary gas exchange is normal . For this purpose comparison with the oxygenation index or the alveolar-arterial PO2 difference is helpful . Pathological changes of these variables are mainly caused by ventilation-perfusion ( V. A/Q . ) mismatch . In daily practice , venous admixture or intrapulmonary shunt can be calculated using arterial and mixed-venous blood . By analysing arterial and expired PCO2, dead-space ventilation can be determined , but extended analyses of V. A/Q . distribution are not possible in daily practice . However , knowledge of the principles of typical disturbances of pulmonary gas exchange in acute and chronic lung disease allows the use of therapeutic strategies based on the pathophysiological changes ." ], "offsets": [ [ 0, 909 ] ] } ]

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[ { "id": "DerAnaesthesist.40430699.eng.abstr-passage-0", "type": "abstract", "text": [ "Objective . The aim of our review is to summarize relevant data on the perioperative use of anti-ischaemic drugs in patients at risk for or with proven coronary heart disease . Data sources . The accessible medical literature according to current electronic information sources was explored . Results . One in every eight general anaesthetics is administered to a patient at risk for or with proven coronary heart disease . Of these patients , it is estimated that 20% - 40% have perioperative myocardial ischaemia ( PMI ) , the majority being nonsymptomatic . This figure correlates with the occurrence of postoperative cardiac complications and myocardial infarction . The anaesthetist therefore has an important role to play in reducing the rate of perioperative cardiac sequelae . This can be achieved with good control of haemodynamic stability and the timely and appropriate use of antiischaemic drugs . Nitrocompounds ( nitrates , molsidomine ) serve as the gold standard in current angina pectoris treatment . Acting as coronary and systemic vasodilators , they effect an immediate reduction in preload and have been shown to be the drugs of first choice for intraoperative myocardial ischaemia . Beta-blockers reduce the rate of PMI to a greater extent than nitrates . They are also effective in myocardial ischaemia not accompanied by an increased heart rate . Single pre-operative administration of beta-blockers has also been shown to be beneficial in reducing theincidence of perioperative tachycardia , hypertension , and PMI . Consequently , such one-time medication can be considered for previously untreated high-risk patients presenting for surgery . The continuation of oral calcium channel blockers to the morning of surgery also reduces the rate of PMI and myocardial infarction in coronary-bypass patients , and combination with beta-blockers enhances this effect . Intra-operative diltiazem infusions are similarly advantageous in this patient group . In addition to nitrates , calcium antagonists are the drug of choice for coronary vasospasm . Drugs inhibiting platelet aggregation have a particular role in patients with coronary heart disease , however , they also cause increased perioperative bleeding . Consequently , it is recommended that these medications be discontinued 5 - 10 days prior to major surgery , with the exception of high-risk patients . Pilot studies using alpha2-agonists have shown reduced anaesthetic requirements and a reduction in PMI . The perioperative relevance of these drugs is currently being investigated . Conclusions . Beta-blockers , calcium channel blockers , nitrates , and possibly alpha2-agonists lead to reduced rates of PMI and other cardiac complications in risk patients . Current anti-anginal medications , with the exception of anti-platelet agents , should be maintained to the day of surgery and continued as soon as possible thereafter . All of these drugs except anti-platelet agents may also be used intra-operatively , however , possible interactions with anaesthetic agents should be carefully considered ." ], "offsets": [ [ 0, 3086 ] ] } ]

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[ { "id": "DerAnaesthesist.40430718.eng.abstr-passage-0", "type": "abstract", "text": [ "After laparoscopic cholecystectomy , carbon dioxide ( CO2) must be exhaled after resorption from the abdominal cavity . There is controversy about the amount and relevance of postoperative CO2 resorption . Without continuous postoperative monitoring , after laparoscopic cholecystectomy a certain risk may consist in unnoticed hypercapnia due to CO2 resorption . Studies exist on the course of end-expiratory CO2 ( PeCO2) alone over a longer postoperative period of time in extubated patients during spontaneous breathing . The goal of this prospective study was to investigate the amount of CO2 resorbed from the abdominal cavity in the postoperative period by means of CO2 metabolism . Methods . After giving informed consent to the study , which was approved by the local ethics committee , 20 patients underwent laparoscopic cholecystectomy . All patients received general endotracheal anaesthesia . After induction , total IV anaesthesia was maintained using fentanyl , propofol , and atracurium . Patients were ventilated with oxygen in air ( FiO2 0.4 ) . The intraabdominal pressure during the surgical procedure ranged from 12 to 14 mm Hg. Thirty minutes after releasing the capnoperitoneum ( KP ) , CO2 elimination ( V. CO2), oxygen uptake ( V. O2), and respiratory quotient ( RQ ) were measured every minute for 1 h by indirect calorimetry using the metabolic monitor Deltatrac according to the principle of Canopy . Assuming an unchanged metabolism , the CO2 resorption ( V. CO2) at any given time ( t ) can be calculated from V. CO2 ( t ) =V.CO2 ( t ) -RQ ( preop ) V. O2 ( t ) . It was thus necessary to define the patient's metabolism on the day of operation . The first data were collected before surgery and after introduction of the arterial and venous cannulae for a 15-min period . Measuring point 0 was determined after exsufflation of the KP and emptying of the remaining CO2 via manual compression by the surgeon at the end of surgery . Patient's tracheas were extubated and metabolic monitoring started 30 min after release of the KP for 60 min . Simultaneously , a nasal side-stream capnometry probe was placed and the PeCO2 and respiratory frequency ( RF ) were obtained by the Capnomac Ultima ( Datex ) and registered every minute as well . Values were averaged over four periods of 15 min each . An arterial blood gas sample was drawn at the end of every 15-min period . Postoperative pain was scored by a visual analog scale and completed by a subjective index questionnaire on general well-being . All data were analysed by the Friedman or Wilcoxon test ; P 0.05 was considered significant . Results . The findings do not indicate CO2 resorption in the postoperative period after laparoscopic cholecystectomy ( Tables 2 and 3 , Fig . 1 ) . Arterial CO2 as well as PeCO2 were elevated postoperatively ( 45 mm Hg vs. 36 mm Hg intraoperatively ) , while V. CO2 and V. O2 were unchanged when compared to the preoperative measuring period . The postoperative RF was comparable to preoperative values . Calculated CO2 was lower than 10 ml/min and within accuracy of measurements . The postoperative pain index ranged between 3 and 4 , and 3.75 - 15 mg piritramid was administered . All patients feld tired immediately after the operation , but scores improved slightly at the end of the 60-min period of metabolic monitoring . Conclusions . There is no significant resorption of CO2 from the abdominal cavity later than 30 min after releasing the KP . Up to this time , any CO2 remaining in the abdominal cavity after careful emptying by the surgeon has been resorbed and exhaled ." ], "offsets": [ [ 0, 3604 ] ] } ]

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[ { "id": "DerAnaesthesist.40430723.eng.abstr-passage-0", "type": "abstract", "text": [ "In addition to laryngoscopy , endotracheal intubation , and other stressful intraoperative phases , hypertension occurs during recovery from anaesthesia , provoking postoperative complications like bleeding and increased intracranial or intraocular pressure . Furthermore , these hypertensive reactions result in life-threatening complications , especially in patients with pre-existing cardiovascular diseases . In this study , the effect of the new , short-acting beta-blocker esmolol given as a single bolus for preventing the increases in blood pressure and heart rate during recovery from anaesthesia and extubation in patients with hypertension was investigated . Patients and Methods . Sixty-three patients with a history of hypertension over a period of more than 6 months and blood pressure ( BP ) more than 150/90 mm Hg undergoing intervertebral-disc , otolaryngologic , or eye surgery were included in the study . The operations were performed during thiopentone-induced isoflurane anaesthesia with relaxation by atracurium . The patients were assigned to three groups after giving witnessed oral informed consent . During the study period they received the study drug twice : ( A ) 30 - 90 s before turning off the nitrous oxide ; and ( B ) 20 - 90 s before extubation . Group I ( placebo ) received placebo each time , group II ( 100 mg esmolol ) placebo at A and 100 mg esmolol i.v. at B , and group III ( 200 mg esmolol ) 100 mg esmolol i.v. each time . After each medication the cardiovascular parameters were measured noninvasively over a period of 10 min every minute and in the following 2 h every 15 min . Results After the first medication systolic and diastolic BP , heart rate ( HR ) , and rate-pressure product ( RPP ) were lower in patients receiving 100 mg esmolol ( Group III ) than in groups I and II . After the second injection the blood pressure was lower in the two groups receiving 100 mg esmolol , than the placebo group ( I : 180.1 +/- 7.4/100.7 +/- 3.6 ; II : 152.8 +/- 5.8/87.9 +/- 3.4 ; III : 157.9 +/- 5.3/91.5 +/- 3.6 mm Hg [ \\=2 min +/- SEM ] ) . The changes in HR ( I : 88.2 +/- 3.8 ; II : 75.6 +/- 2.6 ; III : 72 +/- 3.1 min-1) and RPP ( I : 15,800 +/- 900 ; II : 11,700 +/- 700 ; III : 11,400 +/- 600 ) were similar . In 8 of the 20 patients in group III the HR dropped below 60 - min-1, but in none of these patients did the BP become instable . Conclusions . The sympathoadrenergic reaction during recovery from anaesthesia and extubation can be treated by beta-blocking agents , but such therapy is not without risk because of the long half-life and effects of the therapy on other factors such as postoperative loss of intravascular volume . Esmolol is a new , short-acting , cardioselective beta-blocker with a very short plasma distribution time and an elimination half-life of 9.2 min . Thus , the potential risks of beta-blockers due to half-life are minimised . The results of this study show that a dangerous increase in BP and HR with increased myocardial oxygen consumption can be prevented by a single bolus , and better by a double bolus of 100 mg esmolol . Although bradycardia with HR below 50 - min-1 in 8 patients might indicate a risk of cardiac instability , the systolic BP did not fall below 100 mm Hg , and the episode of bradycardia was so short that there was no risk to the patients ." ], "offsets": [ [ 0, 3354 ] ] } ]

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[ { "id": "DerAnaesthesist.40430738.eng.abstr-passage-0", "type": "abstract", "text": [ "Different anaesthetic procedures that were used during an in vitro fertilisation and embryo transfer ( IVF-ET ) program have been analysed in order to determine their influence on plasma levels of estradiol , progesterone , prolactin , and -endorphin and results of IVF-ET . Methods . Fifty-four patients awaiting transvaginal oocyte aspiration were randomised into three groups : ( 1 ) anaesthesia with ketamine as an induction agent and analgesic ( n=20); ( 2 ) general intubation anaesthesia using thiopentone for induction and enflurane for maintenance ( n=18); and ( 3 ) no anaesthesia ( n=16). Estradiol , progesterone , prolactin , and -endorphin were measured from day 3 to 14 referring to follicle aspiration . Differences between preoperative hormone levels and their intra- and postoperative peaks were analysed using the Kruskal-Wallis test ( P 0.03 ) . The results were corrected using the Holms method ( =0 . 05 ) . Results . No differences were observed in estradiol and progesterone levels ( Figs . 1 , 2 ) . Prolactin levels were 1.4 times higher ( P 0.001 ) when ketamine was used and 2.2 times higher ( P 0.001 ) after short general anaesthesia than in the control group ( Fig . 3 ) . Similar results were observed with respect to -endorphin : in comparison with the control group we found significant elevation by a factor of 2.1 when ketamine was used ( P 0.001 ) . The discrepancy became even more marked with general anaesthesia : -endorphin was 3.9 times higher compared to the controls ( P 0.001 ) ( Fig . 4 ) . Comparing the two groups who were given anaesthetics , prolactin and -endorphin levels were also significantly different ( P 0.001 ) . The IVF procedure itself did not appear to be affected by different anaesthetic procedures during oocyte aspiration ( Table 2 ) . Conclusions . The increased prolactin and -endorphin plasma levels associated with ketamine and general anaesthesia reflect a significant alteration of the observed hormone levels . When anaesthesia is indicated , we try to avoid general intubation anaesthesia in favor of ketamine ." ], "offsets": [ [ 0, 2085 ] ] } ]

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"DerAnaesthesist.40430738.eng.abstr-s1-t6", "type": "umlsterm", "text": [ "program" ], "offsets": [ [ 112, 119 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0376691" } ] }, { "id": "DerAnaesthesist.40430738.eng.abstr-s1-t7", "type": "umlsterm", "text": [ "plasma" ], "offsets": [ [ 180, 186 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0032105" } ] }, { "id": "DerAnaesthesist.40430738.eng.abstr-s1-t8", "type": "umlsterm", "text": [ "estradiol" ], "offsets": [ [ 197, 206 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0014912" } ] }, { "id": "DerAnaesthesist.40430738.eng.abstr-s1-t9", "type": "umlsterm", "text": [ "progesterone" ], "offsets": [ [ 209, 221 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033308" } ] }, { "id": "DerAnaesthesist.40430738.eng.abstr-s1-t10", "type": "umlsterm", "text": [ "prolactin" ], "offsets": [ [ 224, 233 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033371" } ] }, { "id": "DerAnaesthesist.40430738.eng.abstr-s1-t11", 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[]

[]

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[ { "id": "DerAnaesthesist.40430743.eng.abstr-passage-0", "type": "abstract", "text": [ "Efficient analgesia may be the major objective in the cardiovascular risk patient following myocardial infarction , acute occlusion of peripheral vessels , or dissection/perforation of major abdominal vessels . It was the purpose of the study to investigate the haemodynamic and respiratory side effects of eight different opioids in 57 circulatory risk patients prior to major vascular surgery . Methods . Patients were randomly allocated to eight groups , each receiving a different opioid within a clinical , equipotent dose range ( buprenorphine , fentanyl , morphine , nalbuphine , pentazocine , pethidine , tramadol , alfentanil ) . A complete haemodynamic and blood gas status was obtained prior to as well as 5 , 10 , 15 , and 20 min following opioid administration . Monitoring included a complete invasive haemodynamic and blood gas status . Statistical evaluation was performed by 1- and 2-factorial ANOVA ( P 0.05 ) . Results . Significant time effects ( changes from baseline at the time of measurement ) were observed for heart rate and total peripheral resistance , while significant group ( group-specific differences in the course of values at the different times of measurements ) and time effects were noted for mean pulmonary artery pressure , pulmonary capillary wedge pressure , stroke volume index , and PaO2. No major effects were observed following morphine , fentanyl , alfentanil , tramadol , and nalbuphine . Buprenorphine caused distinct respiratory depression accompanied by an increase in pulmonary vascular tone . Pentazocine and pethidine caused a significant increase in MPAP and peripheral vascular resistance while pethidine also produced marked respiratory depression . Conclusions . For interpretation of the results , factors such as respiratory depression , histamine release , secretion of endogenous catecholamines , and hypoxia-induced pulmonary vasoconstriction have to be discussed . Tramadol , an opioid with moderate potency , seems to offer some advantages due to its minor cardiovascular and respiratory side effects ." ], "offsets": [ [ 0, 2067 ] ] } ]

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[ { "id": "DerAnaesthesist.40430750.eng.abstr-passage-0", "type": "abstract", "text": [ "A 41-year-old woman with severe juvenile diabetes mellitus suffered from profund hypothermia after loss of thermoregulation in diabetic ketoacidosis . She was found unconscious , without measurable blood pressure ; the electrocardiogram ( ECG ) showed bradycardia of 30/min and the rectal temperature was 23.7 °C. The patient received mechanical ventilation , fluid therapy , warmed gastric lavage , and , unfortunately , inotropic medication . She was transferred to a department of cardiac surgery in order to continue the therapy with cardiopulmonary bypass ( CPB ) . On arrival , the patient had a rectal temperature of 27.3 °C, the ECG showed an absolute arrhythmia with a frequency of 70/min, and the blood pressure was 63/43 mm Hg. We decided to use a rapidly available but not highly invasive venovenous hemofiltration technique for slowly rewarming the patient . Vascular access was achieved by percutaneous femoral vein cannulation with a Shaldon catheter . The hemofiltration system ( Gambro AK-10, Gambro AB , Sweden ) was instituted with a blood flow rate of 200 ml/min . The hemofiltration monitor controls the pumps for filtering and substituting fluid volumes and allows the infusion solutions to be heated up to 40 °C. Sinus rhythm resumed without antiarrhythmic medications at a temperature of 29.5 °C, and within 8 h the patient was rewarmed to 35.5 °C. After treatment of the adult respiratory distress syndrome caused by pneumonia , she was discharged from the intensive care unit to complete treatment with no evidence of any permanent organ damage . We conclude that hemofiltration may be the method of choice for rewarming deeply hypothermic patients when their circulation is preserved . Under these circumstances , it is preferable to external rewarming techniques , as it avoids the disadvantages of temperature afterdrop and rewarming shock . Rewarming rates of 1.5 °C/h seem to be adequate . Hemofiltration systems are more widespread , less invasive , and easier to handle compared to CPB techniques , which should be preferred in situations of prolonged unsuccessful cardiopulmonary resuscitation with cardiac arrest and deep core temperatures ." ], "offsets": [ [ 0, 2176 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.40430759.eng.abstr-passage-0", "type": "abstract", "text": [ "The implementation of an experienced pre-hospital care emergency physician as an on the-scene medical command officer ( MCO ) within the emergency medical service ( EMS ) is an essential prerequisite to guarantee qualified medical supervision during mass-casualty incidents ( MCI ) . The MCO has four basic functions . Within the administration of the EMS system , he is responsible for the medical aspects of strategic planning for the MCI response . During the MCI the MCO is responsible for the overall assessment of the situation , triage , and supervision of medical treatment by physician and non-physician providers . Aside from extensive personal experience in pre-hospital care , the MCO needs special training to be qualified for this position . State EMS laws provide the legal basis for the MCO within the EMS system ." ], "offsets": [ [ 0, 830 ] ] } ]

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[ { "id": "DerAnaesthesist.40430773.eng.abstr-passage-0", "type": "abstract", "text": [ "Ideal evaluation of neuromuscular blockade can be done by mechanical or electromyographical registration of muscle contractions evoked by ulnar nerve stimulation . Unfortunately , devices needed for such registration are expensive or complicated to set up , and thus are not often used for routine monitoring in anaesthesia . In this study , we describe a simple and low-priced method permitting intra- and postoperative monitoring of neuromuscular blocking agents . The accuracy of plethysmomechanomyography ( PMG ) was evaluated by comparing simultaneous electromyographic ( EMG ) and plethysmographic measurements . Methods . For plethysmographic registration of muscle response to nerve stimulation a simple infusion system is twisted there to five times around one hand and connected to an anaesthetic monitor via a pressure transducer . The drip chamber is fixed about 20 cm above the hand ( Fig . 1 ) . Then , the infusion system is then filled up with physiologic saline solution and the clamp is nearly closed . Electric stimulation can be carried out using any nerve stimulator . Using this method , PMG mainly records the contractions of abductor digiti minimi muscle , but also partly those of the interossei . Evoked muscle contractions cause stretching of the infusion system , which leads to pressure changes proportional to the strength of contraction . The muscle response to \" train-of-four \" ( TOF ) stimulation of the ulnar nerve was recorded simultaneously by EMG and PMG in 11 patients ( ASA class I or II ) undergoing neurosurgical procedures and therefore requiring muscle relaxation . After induction of anaesthesia by injection of etomidate and fentanyl , supramaximal stimulation and control values ( T0) were defined . Anaesthesia was maintained by supplementation with nitrous oxide/oxygen ( 1:2 ) and muscle relaxation was carried out with vecuronium . We used the integrated nerve stimulator of a Datex Relaxograph NMT-100 EMG monitor and proceeded to stimulate the ulnar nerve at the forearm with supramaximal strength . The PMG was registered by a Siemens Siredoc 220 printer connected to a Siemens Sirecust 1281 anaesthetic monitor . First twitch ratio ( T1/T0) and TOF ratio ( T4/T1) were calculated from these recordings . The EMG recordings were made by a Datex Relaxograph NMT-100 monitor , which automatically computes T1/T0 and T4/T1. The comparison of EMG and PMG values was carried out by simple linear regression . Statistical evaluation was performed using analysis of variance . Results . A plethysmographically registered graph of the TOF-evoked muscle response is illustrated in Fig . 2. Simultaneous EMG and PMG recordings of onset and recovery from a nondepolarizing blockade are shown in Fig . 3. A strong positive correlation ( P 0.001 ) of EMG and PMG was found with correlation coefficients of 0.98 for T1/T0 and of 0.97 for T4/T1. The mean difference between values of both methods was 5% , maximally 18% ( T1/T0) and 20% ( T4T1). Conclusions . Mechanomyography and EMG are well established methods of neuromuscular monitoring . Our data demonstrate that PMG provides a reliable measurement of neuromuscular transmission that correlates well with EMG . Since only materials of daily use in anaesthesia are needed , no substantial costs will arise when the plethysmographic method of measurement is used for routine anaesthetic monitoring ." ], "offsets": [ [ 0, 3393 ] ] } ]

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[]

[]

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