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[ { "id": "DerAnaesthesist.40430780.eng.abstr-passage-0", "type": "abstract", "text": [ "Axillary block is a common anaesthetic technique for operations on the hand and forearm . In our hospital , with many trainees in anaesthesia , only 250 - 300 axillary blocks per year are performed by about 30 colleagues . This implies a small number of blocks for each anaesthetist . The present study was designed to assess whether it is possible to teach this technique and use it with an adequate degree of success under these conditions . We used a nerve stimulator and studied whether the success of the block under these conditions is independent of anaesthetist's experience in this technique . Furthermore , we examined other factors involved in the success of the block . Methods . The study included 112 patients subjected to elective surgery of the upper extremity ; all received an axillary block . We used a nerve stimulator and injected mepivacaine 1% without adrenaline . The following parameters were recorded : the number of blocks to date performed by the anaesthetist ; the minimal current required for nerve stimulation ; the dose of local anaesthetic ; the time between the end of injection and the beginning of surgery ; the duration of surgery ; and the quality of sensory and motor blockade after 10 , 20 , and 30 min . Sensory blockade was assessed by the pinprick method ( no blockade , analgesia , anaesthesia ) ; motor blockade was judged by comparing the muscle strength of both arms ( no blockade , paresis , paralysis ) . Data were analyzed using the Mann-Whitney test , with P 0.05 considered statistically significant . Results . Of the 112 blocks , 95 ( 85% ) were successful ; 17 ( 15% ) failed and the patients required general anaesthesia . Eight of the successful blocks showed a decrease in analgesic quality after > =70 min and required additional analgesics or general anaesthesia . We found no correlation between the experience of the anaesthetist and the success of the block . The minimal required current for nerve stimulation in the success group was 0.4 mA and differed significantly from the value of 0.6 mA in the failure group ( Table 3 ) . The dose of mepivacaine was higher in the success group ( 5.9 vs. 5.3 mg/kg ) . Complete sensory blockade was more frequently achieved for the median , ulnar , and radial nerves than for the musculocutaneous and cutaneous brachii medialis ( Fig . 3 ) . The frequency of complete sensory blockade ( anaesthesia ) had increased by 21.9% between the 20th and 30th min . Complete motor blockade was less often achieved than sensory blockade ( Fig . 4 ) . Conclusions . Using the method of electrostimulation , the axillary block is an appropriate anaesthetic technique that can be applied in a hospital where each anaesthetist only occasionally performs it . Prior to injection of the local anaesthetic , the current for nerve stimulation should be reduced to 0.5 mA . The time between the end of injection and the beginning of surgery should be no less than 30 min because complete sensory blockade can more often be achieved . The dose of mepivacaine should be no less than 6 mg/kg body weight ." ], "offsets": [ [ 0, 3086 ] ] } ]

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[ { "id": "DerAnaesthesist.40430786.eng.abstr-passage-0", "type": "abstract", "text": [ "Posttraumatic cardiopulmonary resuscitation ( CPR ) is associated with a poor outcome . When evaluating the literature according to the Utstein method , there were only 2 survivors ( 0.18% ) out of 1,135 CPR attempts after trauma ( Table 1 ) . Differences in the study populations and levels of prehospital trauma care led us to analyse the results of a physician-staffed prehospital trauma care system in Cologne . Methods . From January 1987 to December 1990 , a total of 49,054 emergency calls were registered using a standardised protocol . Among 9,595 trauma-related calls , 636 patients were found to be pulseless on arrival of the emergency team , 412 of these were pronounced dead . CPR was initiated in the remaining 224 patients , who comprise the study population ( defined as 100% ) . All patients who were admitted to a hospital were followed using a second protocol . Results . CPR in the field was successful in 68 ( 30.4% ) patients , who were then admitted to a hospital ; 42 of these died within the first 24 h . Four patients ( 1.8% ) could be discharged from hospital alive and were still living 1 year later , 1 with a lasting neurological deficit ( Fig . 1 ) . In 156 ( 69.6% ) cases resuscitative attempts were unsuccessful in the field . Conclusions . Even in a physician-staffed prehospital trauma care system , the chance of surviving a post-traumatic cardiac arrest is minimal . Survival has to be regarded as an individual fate ; the overall results are discouraging . Even though this study analyses the largest population of posttraumatic CPR ever published , prognostic factors could not be identified due to the few survivors . Nevertheless , the result does not justify general omission of CPR after trauma as : ( 1 ) prognostic factors for survival have not been identified thus far ; and ( 2 ) no significant additional costs arise from posttraumatic CPR ." ], "offsets": [ [ 0, 1891 ] ] } ]

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[ { "id": "DerAnaesthesist.40430835.eng.abstr-passage-0", "type": "abstract", "text": [ "In order to assess the significance of drug levels measured in clinical and forensic toxicology as well as for therapeutic drug monitoring ( TDM ) , it is essential that good collections of data are readily available . For more than 400 frequently used drugs therapeutic and , if data were available , toxic and fatal plasma concentrations as well as elimination half-lives were compiled in a table including , e.g. , hypnotics like barbiturates and benzodiazepines , neuroleptics , antidepressants , sedatives , analgesics , anti-inflammatory agents , antihistamines , anti-epileptics , beta-adrenergic antagonists , antibiotics ( penicillins , cephalosporins , aminoglycosides , gyrase inhibitors ) , diuretics , calcium-channel blockers , cardiac glycosides , anti-arrhythmics , anti-asthmatics , angiotensin converting enzyme inhibitors , opioid agonists , and local anaesthetics . Data have been abstracted from published information , both compilations and primary sources , and supplemented with data collected in our own forensic and clinical toxicology laboratories . Wherever possible , ranges for therapeutic plasma concentrations are expressed as trough concentration at steady-state . The range of ( or single ) half-life values given for each drug are chosen to represent the terminal log-linear phase at most . In addition to the assessment of significance of drug levels for the therapeutic monitoring of patients , this list can assist the diagnostic assessment in cases of intoxication ." ], "offsets": [ [ 0, 1505 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440001.eng.abstr-passage-0", "type": "abstract", "text": [ "Although the attempts to develop an oxygen-carrying alternative to red blood cells ( RBC ) have spanned the last 100 years , it has proven difficult to develop a clinically useful haemoglobin-based oxygen carrier . Four major problems have been shown to compromise the use of haemoglobin outside the RBC as an oxygen carrier : ( 1 ) the increased oxygen affinity due to the loss of 2,3-diphosphoglycerate ; ( 2 ) dissociation into dimers and monomers with consequent renal and capillary loss of hemoglobin ; ( 3 ) insufficient concentrations of prepared solutions under iso-oncotic conditions , and thereby reduced oxygen-carrying capacity ; and ( 4 ) toxicity . Most of these limitations have been overcome by different modifications of haemoglobin , including pyridoxylation , intra- and intermolecular cross-linking , polymerisation , liposome encapsulation , conjugation to inert macromolecules , and genetic engineering ." ], "offsets": [ [ 0, 926 ] ] } ]

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[ { "id": "DerAnaesthesist.50440024.eng.abstr-passage-0", "type": "abstract", "text": [ "Epidurography with contrast medium is used to verify the correct poition of an epidural catheter and to detect malpositioning . There is great variability in the distribution of contrast medium according to the individual morphology of the epidural space and the way it is injected . Results of investigations of the anatomy of the spinal canal and epidural space performed with anatomic specimens , epiduroscopy , and conventional and computed tomographic ( CT ) epidurography are sometimes contradictory . We have performed CT epidurography in approximately 30 patients to date . Insights regarding the distribution of contrast medium in the epidural space can help to interpret conventional epidurographies and to explain special features , such as the \" rail-road-track phenomenon \" or the plica mediana dorsalis . Methods . Patients scheduled for major abdominal operations were studied . Catheters were introduced into the thoracic epidural space on the day before the operation . Conventional epidurographies were performed routinely after insertion of the catheters with a mobile X-ray apparatus , usually in the recovery room , using 5 ml iopamidol ( Solutrast 250 M ) . Selected patients ( good mental state and stable psychic condition ) , after written consent and with approval of the local ethical committee , were investigated with CT epidurography using the same contrast medium ( partly diluted ) . From among the CT scans performed until now , five characteristic images are presented and compared to conventional epidurographies . Results . When small volumes ( 5 mL ) of iopamidol were injected slowly , we regularly observed a railroad-track phenomenon in the AP images of conventional epidurographies . After rapid injection of larger volumes ( 10 - 15 ml ) , the spread was more homogeneous and sometimes outline a lighter zone of contrast distribution in the midline . CT epidurography in these cases ( 5 out of 30 patients ) revealed a plica mediana dorsalis . In the majority of the CT scans of the thoracic epidural space its anterior ( ventral ) compartment was unfilled by contrast medium . According to the findings of several investigators , dura mater and ligamentum longitudinale posterius have grown together , so that an epidural space does not exist in ventral thoracic segments of the spinal canal . In lower thoracic and lumbar segments both structures are separate , and a wide anterior epidural space was present and filled with contrast medium . In other cases the dorsal and dorsolateral epidural space was completely filled , but the contrast medium stopped behind the spinal nerves and surrounding dural sheaths , as if these structures , together with the connective tissue strands between them , formed a membrane that spread in a frontal plane . A railroad-track phenomenon is interpreted in the literature as the X-ray correlate of contrast medium spread in the subdural space , indicating an incorrect catheter position . According to conventional epidurographies and confirmed by CT scans , this feature is also seen regulary in cases with correct catheter position . Small volumes of iopamidol spread preferentially into the wider parts of the epidural space between the gaps of the vertebral arcs , whereas the dura mater and periosteal layers touch at the inner side of the pedicules and laminae , allowing the existence of only a potential epidural space . This rhythmic widening and narrowing of the epidural space is the explanation of the \" railroad track \" in AP contrast epidurographies . Conclusions . CT epidurography is a valuable tool to provide better insight into the morphology of the epidural space when filled with fluid ( contrast medium , local anaesthetics ) , complementing findings using epiduroscopy and anatomic specimens . It stands to reason that this time- and cost-expensive method can never replace conventional epidurographies , but can help to interpret them properly ." ], "offsets": [ [ 0, 3951 ] ] } ]

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[ { "id": "DerAnaesthesist.50440037.eng.abstr-passage-0", "type": "abstract", "text": [ "The Acute Physiology and Chronic Health Evaluation model ( APACHE II , APACHE III ) is used to describe the severity of illness and predict the outcome in critically ill patients . APACHE III , introduced in 1991 , has not yet been validated in Europe . We calculated APACHE II and APACHE III scores in patients after admission to the intensive care unit ( ICU ) and compared the prognostic value on hospital mortality . Method . One hundred fifty patients with stay of over 24 h were enrolled in the study and prospectively and consecutively investigated . APACHE II and III scores were calculated as described by the authors . The mean and median values of the survivors were compared with the non-surviving group ( Mann-Whitney U test ) . Receiver operating characteristics ( ROC analysis ) and the areas under the ROC curves were plotted . Results . Of the 150 patients , 34 died during their hospital stay ( 22.7% ) . The mean and median APACHE II and III scores were significantly higher ( P 0.001 ) in the non-surviving group . The area under the ROC curve was higher for APACHE III ( 0.899 ) compared to APACHE II ( 0.847 ) . Conclusions . APACHE II and APACHE III were both found to have good prognostic value in general ICU patients . Our results suggest that the APACHE III version includes a more precise prediction of hospital mortality than APACHE II . A new aspect of APACHE III is an expanded modification of the Glasgow Coma Scale to assess neurologic derangements ." ], "offsets": [ [ 0, 1483 ] ] } ]

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[ { "id": "DerAnaesthesist.50440048.eng.abstr-passage-0", "type": "abstract", "text": [ "Surgery by three-dimensional ( 3D ) endoscopy is being used routinely in abdominal surgery and , in special cases , in thoracic surgery ; however , it has not been reported as being used in microlaryngeal surgery . Methods . We inserted a 3-D endoscope into a jet laryngoscope and studied the pressure properties at the tip of the laryngoscope as well as intrapulmonary pressures while applying superimposed high-frequency jet ventilation . The studies were conducted initially using a lung simulator , and then in seven patients undergoing microlaryngeal surgery . Results . Due to the rather large 3-D endoscope , the diameter of the jet laryngoscope was reduced by between 25.2% and 70.9% , depending on its size . The measurements on the lung simulator revealed that reduction of laryngoscope diameter leads to an increase in the following parameters : expiratory resistance , tidal volume , and peak inspiratory pressure . The mean FiO2 was 0.74 +/- 0.1 ; the mean paO2 was 169.2 +/- 80.4 mm Hg ; and the mean paCO2 was 40.9 +/- 2.4 mm Hg. The mean airway pressure was 19 +/- 5.3 mm Hg prior to insertion of the endoscope and 12.3 +/- 6.9 mm Hg after insertion . The mean positive end-expiratory pressure values increased from 2 +/- 0.6 to 3.6 +/- 2.3 mm Hg. Reduction of the working pressure resulted in restoration of the initial inspiratory pressures and tidal volumes . Conclusions . In the clinical application of 3-D endoscopy via a jet laryngoscope , it was possible to achieve sufficient ventilation , inspection of the surgical field , and performance of the surgical procedure . A CO2 laser was used without changing the ventilation regime . Although technical alterations would be desirable for its application to microlaryngeal surgery , it is presently possible to safely use the 3-D endoscope via the jet laryngoscope for microlaryngeal surgery , presenting the surgeon with new possibilities in voice-improving microsurgery of the larynx ." ], "offsets": [ [ 0, 1959 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.50440061.eng.abstr-passage-0", "type": "abstract", "text": [ "Preventive strategies aim to reduce gastric acidity ( H2ms ( sucralfate , antacids , pirenzepine ) and to normalize gastric mucosal microcirculation ( sucralfate , pirenzepine ) . Thus , the most important prophylactic measure is an optimized emergency and ICU regime aiming to improve oxygenation and microcirculation . All specific drugs used for stress ulcer prophylaxis have been shown to be effective in prospective controlled studies . Furthermore , pirenzepine has been found to be superior to H2-antagonists, at least in neurosurgical patients . Insufficient or no data exist to support the use of prostaglandins or omeprazole for stress ulcer prophylaxis . The most important adverse effect of stress ulcer prophylaxis is nosocomial pneumonia due to gastric alkalinization . This may occur in long-term ventilated patients with a gastric pH > 4 and may account for up to 50% of all nosocomial pneumonias in certain groups of patients . Mortality is not influenced by antacids or H2-antagonists, while sucralfate has been shown to reduce mortality , most probably by inhibition of bacterial translocation ." ], "offsets": [ [ 0, 1114 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440081.eng.abstr-passage-0", "type": "abstract", "text": [ "On the subject of natriuretic peptides there is a great deal of controversy , and intensive research efforts have been made studying their effects on electrolyte homeostasis . In the early 1980s , a peptide that caused diuresis , natriuresis , and had a relaxant effect on vascular smooth muscle was discovered independently by several groups . This was the breakthrough for the identification of natriuretic peptides , followed by the characterisation of the amino-acid sequences of several species . Synthesis of the peptide , cloning of the encoding gene , identification and characterisation of specific receptors , as well as the development of antibodies and radioimmunoassays were rapidly accomplished . Research on the immunohistochemistry of cardiodilatin/atrial natriuretic peptide ( CDD/ANP ) and the regulation of CDD/ANP gene expression led to detection of the peptide in extra-atrial tissues . Later on , two new peptides were discovered brain natriuretic peptide ( BNP ) and C-type natriuretic peptide ( CNP ) . These peptides share structural features with CDD/ANP with regard to their 17-amino-acid-exhibiting loop bridged by a disulfide bond . Another recently discovered peptide is urodilatin ( URO ) , a renal-borne new member of A-type natriuretic peptide . URO was isolated from human urine and consists of the same sequence as CDD/ANP , containing the 17-amino-acid residue loop of the circulating hormone with 4 additional amino acids located at the NH2-terminus of the peptide . Regarding physiological actions , data strongly support a close association between URO and urinary sodium excretion . The application of URO in animals revealed a stronger diuresis and natriuresis with a lower influence on arterial blood pressure compared to CDD/ANP-99-126. These results were encouraging for the use of URO in clinical trials as a tool to prevent acute renal failure ( ARF ) in patients following heart transplantation and for treatment of incipient ARF in patients following liver transplantation . Summarising the results of these two studies , URO represents a new approach for not only prevention , but also for treatment of ARF following organ transplantation . This opens up new possibilities for the treatment of ARF of other origins in intensive care medicine ." ], "offsets": [ [ 0, 2292 ] ] } ]

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[ { "id": "DerAnaesthesist.50440092.eng.abstr-passage-0", "type": "abstract", "text": [ "The incidence of postoperative myocardial infarction ( MI ) is proportional to the incidence of myocardial ischaemic episodes . Therefore , the prevention of such episodes is of great clinical importance ." ], "offsets": [ [ 0, 205 ] ] } ]

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[ { "id": "DerAnaesthesist.50440108.eng.abstr-passage-0", "type": "abstract", "text": [ "Left ventricular afterload is most accurately represented by left ventricular end-systolic wall stress , but in clinical practice is commonly estimated by the systemic vascular resistance ( SVR ) . End-systolic wall stress can be derived from M-mode and two-dimensional ( 2D ) echocardiograms in combination with systolic arterial pressure ( SAP ) . We tested transoesophageal echocardiography for the assessment of acute left ventricular afterload alterations in ventilated patients requiring cardiovascular support with noradrenaline or nitroglycerine ." ], "offsets": [ [ 0, 555 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440119.eng.abstr-passage-0", "type": "abstract", "text": [ "Case Report . A 31-year-old pregnant woman had to undergo emergency abdominal surgery due to acute intestinal obstruction . The patient's preoperative history demonstrated multiple allergies as well as abdominal trauma several years before . The physical examination - including sonography of the two fetuses - showed no pathological signs . Anaesthesia was induced intravenously with the operating table tilted to the left side , using routine precautions pre-oxygenation , and rapid sequence intubation , and was maintained unproblematically . About 20 min after the onset of surgery , hypotension , tachycardia , and a drop in oxygen saturation appeared . Volume substitution and the application of vasoactive drugs failed to stabilise the haemodynamic situation . Elevation of the pregnant uterus and increased left tilzing of the operating table did not lead to improvement . The development of eyelid edema led to the diagnosis of an anaphylactic reaction . The patient was treated successfully with epinephrine , antihistamines , and corticosteroids ( prednisolone ) . The suspicion of latex-related allergy was verified postoperatively by radio-allergen-sorbent test ( RAST ) and prick and scratch tests ." ], "offsets": [ [ 0, 1213 ] ] } ]

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[ { "id": "DerAnaesthesist.50440143.eng.abstr-passage-0", "type": "abstract", "text": [ "The safety of blood and blood components is an important aspect of transfusion medicine . Even if absolute safety of blood products cannot be achieved , this goal has come closer due to significant improvements . These include : ( 1 ) exact donor registration ; ( 2 ) component preparation according to legal requirements and GMP guidelines ; ( 3 ) determination of all relevant diagnostic parameters according to GMP/GLP guidelines ; ( 4 ) adequate storage of products ; and ( 5 ) an often underestimated parameter ensuring safety , strict guidelines for the use of blood products in the treatment of patients . Some of the results of the first Graz Consensus Conference on Transfusion Medicine are presented ." ], "offsets": [ [ 0, 711 ] ] } ]

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"C0059927" } ] }, { "id": "DerAnaesthesist.50440143.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "donor" ], "offsets": [ [ 241, 246 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013018" } ] }, { "id": "DerAnaesthesist.50440143.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "GMP" ], "offsets": [ [ 326, 329 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0520462" } ] }, { "id": "DerAnaesthesist.50440143.eng.abstr-s3-t4", "type": "umlsterm", "text": [ "guidelines" ], "offsets": [ [ 330, 340 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0220845" }, { "db_name": "UMLS", "db_id": "C0162791" }, { "db_name": "UMLS", "db_id": "C0282423" } ] }, { "id": "DerAnaesthesist.50440143.eng.abstr-s3-t5", "type": "umlsterm", "text": [ "determination" ], "offsets": [ [ 349, 362 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002778" } ] }, { "id": "DerAnaesthesist.50440143.eng.abstr-s3-t6", "type": "umlsterm", "text": [ "diagnostic" ], "offsets": [ [ 379, 389 ] ], 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"id": "DerAnaesthesist.50440143.eng.abstr-s3-t11", "type": "umlsterm", "text": [ "blood" ], "offsets": [ [ 567, 572 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005767" }, { "db_name": "UMLS", "db_id": "C0005768" }, { "db_name": "UMLS", "db_id": "C0005835" } ] }, { "id": "DerAnaesthesist.50440143.eng.abstr-s3-t12", "type": "umlsterm", "text": [ "treatment" ], "offsets": [ [ 589, 598 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0087111" }, { "db_name": "UMLS", "db_id": "C0039798" } ] }, { "id": "DerAnaesthesist.50440143.eng.abstr-s3-t13", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 602, 610 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.50440143.eng.abstr-s4-t1", "type": "umlsterm", "text": [ "Consensus" ], "offsets": [ [ 651, 660 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0376298" } ] }, { "id": "DerAnaesthesist.50440143.eng.abstr-s4-t2", "type": "umlsterm", "text": [ "Conference" ], "offsets": [ [ 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[]

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[ { "id": "DerAnaesthesist.50440154.eng.abstr-passage-0", "type": "abstract", "text": [ "Methods . To assess the occupational exposure of the anaesthetist to anaesthetic gases , a total of 1 German and 25 Swiss hospitals were investigated . A Brueel & Kjær Type 1302 multi-gas monitor was used to measure concentrations of nitrous oxide and halogenated anaesthetic agents in the anaesthetist's breathing zone . Measurements were performed during 114 general anaesthetic , 55 of which were in patients under 11 years of age . In these 55 patients , the influence of various factors on the exposure ( time-weighted average concentrations ) was estimated by comparing different data groups . The efficiency of the applied scavenging equipment was examined by surveying the exhalation valve with a leak detector ( type TIF 5600 , TIF Instruments , Miami ) . Results . Sessions with patients under 11 years of age revealed much higher anaesthetic gas exposures compared to older patients . The concentrations of nitrous oxide were on average threefold ( Fig . 1 ) , those of the halogenated anaesthetics fivefold higher ( Fig . 2 ) for the younger patients . In 11- to 16-year-old patients the exposure level was the same as in adult patients . The measurements showed a reduction of 85% in exposure if an efficient scavenging system ( i.e. , no waste gas discharge to room air through the exhalation valve ) or lower fresh gas flow were used ( Fig . 4 ) ; 42% of the inspected scavengers were inefficient , and reduced the exposure on average by only 30% . In operating theatres with a ventilation rate of at least ten air changes per h , the measured concentrations of anaesthetic gases in the inhalation zone of the anaesthetists were reduced more than 50% compared to poorly ventilated rooms ( Figs . 4 and 5 ) . The use of tracheal intubation or laryngeal mask airway ( LMA ) anaesthesia resulted in a reduction of 80% in exposure compared to standard face masks if efficient scavenging was used . The exposures during sessions with inefficiently scavenged Bain coaxial systems or unscavenged semi-open delivery systems of the Jackson-Rees type were tenfold higher than with scavenged rebreathing circuit systems ( Fig . 6 ) . During anaesthesia with IV or double-mask induction , the average levels of inhalation anaesthetics were reduced by about 80% compared to inhalational induction with standard masks ( Fig . 7 ) . The anaesthetist's working technique is a very important factor that strongly influences the concentrations . Poor work practices , like lifting off the face mask with anaesthetic gas flow turned on , increased the exposure of the anaesthetist and other operating room personnel drastically , even if the other conditions ( scavenger and room ventilation ) were good . Discussion . The exposure levels of anaesthetic gases are generally higher during anaesthesia in children up to 10 years of age than in older patients . Nevertheless , the measurements showed that exposure during paediatric anaesthesia can be kept below the recommended limit ( 8-h TWA in Switzerland ) of 100 ppm nitrous oxide and 5 ppm halothane or 10 ppm enflurane or isoflurane . Causes of high exposures were particularly high fresh gas flows often applied without scavenging or together with inefficient scavenging devices and the high part of mask anaesthesia and inhalation induction with a loosely held mask . To achieve an effective reduction of occupational exposure , well-adjusted and maintained scavenging systems and low-leakage work practices are of primary importance . As leakage can never be completely avoided , a ventilation rate of at least ten air changes per h should be maintained in operating rooms and rooms where anaesthesia is induced to keep down concentrations of waste anaesthetic gases . High exposure during mask anaesthesia and inhalation induction can be prevented by further measures . Using a LMA instead of a standard mask reduces the exposure to the same level as endotracheal intubation ." ], "offsets": [ [ 0, 3931 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.50440171.eng.abstr-passage-0", "type": "abstract", "text": [ "By measuring pulse rate ( PR ) , blood pressure ( BP ) , electrical integral skin resistance ( SR ) , and skin surface temperature in different areas , the activity of the sympathetic nerves in spinal anaesthetics of different levels was evaluated . It was found that the sympathetic subsystems for vasomotor and sudomotor activity have their own innervation and that the functionally different effectors also manifest different deficiency reactions in low- and medium-level spinal anaesthesia . Functional sympathetic innervation , however , is unimportant after high sensory spread of spinal anaesthesia . The sympathetic nerves show similar signs of deficiency during administration of centrally acting general anaesthetics . In contrast to these , however , high spinal anaesthesia does not block the vagal component of the autonomic nervous system . The unopposed parasympathetic nerves directly affect the heart and other effectors , which may result in life-threatening cardiovascular reactions with decreases in BP and bradycardia . If high sympathetic blockade is recognized early , such life-threatening situations can be managed successfully . Suitable means of measuring sympathetic activity are the observation of BP , HR , temperature , and particularly SR at the hand . Sympathetic nerve blockade due to spinal anaesthesia first causes a reduction of SR in the lower extremity . In high spinal anaesthesia there is also a loss of sympathetic activity at the hands . Subsequently , hand temperature increases , and finally bradycardia and hypotension occur . The functional reaction of sympathetic activity is indicated by correlation of the vasomotor and sudomotor activities in high and low spinal anaesthesia . Failure of sudomotor activity can be observed on average at least 3 min prior to an increase in acral temperature and 9 min at the hands in cases of high spinal anaesthesia . The maximum increase in temperature in the feet was 4 ° C in high spinal anaesthesia , which was equal to that measured at the hand during centrally acting general anaesthesia ." ], "offsets": [ [ 0, 2080 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440178.eng.abstr-passage-0", "type": "abstract", "text": [ "Propofol is commercially available as Disoprivan . It is formulated as an aqueous emulsion with 1% 2,6-diisopropylphenol , 10% soya bean oil , 2,5% glycerol and 1.2% egg phosphatide . Since 1986 , propofol has been used as a sedative drug in the ICU and is highly valued for its numerous positive qualities . High effectiveness is combined with excellent control , which is demonstrably still present even after 2 weeks of sedation . This control enables short-term neurological surveillance of the patient and rapid weaning from the respirator once drug administration is stopped . Propofol does not disturb cerebral autoregulation . Depression of spontaneous breathing facilitates the ventilation of intubated patients . As the solution contains lipids , it contributes to parenteral nutrition . All in all , ease of control and rapid response make propofol a highly valued product in ICUs . It is easy to understand why many ICU specialists consider propofol an ideal drug for long-term sedation . The present authors , however , are convinced that certain limitations must be taken into account . First , cardiovascular depression , especially if potentiated by drugs such as - and Ca-entry blockers , may lead to hypotensive episodes . Potential problems ( drug tolerance , hypertriglyceridaemia ) may be revealed in long-term studies . As long as no such studies have been presented , the authors believe that it is too early to consider propofol the ideal drug for long-term sedation ." ], "offsets": [ [ 0, 1492 ] ] } ]

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[ { "id": "DerAnaesthesist.50440186.eng.abstr-passage-0", "type": "abstract", "text": [ "The authors report a tracheal rupture in a 34-year-old patient who was primarily intubated following generalised seizures and loss of consciousness ( Ruesch endotracheal tube ) . Some hours later , she developed high ventilatory airway pressures and subcutaneous and mediastinal emphysema were noted . Reintubation with a high-volume , low-pressure endotracheal tube was planned when it was noted that the ballon of the Ruesch tube was grossly overinflated . Endotracheal tube cuff pressure was measured and found to be greater than 120 cm H2O ( the maximum measurement possible with the manometer ) . The diagnosis of tracheal rupture was confirmed by fiberoptic bronchoscopy . The patient immediately underwent a throacotomy and a 3-cm tear of the pars membranacea of the trachea was sutured with a dural patch . To maintain low airway pressures post-operatively , she remained sedated for 2 days and received a muscle relaxant to permit pressure-controlled ventilation . In this case , it can be concluded that excessive inflation of the endotracheal tube cuff resulted in the tracheal rupture . Other possible causes and results of tracheal rupture are discussed ." ], "offsets": [ [ 0, 1168 ] ] } ]

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[ { "id": "DerAnaesthesist.50440191.eng.abstr-passage-0", "type": "abstract", "text": [ "After rapid changes in transfusion practice over the past few years , blood conservation techniques have become standard in modern perioperative management . As a result , the amount of homologous blood products transfused has been markedly reduced in some types of surgical procedures . Provided that skilful surgical technique is applied and the use of blood products is restricted , autologous transfusion techniques ( predonation of autologous blood , preoperative plasmapheresis , acute normovolaemic haemodilution , and intra- and postoperative blood salvage ) can be performed with an acceptable risk for patients . In addition , stimulation of erythropoiesis with recombinant human erythropoietin , supplemental iron therapy , and improving haemostasis by aprotinin may further reduce homologous blood requirements . All patients undergoing elective surgery have to be informed about the side effects of transfusion of homologous blood products and the possibility of blood-saving methods . An individual blood conservation plan , based on the patient's status and surgery , the equipment available , and personal experience should be worked out by the responsible anaesthesiologist , whereby a combination of different methods may be most effective . If storage is necessary , autologous blood products should be preparated like homologous products . The feasibility of predonation and retransfusion of autologous blood in patients with infectious diseases like hepatitis or acquired immune deficiency syndrome and the amount of labaratomy testing are still under discussion . Although blood conservation programs are time-consuming and more expensive , they reduce the various risks of using homologous blood products ." ], "offsets": [ [ 0, 1729 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440219.eng.abstr-passage-0", "type": "abstract", "text": [ "Only 53%-58% of patients with a subarachnoid haemorrhage ( SAB ) following the rupture of a cerebral aneurysm survive without neurological damage . Morbidity and mortality are closely related to the delayed ischaemic neurological deficit due to cerebral vasospasm . The following review gives an account of pathophysiological mechanisms ; the importance of treatment with calcium antagonists , hypervolaemic haemodilution , and induced arterial hypertension is discussed in light of the current literature ." ], "offsets": [ [ 0, 507 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440230.eng.abstr-passage-0", "type": "abstract", "text": [ "The objective of the study was to evaluate the role of autologous blood transfusion in current clinical practice in the Federal Republic of Germany after reunification ." ], "offsets": [ [ 0, 169 ] ] } ]

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[ { "id": "DerAnaesthesist.50440242.eng.abstr-passage-0", "type": "abstract", "text": [ "The German Social Law has required quality assurance ( QA ) procedures since 1989. The measures must be suitable to allow \" comparing investigations \" . In 1992 the German Society of Anaesthesiology and Intensive Care Medicine published recommendations for QA in anaesthesia : most problems during an anaesthetic should be documented in a standardised manner , and thus , a list of 63 pitfalls , events , and complications ( PECs ) and five degrees of severity were defined . The goal of this study was to determine the frequency of PECs in anaesthesia and to correlate PECs with procedures and preoperative health status ." ], "offsets": [ [ 0, 623 ] ] } ]

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[ { "id": "DerAnaesthesist.50440250.eng.abstr-passage-0", "type": "abstract", "text": [ "Paediatric cardiac transplantation ( pHTX ) has gained widespread acceptance as a therapy in end-stage myocardial failure and some forms of congenital heart disease , particularly hypoplastic left heart syndrome ( HLHS ) . The major problems to the anaesthesiologist in these patients are induction of anaesthesia in infants with HLHS and treatment of pulmonary hypertension in the early post-bypass period ." ], "offsets": [ [ 0, 408 ] ] } ]

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[ { "id": "DerAnaesthesist.50440284.eng.abstr-passage-0", "type": "abstract", "text": [ "Objectives . The purpose of this study was to check the precision of the Draeger vaporizer model 19.3 when filled with three different preparations of isoflurane ." ], "offsets": [ [ 0, 163 ] ] } ]

[ { "id": "DerAnaesthesist.50440284.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "Objectives" ], "offsets": [ [ 0, 10 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018017" } ] }, { "id": "DerAnaesthesist.50440284.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "vaporizer" ], "offsets": [ [ 81, 90 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042325" } ] }, { "id": "DerAnaesthesist.50440284.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "isoflurane" ], "offsets": [ [ 151, 161 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0022180" } ] } ]

[]

[]

[]

[ { "id": "DerAnaesthesist.50440288.eng.abstr-passage-0", "type": "abstract", "text": [ "This randomized , double-blind , multicentre , parallel-group study compared the efficacy and safety of an intravenous dose of ondansetron 4 mg for the prevention of postoperative nausea and vomiting ( PONV ) with metoclopramide 10 mg and placebo in patients undergoing major gynaecological surgery . A total of 1044 patients ( 465 ondansetron , 462 metoclopramide , 117 placebo ) received study medication immediately prior to induction of anaesthesia and were included in the analysis of data . The proportion of patients experiencing no emesis and no nausea or provided with rescue antiemetic medication , the number of emetic episodes , and the duration and severity of nausea were recorded during the 24-h period after recovery . Significantly more patients who received ondansetron had no emetic episodes ( 44% ) than those who received metoclopramide ( 36% , P=0.049) or placebo ( 25% , P 0.001 ) . A higher proportion of patients receiving ondansetron ( 32% ) did not experience nausea ( metoclopramide 24% , P=0.009; placebo 16% , P 0.001 ) . Significantly fewer patients in the ondansetron group required rescue medication or were withdrawn due to treatment failure ( P 0.05 ) . In the ondansetron group the total number of emetic episodes , the median time to the first emetic episode or treatment failure , and the duration and severity of nausea were reduced significantly compared with metoclopramide or placebo ( P 0.05 ) . The safety profile was similar for each treatment group ." ], "offsets": [ [ 0, 1496 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.50440291.eng.abstr-passage-0", "type": "abstract", "text": [ "Induced hypotension is defined as a reduction in mean arterial blood pressure to 50-60 mm Hg in normotensive subjects . The aim of induced hypotension is to decrease intraoperative blood loss , decrease the need for blood transfusions and improve operating conditions . Most studies indicate that induced hypotension can decrease intraoperative blood loss by 50% in many surgical procedures ; however , some studies report that blood loss is not significantly reduced . Current methods of induced hypotension are based on the use of rapid and short-acting vasodilators as primary agents ( nitroprusside , nitroglycerine , urapidil ) , supplemented by volatile anesthetics ( isoflurane ) and/or -blockers ( esmolol ) to improve effect , reduce dosage and prevent side effects ( reflex tachycardia , tachyphylaxis , rebound hypertension ) . Proper positioning of the patient and controlled ventilation aid in reducing blood loss . Major risks of induced hypotension are a reduction in blood flow ( i.e. ischaemia ) of vital organs ( brain , myocardium ) and elevation of intracranial pressure in neurosurgical patients . Thus , major contraindications of induced hypotension are severe coronary artery disease , hypertension combined with arteriosclerosis of cerebral vessels and increased intracranial pressure in patients with cerebral disease . Complications are rare in otherwise healthy patients , but may be higher in elderly patients and those with underlying organ dysfunction . Therefore , careful assessment and selection of patients , together with consideration of the potential complications , appropriate choice of drugs and invasive beatby-beat monitoring , are essential for the safe practice of induced hypotension ." ], "offsets": [ [ 0, 1731 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.50440312.eng.abstr-passage-0", "type": "abstract", "text": [ "Postoperative vomiting is induced by different mechanisms such as age , anaesthetic technique and medications , postoperative analgesia , and surgical traction on the extra-ocular muscles . The influence of anticholinergic premedication and the use of benzodiazepines as factors affecting the incidence of vomiting is controversial . In a prospective , randomised , single-blind study we examined two different treatments with regard to postoperative pain , vigilance , and vomiting in young children undergoing strabismus repair . Methods . After institutional ethical committee approval , informed written consent was obtained from all parents . The children were randomly assigned to three groups : ( 1 ) paracetamol ( P ) - 17 patients who received 250-500 mg paracetamol rectally ( dependent on body weight ) immediately after intubation of the trachea ; ( 2 ) bupivacaine ( B ) - 17 patients who received two drops 0.5% bupivacaine hydrochloride on the conjunctiva of the eye ( s ) being corrected following intubation of the trachea and again 10 min after intubation . After the surgeon had exposed the extra-ocular muscle and before readaptation of the conjunctiva , two drops of the same solution were applied again each time directly on the muscle ; and ( 3 ) controls ( C ) - 16 patients who received rectal paracetamol after completion of the operation but before extubation . The children were premedicated with 0.05 mg/kg flunitrazepam sublingually . After 0.25 mg atropine i.v. , anaesthesia was induced with 0.1 mg/kg vecuronium , 5 mg/kg thiopentone , 1.5 vol% enflurane , and N2O/O2 50:50 . When the trachea was intubated anaesthesia was maintained with enflurane as required and 70% N2O in oxygen . Extubation was performed only if the patient could touch or did not tolerate the tube . Oral diet was allowed 6 h after extubation at the earliest . Examination of vigilance and analgesia . The degrees of vigilance and pain were evaluated preoperatively and after extubation over 24 h using two different scales . Evaluation of the scales was performed during the first 3 postoperative h at 12 different time points ( Figs . 1 , 2 ) and 6 , 12 , and 24 h after extubation . The evaluation was conducted by nursing staff who were blinded to the treatment ( single-blind study ) . Postoperative analgesia consisted of 250-500 mg rectal paracetamol ( all patients ) . Parametric data were expressed as mean +/- SD , and comparisons were made with the one-way analysis of variance . Fisher's exact test was applied to ordinal data . P 0.05 indicates a statistically significant difference . Results . Two patients ( P ) were excluded from the study postoperatively because of refusing rectal paracetamol in spite of pain and postoperative infection of the upper airways , which had manifestated on the afternoon of the operative day . No significant differences were found between the three groups in patient characteristics ( Table 1 ) . The quantity of enflurane administered , rate , postoperative consumption of rectal paracetamol , and postoperative emesis were highest in the control group ( Tables 2 , 3 ) , but the incidence of postoperative vomiting ranged only between 13% and 24% ( Table 3 ) . Children with preoperative paracetamol needed more time to fulfill the criteria to \" stick out the tongue \" and \" recognising the mother \" . Vigilance . The time to postoperative crying or screaming and restlessness was shorter in the control group . The values reached significant difference at 10 min ( P ) and 25 min ( P and B ) after extubation compared with the other groups ( Fig . 1 ) . Analgesie . At 5 , 10 , and 150 min after extubation pain was significantly higher in patients in the control group ( Fig . 2 ) . Conclusions . Intraoperative administration of rectal paracetamol or topical 0.5% bupivacaine was most effective in the treatment of postoperative pain for strabismus surgery in younger children ." ], "offsets": [ [ 0, 3939 ] ] } ]

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"type": "umlsterm", "text": [ "muscles" ], "offsets": [ [ 180, 187 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "DerAnaesthesist.50440312.eng.abstr-s1-t12", "type": "umlsterm", "text": [ "Postoperative vomiting" ], "offsets": [ [ 0, 22 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0520905" } ] }, { "id": "DerAnaesthesist.50440312.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "anticholinergic" ], "offsets": [ [ 207, 222 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242896" } ] }, { "id": "DerAnaesthesist.50440312.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "premedication" ], "offsets": [ [ 223, 236 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033045" } ] }, { "id": "DerAnaesthesist.50440312.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "use" ], "offsets": [ [ 245, 248 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042153" } ] }, { "id": "DerAnaesthesist.50440312.eng.abstr-s2-t4", "type": "umlsterm", "text": [ 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[]

[]

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"DerAnaesthesist.50440312.eng.abstr-s35-t8", "arg2_id": "DerAnaesthesist.50440312.eng.abstr-s35-t1", "normalized": [] }, { "id": "DerAnaesthesist.50440312.eng.abstr-s35-r48-t7.1-t10.1", "type": "degree_of", "arg1_id": "DerAnaesthesist.50440312.eng.abstr-s35-t7", "arg2_id": "DerAnaesthesist.50440312.eng.abstr-s35-t10", "normalized": [] } ]

[ { "id": "DerAnaesthesist.50440319.eng.abstr-passage-0", "type": "abstract", "text": [ "The physiological pattern of regional pulmonary blood flow is mainly determined by the relationship of pulmonary arterial , venous , and alveolar pressures [ 12 , 32 ] . Changes in alveolar pressure and pulmonary geometry may therefore be expected to influence regional perfusion , which is a key determinant of pulmonary gas exchange . Unilateral thoracotomy is usually performed with the patient in the lateral decubitus position . The present study examined the influence of mechanical factors on regional pulmonary blood flow distribution in rabbits in the lateral decubitus position during normoxia and unilateral hypoxia ." ], "offsets": [ [ 0, 628 ] ] } ]

[ { "id": "DerAnaesthesist.50440319.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "blood" ], "offsets": [ [ 48, 53 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005767" }, { "db_name": "UMLS", "db_id": "C0005768" }, { "db_name": "UMLS", "db_id": "C0005835" } ] }, { "id": "DerAnaesthesist.50440319.eng.abstr-s1-t2", "type": "umlsterm", "text": [ "pressures" ], "offsets": [ [ 146, 155 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033095" } ] }, { "id": "DerAnaesthesist.50440319.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "pressure" ], "offsets": [ [ 190, 198 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033095" } ] }, { "id": "DerAnaesthesist.50440319.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "perfusion" ], "offsets": [ [ 270, 279 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0031001" } ] }, { "id": "DerAnaesthesist.50440319.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "gas" ], "offsets": [ [ 322, 325 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0017110" } ] }, { "id": "DerAnaesthesist.50440319.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "regional perfusion" ], "offsets": [ [ 261, 279 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0031006" } ] }, { "id": "DerAnaesthesist.50440319.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "pulmonary gas exchange" ], "offsets": [ [ 312, 334 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0034071" } ] }, { "id": "DerAnaesthesist.50440319.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "thoracotomy" ], "offsets": [ [ 348, 359 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039991" } ] }, { "id": "DerAnaesthesist.50440319.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "patient" ], "offsets": [ [ 390, 397 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.50440319.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "decubitus" ], "offsets": [ [ 413, 422 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0011127" } ] }, { "id": "DerAnaesthesist.50440319.eng.abstr-s4-t1", "type": "umlsterm", "text": [ "blood" ], "offsets": [ [ 519, 524 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005767" }, { "db_name": "UMLS", "db_id": "C0005768" }, { "db_name": "UMLS", "db_id": "C0005835" } ] }, { "id": "DerAnaesthesist.50440319.eng.abstr-s4-t2", "type": "umlsterm", "text": [ "distribution" ], "offsets": [ [ 530, 542 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0520511" } ] }, { "id": "DerAnaesthesist.50440319.eng.abstr-s4-t3", "type": "umlsterm", "text": [ "rabbits" ], "offsets": [ [ 546, 553 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0034493" } ] }, { "id": "DerAnaesthesist.50440319.eng.abstr-s4-t4", "type": "umlsterm", "text": [ "decubitus" ], "offsets": [ [ 569, 578 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0011127" } ] }, { "id": "DerAnaesthesist.50440319.eng.abstr-s4-t5", "type": "umlsterm", "text": [ "hypoxia" ], "offsets": [ [ 619, 626 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242184" } ] } ]

[]

[]

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[ { "id": "DerAnaesthesist.50440328.eng.abstr-passage-0", "type": "abstract", "text": [ "In animal models authors have dealt with the question of whether hypotension alone can cause an acute-phase response even in the absence of marked blood loss and trauma . Sodium nitroprusside ( SNP ) , which was employed in the animal models , is also used to induce hypotension in humans . Since no data are available on human subjects plasma concentrations of interleukin-6 ( IL-6), an important mediator of the acute-phase response , were studied in patients during SNP infusion for induction of hypotension ." ], "offsets": [ [ 0, 512 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.50440334.eng.abstr-passage-0", "type": "abstract", "text": [ "The aim of this study was to compare the intubating conditions of a mivacurium-induced neuromuscular block 90 s after a divided administration with three different methods of induction of anaesthesia ." ], "offsets": [ [ 0, 201 ] ] } ]

[ { "id": "DerAnaesthesist.50440334.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "aim" ], "offsets": [ [ 4, 7 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0108800" } ] }, { "id": "DerAnaesthesist.50440334.eng.abstr-s1-t2", "type": "umlsterm", "text": [ "administration" ], "offsets": [ [ 128, 142 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001554" } ] }, { "id": "DerAnaesthesist.50440334.eng.abstr-s1-t3", "type": "umlsterm", "text": [ "methods" ], "offsets": [ [ 164, 171 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0025663" }, { "db_name": "UMLS", "db_id": "C0025664" } ] }, { "id": "DerAnaesthesist.50440334.eng.abstr-s1-t4", "type": "umlsterm", "text": [ "neuromuscular block" ], "offsets": [ [ 87, 106 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0235062" } ] } ]

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[ { "id": "DerAnaesthesist.50440339.eng.abstr-passage-0", "type": "abstract", "text": [ "Patchy analgesia and incomplete motor blockade sometimes occur during surgery of the upper limb under axillary brachial plexus blockade . To avoid these problems , we sought an alternative approach to the brachial plexus to guarantee reliable anaesthesia . Based on anatomic studies , we undertook a prospective clinical study with 175 patients ." ], "offsets": [ [ 0, 346 ] ] } ]

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[ { "id": "DerAnaesthesist.50440345.eng.abstr-passage-0", "type": "abstract", "text": [ "Gamma-hydroxybutyric acid ( GHB ) is a naturally occurring transmitter in the mammalian brain , related to sleep regulation and possibly to energy balance in diving or hibernating animals . It has been used for almost 35 years as an intravenous agent for induction of anaesthesia and for long-term sedation . Its convincing pharmacological properties , without serious adresse effects on circulation or respiration , are compromised by its unpredictable duration of action . This is not a major problem with long-term sedation during ICU treatment . GHB has been used with good results for sedation of patients with severe brain injury , where it compares favourably with barbiturates . In animal studies , it seems to possess a protective action against hypoxia on a cellular and whole organ level . However , in some experimental animals GHB has been shown to produce seizure-like activities , and the compound is being used to produce absence-like seizures . GHB has been used in our ICU for years to provide adequate sedation for patients under controlled ventilation or for patients figthing the respirator during spontaneous respiration . No serious side effects were observed in these patients , while in some patients under haemodialysis hypernatraemia and metabolic alkalosis developed ; both were reversible after discontinuation of GHB and restriction of additional sodium input ( Somsanit , the commercially available GHB preparation in Germany , contains 9.2 mmol sodium/g ; the daily dose averages 20-40 g GHB , i.e. 180-370 mmol sodium ) ." ], "offsets": [ [ 0, 1554 ] ] } ]

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[ { "id": "DerAnaesthesist.50440369.eng.abstr-passage-0", "type": "abstract", "text": [ "The occurrence of severe head injury , isolated or in connection with polytrauma , is a challenge for all physicians working in emergency care at the scene of an accident or afterwards in hospital care . It is an advantage to have a basic knowledge of neurological assessment . The Glasgow Coma Scale is widely used in this context ; we refer to mild , moderate , and severe injuries . It is very important to recognise concomitant injuries , which occur in about 40% of cases . As coexisting hypoxaemia and hypotension have an adverse effect on the time course of head injury by inducing secondary brain damage , it is essential in therapy to quickly restore the vital body functions . Unconscious patients are tracheally intubated and ventilated . Forced hyperventilation over a lengthy period seems to have an unfavourable effect on outcome . Anaesthetic drugs and adjuvant therapies are used that do not increase intracranial vessel diameter and consequently intracranial pressure ( ICP ) . This applies to all i.v. anaesthetics , sedatives , and opioids , as long as no respiratory depression occurs . Ketamine has been useful for many years at the scene of an accident . An existing low blood pressure ( BP ) is raised while a significantly increased BP is moderately lowered . It is necessary to have adequate cerebral perfusion pressure ( CPP ) , which is defined as mean BP minus ICP . In cases of polytrauma with heavy bleeding , e.g. , from the liver or spleen , the blood loss must be stopped before the neurosurgeon begins . Excessive i.v. administration of Ringer's lactate should be avoided . Today , the routine use of osmodiuretics , e.g. , mannitol , is not indicated . It has not yet been possible to show that using corticosteroids is definitely beneficial in human brain trauma ; there may be a positive effect in connection with spinal trauma . New therapies are being investigated , such as increasing CPP , administering AMPA/NMDA-antagonists , 21-aminosteroids , or hypertonic-hyperoncotic solutions . However , they have not as yet been proven effective for general clinical use or clinical use et al." ], "offsets": [ [ 0, 2127 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.50440395.eng.abstr-passage-0", "type": "abstract", "text": [ "Pregnancy causes substantial changes in the cardiovascular system : cardiac output ( 40%-50% ) and blood volume ( 40% ) increase whereas systemic peripheral resistance and arterial pressure decrease . The rise in progesterone and estrogen levels accompanying pregnancy stimulates the renin-angiotension-aldosterone system . Increased prostaglandin production follows renin activation ; simultaneously , the arterial vessels show diminished angiotension sensitivity . The result is pronounced vasodilatation . Heart disease remains the most important nonobstetric cause of maternal death . The physiological changes in the cardiovascular system during pregnancy influence cardiac diseases in different ways . Pregnancy , labor , and delivery appear to be well tolerated in gravidae with an atrial septal defect , ventricular septal defect , and patents ductus arteriosus . Sometimes congestive heart failure occurs and appropriate medical therapy is necessary . Pregnant women with uncorrected cyanotic congenital heart disease ( Eisenmenger's syndrome , tetralogy of Fallot ) constitute a high-risk group because of right ventricular insufficiency and hypoxic attacks . The consequences for anaesthesia in parturients with congenital heart disease are discussed . The symptoms of acquired mitral or aortic stenosis are aggravated by the physiological changes in the cardiovascular system during pregnancy ; the clinical symptoms of valve insufficiency are ameliorated by vasodilatation . Peripartum cardiomyopathy clinically shows similar features to idiopathic dilated cardiomyopathy . The basis of treatment is the same as that of congestive heart failure , with the therapeutic spectrum ranging from diet to heart transplantation . Women with hypertrophic cardiomyopathy tolerate pregnancy , labor , and delivery surprisingly well . Vaginal delivery is possible , but epidural anaesthesia is contraindicated . Hypertensive disorders associated with pregnancy are classified into three groups : chronic , treatment , and preeclamptic hypertension . Whereas chronic and transient hypertension do not affect the outcome of pregnancy appreciably , pre-eclampsia presents a potential danger to mother and fetus . Pre-eclamptic hypertension is accompanied by low cardiac output and plasma volume . An upregulation of angiotension receptors enhances vascular reactivity , with the consequence of high peripheral resistance . For antihypertensive therapy hydralazine , -methyldopa , and magnesium sulfate are the drugs of choice . A generalised recommendation of anaesthesia for the pre-eclamptic gravida cannot be made because both general and epidural anaesthesia have risks of severe side effects ." ], "offsets": [ [ 0, 2696 ] ] } ]

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[ { "id": "DerAnaesthesist.50440405.eng.abstr-passage-0", "type": "abstract", "text": [ "The quality , result , and prognosis of neurosurgery relies heavily on the anaesthetic technique . Many different classes of drugs have been used during neurosurgical anaesthesia . This article reviews the use of intravenous ( IV ) propofol as an alternative to volatile anaesthetic techniques . Anaesthesia requirements for neurosurgical procedures are elaborated upon in the first part of the article . The priority of neuroanaesthesia is to preserve neuronal function by avoiding complications such as hypoxia , hypercarbia , and cardiovascular instability . Thereafter , the chosen anaesthetic technique should minimally interfere with cerebral autoregulation and CO2 responsiveness , while brain relaxation is encouraged by decreasing the cerebral metabolic rate for oxygen ( CMRO2) and cerebral blood flow ( CBF ) . In addition , the anaesthetic technique should be associated with rapid and predictable recovery in the operating theatre in order to allow early evaluation of the surgery . The second part of the article describes IV techniques for neurosurgery as an alternative to volatile anaesthetics , all of which increase CBF , cerebral blood volume , and intracranial pressure ( ICP ) in a dose-related manner and diminish cerebral autoregulation and interfere with cerebrovascular CO2 reactivity . Nitrous oxide has a stimulant effect on cerebral metabolism and is associated with an increase in CBF . On the other hand , all IV agents except ketamine are associated with decreases in CMRO2 and are cerebral vasoconstrictors . For this reason , it is rational to use them for the induction and maintenance of anaesthesia for neurosurgery as part of a total IV anaesthetic technique . The third part of the article focuses on propofol as the newest representative of IV anaesthetics . It is a sedative-hypnotic agent that has a pharmacokinetic-dynamic profile ideally suited for continuous infusion . Propofol reduces ICP , CBF , and CMRO2. Animal models have suggested the possibility of cerebral protection . The responsiveness of the cerebral circulation to alterations in arterial blood pressure is maintained . Evaluating propofol for major neurosurgery demonstrated good quality and depth of anaesthesia , excellent brain relaxation , and minimal surgical bleeding . In conclusion , total IV anaesthesia with propofol has proven to be a valid alternative to conventional thiopentone-isoflurane anaesthesia for intracranial surgery ." ], "offsets": [ [ 0, 2452 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.50440410.eng.abstr-passage-0", "type": "abstract", "text": [ "At present , phosphodiesterase III inhibitors are commonly used for the treatment of low cardiac output states . Despite their positive inotropic and lusitropic effects , these drugs are still under discussion because of certain adverse effects like thrombopaenia , elevation of transaminases , abdominal disregulation , and excessive periphereal vasodilatation . As a consequence , more cardioselective phosphodiesterase inhibitors were developed with the aim of reducing these adverse effects . One of them , enoximone ( Marion Merrell Dow , Fig . 1 ) , an imidazole derivative , has nearly no influence on platelets and abdominal organ function . In addition , in many studies vasodilatation was found to be absent . Recently a new substance , R80122 ( Janssen , Belgium , Fig . 1 ) , was developed . First experimental studies showed high cardioselectivity of this substance . The aim of this study was to compare the haemodynamic effects of enoximone and R80122 in patients with ischaemic heart disease ." ], "offsets": [ [ 0, 1009 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440417.eng.abstr-passage-0", "type": "abstract", "text": [ "The present study compared the effects of propofol/alfentanil versus isoflurane anaesthesia on cerebral vascular reactivity to changes in carbon dioxide ( CO2) using transcranial Doppler sonography ( TCD ) ." ], "offsets": [ [ 0, 207 ] ] } ]

[ { "id": "DerAnaesthesist.50440417.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "isoflurane" ], "offsets": [ [ 69, 79 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0022180" } ] }, { "id": "DerAnaesthesist.50440417.eng.abstr-s1-t2", "type": "umlsterm", "text": [ "carbon" ], "offsets": [ [ 138, 144 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0007009" } ] }, { "id": "DerAnaesthesist.50440417.eng.abstr-s1-t3", "type": "umlsterm", "text": [ "sonography" ], "offsets": [ [ 187, 197 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0041618" } ] }, { "id": "DerAnaesthesist.50440417.eng.abstr-s1-t4", "type": "umlsterm", "text": [ "carbon dioxide" ], "offsets": [ [ 138, 152 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0007012" } ] } ]

[]

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[ { "id": "DerAnaesthesist.50440423.eng.abstr-passage-0", "type": "abstract", "text": [ "The introduction of flow-directed pulmonary artery ( PA ) catheters has helped to improve our knowledge of cardiovascular physiology . There have been several developments of this equipment in recent years , including continuous monitoring of mixed-venous O2 saturation ( Sv\\=O2) and cardiac output ( CO ) . The high purchase price , however , is an obstacle to its use in the critically ill. The aim of the present study was to analyse the actual costs of these devices in comparison to standardly used intermittent monitoring of Sv\\=O2 and CO ." ], "offsets": [ [ 0, 546 ] ] } ]

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[ { "id": "DerAnaesthesist.50440429.eng.abstr-passage-0", "type": "abstract", "text": [ "The study aimed to evaluate whether superimposed high-frequency jet ventilation ( SHFJV ) is a useful tool in intensive care medicine to ventilate patients with pulmonary insufficiency ." ], "offsets": [ [ 0, 186 ] ] } ]

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[ { "id": "DerAnaesthesist.50440436.eng.abstr-passage-0", "type": "abstract", "text": [ "The absorption of large volumes of irrigation fluid is a major problem in transurethral prostatic surgery ( TUR-P ) . Various indicators have been tested to monitor fluid absorption with regard to continuous registration and sufficient accuracy . The volumetric fluid balance is not suitable as a routine method because of its inaccuracy . Easily accessible parameters are unspecific because of surgical bleeding ( haematocrit [ Hct ] ) , or are interfered with by physiological counter-regulatory actions ( serum sodium [ Na ] concentration ) . In 1986 Hulten et al. suggested adding 2% ethanol to the irrigation fluid as a marker and investigated it intermittently in the expired air with an alcohol-test appliance . In a prospective clinical study of 17 patients undergoing TUR-P under spinal anaesthesia , expiratory concentrations of alcohol that was added to the irrigation fluid ( 2% ethanol in Purisole , Fresenius , Bad Homburg ) were monitored . Gas was continuously sampled from the nasopharynx through a nasal cannula and the ethanol concentration was measured using a modified diverting anaesthetic gas monitor ( Normac , Datex , Helsinki ) that allows continuous as well as early detection of the absorbed irrigation fluid with reliable accuracy for clinical use . In addition , at intervals of 10 minutes we measured blood alcohol , endtidal alcohol ( Alcotest 7110 , Drauml ; ger , Luebeck ) , haematocrit , serum Na concentration , and blood gases . Sixty-eight measurements were obtained from the 17 patients . As shown in other studies , serum Na ( r2 = 0.68 ) and Hct ( r2 = 0.39 ) correlated poorly with the irrigation fluid as determined by serum alcohol levels . In contrast , the expiratory alcohol measurements with the alcotest 7110 ( r2 = 0.93 ) and Normac devices ( r2 = 0.85 ) were closely related . Continuous monitoring of the expiratory alcohol concentration with a Normac monitor closely reflects blood alcohol concentrations , and may hence serve as a useful semiquantitative monitor of irrigation fluid absorption during TUR-P ." ], "offsets": [ [ 0, 2063 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440445.eng.abstr-passage-0", "type": "abstract", "text": [ "Although the local anaesthetic prilocaine is less cardio- and neurotoxic than lidocaine , it bears the disadvantage of the formation of methaemoglobin by the metabolite o-toluidine . Prilocaine is often successfully used , especially for the blockade of the brachial plexus , but one problem of this technique is the failure rate of 3-10% , with the consequence that general anaesthesia after administration of prilocaine is frequently necessary . Methaemoglobin formation after prilocaine administration has been thoroughly investigated . Nothing is known , however , about the interactions of prilocaine and the induction of general anaesthesia relative to methaemoglobinaemia ." ], "offsets": [ [ 0, 680 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440473.eng.abstr-passage-0", "type": "abstract", "text": [ "The conventional multichannel electroencephalogram is quite inconvenient for long-term monitoring in the operating theatre or intensive care unit . Recording of the EEG would be easier if a small number of channels was sufficient . Aiming at reduction of channels , leads from different regions of the scalp were analysed visually and with regard to their spectral content ." ], "offsets": [ [ 0, 374 ] ] } ]

[ { "id": "DerAnaesthesist.50440473.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "electroencephalogram" ], "offsets": [ [ 30, 50 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0086205" } ] }, { "id": "DerAnaesthesist.50440473.eng.abstr-s1-t2", "type": "umlsterm", "text": [ "care" ], "offsets": [ [ 136, 140 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0150499" } ] }, { "id": "DerAnaesthesist.50440473.eng.abstr-s1-t3", "type": "umlsterm", "text": [ "operating theatre" ], "offsets": [ [ 105, 122 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0029064" } ] }, { "id": "DerAnaesthesist.50440473.eng.abstr-s1-t4", "type": "umlsterm", "text": [ "intensive care" ], "offsets": [ [ 126, 140 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0085559" } ] }, { "id": "DerAnaesthesist.50440473.eng.abstr-s1-t5", "type": "umlsterm", "text": [ "intensive care unit" ], "offsets": [ [ 126, 145 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021708" } ] }, { "id": "DerAnaesthesist.50440473.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "EEG" ], "offsets": [ [ 165, 168 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013819" } ] }, { "id": "DerAnaesthesist.50440473.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "scalp" ], "offsets": [ [ 302, 307 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0036270" } ] } ]

[]

[]

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[ { "id": "DerAnaesthesist.50440478.eng.abstr-passage-0", "type": "abstract", "text": [ "Patients and methods . We have studied mid-latency auditory evoked potentials ( MLAEP ) during general anaesthesia with sufentanil in ten patients scheduled for elective major urological surgery . Anaesthesia was induced with sufentanil 2-3 µg/kg; for maintenance of anaesthesia a further bolus of sufentanil ( 1-2 µg/kg) 10 min before the start of surgery ( skin incision ) was given . MLAEP were recorded before and 10 min after the last sufentanil bolus on the vertex ( positive ) and mastoids on both sides ( negative ) . Latencies of the peaks V , Na , Pa , Nb , and P1 ( ms ) and amplitudes Na/Pa , Pa/Nb , and Nb/P1 ( µV) were measured ." ], "offsets": [ [ 0, 644 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.50440483.eng.abstr-passage-0", "type": "abstract", "text": [ "Friedreich's disease is a very rare neurological disorder that causes degeneration of the posterior roots of the spinal nerves and progresses to the anterior roots , even in young adults . Hospital emergency teams face the question of choice of anaesthesia in such patients should general anaesthesia be preferred to regional anaesthesia . We report a 36-year-old patient with spino-cerebellar heredoataxia ( Friedreich's disease ) who underwent a proctological procedure after administration of spinal anaesthesia with 3 mg hyperbaric bupivacaine in a sitting position . Both the intra- and post-operative courses were unremarkable ; in particular , with regard to the underlying neurological disease , no complications were observed ." ], "offsets": [ [ 0, 736 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.50440486.eng.abstr-passage-0", "type": "abstract", "text": [ "Patients who have undergone cardiac surgery with use of extracorporeal circulation frequently reveal marked hypovolaemia in spite of a highly positive fluid balance . This is thought to be due to transient microvascular damage and extravascular fluid shift . Further volume replacement to achieve haemodynamic stability in the postoperative period may cause fluid overload and congestive heart failure . The present study was designed to investigate whether this fluid overload could be avoided by using a hypertonic-hyperoncotic solution ( group I : HHL , 10% hydroxyethylstarch 200/0 . 5 in 7.2% saline ) instead of two different standard colloid solutions ( group II : HA , 5% albumin ; group III : HES , 6% hydroxyethylstarch in 0.9% saline ) ." ], "offsets": [ [ 0, 748 ] ] } ]

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"DerAnaesthesist.50440486.eng.abstr-s1-t6", "type": "umlsterm", "text": [ "balance" ], "offsets": [ [ 157, 164 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0014653" } ] }, { "id": "DerAnaesthesist.50440486.eng.abstr-s1-t7", "type": "umlsterm", "text": [ "cardiac surgery" ], "offsets": [ [ 28, 43 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0524727" } ] }, { "id": "DerAnaesthesist.50440486.eng.abstr-s1-t8", "type": "umlsterm", "text": [ "extracorporeal circulation" ], "offsets": [ [ 56, 82 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0015354" } ] }, { "id": "DerAnaesthesist.50440486.eng.abstr-s1-t9", "type": "umlsterm", "text": [ "fluid balance" ], "offsets": [ [ 151, 164 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0016284" } ] }, { "id": "DerAnaesthesist.50440486.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "transient" ], "offsets": [ [ 196, 205 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040704" } ] }, { "id": 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[]

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[ { "id": "DerAnaesthesist.50440493.eng.abstr-passage-0", "type": "abstract", "text": [ "Pulse contour cardiac output ( PCCO ) is an easily applicable method for continuous measurement of cardiac output in critically ill patients . Calculation of stroke volume is possible by analysing the area under the systolic part of the arterial pulse pressure waveform together with an individual calibration factor ( Zao ) to account for the individually variable vascular impedance . Since vascular impedance is potentially affected by altered vascular tone , it was the aim of the present study to examine the validity of PCCO in ICU patients receiving various dosages of a variety of vasoactive drugs ." ], "offsets": [ [ 0, 607 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440501.eng.abstr-passage-0", "type": "abstract", "text": [ "The use of autotransfusion devices is an established method of reducing the need for homologous transfusions in surgery [ 3 , 11 , 13 ] , but technical factors still contraindicate the washing and concentration of blood volumes smaller than 300 ml . Therefore , haemoconcentration of small volumes of salvaged blood , as usually found in paediatric surgery , is considered to be a complicated and questionable practice [ 5 ] . Whereas these amounts of blood loss are easily tolerated by adults , they may necessitate homologous transfusions in paediatric surgery . In a prospective study , we investigated whether a simple technical modification in the processing of salvaged blood could facilitate the use of autotransfusion devices , especially in children ." ], "offsets": [ [ 0, 760 ] ] } ]

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[ { "id": "DerAnaesthesist.50440531.eng.abstr-passage-0", "type": "abstract", "text": [ "The choice of appropriate anaesthesia in a more or less seriously ill patient requires detailed information on the risk and tolerance of each specific anaesthetic regimen . The objective of this prospective , randomised clinical trial was to test the hypothesis that three regimens of general anaesthesia - neurolept- ( NLA ) , balanced ( BAL ) , and intravenous propofol anaesthesia ( IVA ) - differ with regard to safety and comfort . The criteria for the intraoperative safety and postoperative comfort of the patients were the incidents , events and complications ( IEC ) that required medical treatment as well as the evaluation of postoperative complaints by the patients according to the IEC list and patient questionnaires of the German Society of Anaesthesia and Critical Care Medicine ( DGAI ) ." ], "offsets": [ [ 0, 805 ] ] } ]

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[ { "id": "DerAnaesthesist.50440545.eng.abstr-passage-0", "type": "abstract", "text": [ "After cardiac surgery , transient renal dysfunction often occurs . Regional differentiation of these processes is possible only using invasive techniques , including renal biopsy . Approximately 30 different plasma protein components have been identified in the urine of healthy individuals by means of qualitative and quantitative immunochemical methods . The detection of microalbuminuria has high diagnostic relevance for the early diagnosis of renal damage at a reversible stage . One typical urinary protein is Tamm-Horsfall protein ( THp ) . After histochemical staining of human kidney sections , activity is seen in the loop of Henle and initial distal tubule . The assay of -1 microglobulin ( MG ) in urine is considered one of the most efficient laboratory parameters for the diagnosis of tubular lesions . Serum concentrations of -1 MG are less dependent on extrarenal changes than are those of other low-molecular-weight proteins . -2 MG is also one of the standards used in recent years for diagnostic relevance . Urinary albumin excretion , normaly less than 30 mg per day , sometimes increases after glomerular damage . Some renal function tests are used daily in many intensive care units , e.g. creatinine clearance ( CCr ) or urea and sodium excretion . Renal dysfunction should , however , be further examined to localise regional damage and to seek new clinical standards in addition to the conventional tests ." ], "offsets": [ [ 0, 1431 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440552.eng.abstr-passage-0", "type": "abstract", "text": [ "Oxygen uptake ( V. O2) and carbon dioxide elimination ( V. CO2) can be measured with an indirect calorimeter ; this method is well established in routine monitoring of ICU patients to evaluate metabolic state as a reflection of stress . In various experimental studies it was demonstrated that anaesthetics can influence whole-body metabolism . The purpose of this study was to examine whether indirect calorimetry can be used intraoperatively during routine anaesthesia and whether presumable changes in metabolism can be detected immediately . Abdominal aortic cross-clamping changes circulation , nutritional supply of the lower extremities and thus V. O2 and V. CO2. We therefore used this operation for our study ." ], "offsets": [ [ 0, 719 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440566.eng.abstr-passage-0", "type": "abstract", "text": [ "Ketamine and midazolam , applied as intravenous medication for conscious sedation in day-case maxillo-facial surgery , has been proven to be superior to pentazocine and midazolam concerning cardiovascular parameters and respiratory depression . The aim of this study was to evaluate the effects of low-dose ketamine/midazolam on anxiety , analgesia , amnesia and subjective feelings ." ], "offsets": [ [ 0, 384 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.50440573.eng.abstr-passage-0", "type": "abstract", "text": [ "Background . Propanidid was widely used as a short-acting i.v. anaesthetic until it was withdrawn due to severe haemodynamic side effects . It was presumed that anaphylactoid reactions with massive histamine release were caused by the solvent cremophor rather than by propanidid itself . A new liposomal preparation of propanidid was examined in this animal study and compared with propanidid in cremophor solution and with propofol ." ], "offsets": [ [ 0, 434 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440581.eng.abstr-passage-0", "type": "abstract", "text": [ "Breathing filters or heat and moisture exchangers ( HME ) , which are placed between a tracheal tube and the Y-piece , allow reuse of breathing tubes without changing between operations . During low-flow and minimal-flow anaesthesia , condensed water accumulates in the breathing circuit . An evaluation of the volume of condensed water is given ( Fig . 1 ) . It may be possible that water flows onto the filter surface , for example , when the breathing tubes are lifted . The water permeability of such breathing filters and HME was tested . For the experiments , a commercial breathing circuit and ventilator ( Draeger Sulla 808+Ventilog) and patient model ( Fig . 2 ) were used ; 12 breathing filters/HMEs of different manufacturers were tested . Only 3 filters were not permeable to the test volume of 20 ml water . The authors suggest the water volume be checked routinely and the breathing tubes be emptied if necessary ." ], "offsets": [ [ 0, 928 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440585.eng.abstr-passage-0", "type": "abstract", "text": [ "Adverse effects of resuscitation due to closed-chest cardiac massage are common , and the incidence is increased when an incorrect technique is used . Nevertheless , thrombolytic therapy of a myocardial infarction can become necessary even after cardiopulmonary resuscitation ( CPR ) . In these patients , the risk of thrombolytic therapy-induced bleeding is immanent ." ], "offsets": [ [ 0, 369 ] ] } ]

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[ { "id": "DerAnaesthesist.50440590.eng.abstr-passage-0", "type": "abstract", "text": [ "Epidemiologic studies have shown that trace concentrations of inhalation anaesthetics polluting the air of operating theatres could have deleterious effects on the personnel's health . Nitrous oxide ( N2O) oxidises vitamin B12 and thus decreases DNA production by inactivation of methionine synthase . Therefore , the United States and most European health authorities recommend threshold values to protect against potential health risks . These values range from 25 to 100 ppm , expressed as time-weighted averages ( TWA ) . There is a lack of data concerning measurements of trace concentrations under defined conditions . The aim of this study was to quantify levels of N2O in a recovery room ( RR ) with an air conditioning system ." ], "offsets": [ [ 0, 736 ] ] } ]

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[ { "id": "DerAnaesthesist.50440613.eng.abstr-passage-0", "type": "abstract", "text": [ "Oesophageal malposition of an endotracheal tube is among the leading causes of anaesthesia incidents . While clinical manoeuvres for detection of tube malposition are unreliable , monitoring ( i.e. capnography ) can prevent such incidents . The problem is particularly important in prehospital care , where capnography is not ( yet ) widely available . We tested three devices used for differentiating oesophageal from endotracheal intubation : 1. Non-CO2dependent Oesophageal Detector Device ( ODD ) as described by Pollard and Wee , 2. Semi-quantitative chemical disposable capnometer EasyCAP ( Nellcor ) , 3. Non-quantitative infrared miniaturised capnometer MiniCAP ( MSA ) ." ], "offsets": [ [ 0, 679 ] ] } ]

[ { "id": "DerAnaesthesist.50440613.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "Oesophageal" ], "offsets": [ [ 0, 11 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0014852" } ] }, { "id": "DerAnaesthesist.50440613.eng.abstr-s1-t2", "type": "umlsterm", "text": [ "causes" ], "offsets": [ [ 69, 75 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0015127" } ] }, { "id": "DerAnaesthesist.50440613.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "care" ], "offsets": [ [ 294, 298 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0150499" } ] }, { "id": "DerAnaesthesist.50440613.eng.abstr-s4-t1", "type": "umlsterm", "text": [ "devices" ], "offsets": [ [ 369, 376 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0699733" }, { "db_name": "UMLS", "db_id": "C0220819" } ] }, { "id": "DerAnaesthesist.50440613.eng.abstr-s4-t2", "type": "umlsterm", "text": [ "oesophageal" ], "offsets": [ [ 402, 413 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0014852" } ] }, { "id": "DerAnaesthesist.50440613.eng.abstr-s4-t3", "type": "umlsterm", "text": [ "intubation" ], "offsets": [ [ 432, 442 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021925" } ] }, { "id": "DerAnaesthesist.50440613.eng.abstr-s4-t4", "type": "umlsterm", "text": [ "Non-CO2dependent" ], "offsets": [ [ 448, 464 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0007012" } ] }, { "id": "DerAnaesthesist.50440613.eng.abstr-s4-t5", "type": "umlsterm", "text": [ "Oesophageal" ], "offsets": [ [ 465, 476 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0014852" } ] }, { "id": "DerAnaesthesist.50440613.eng.abstr-s4-t6", "type": "umlsterm", "text": [ "Device" ], "offsets": [ [ 486, 492 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0699733" }, { "db_name": "UMLS", "db_id": "C0220819" } ] }, { "id": "DerAnaesthesist.50440613.eng.abstr-s4-t7", "type": "umlsterm", "text": [ "Wee" ], "offsets": [ [ 529, 532 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0153064" } ] }, { "id": "DerAnaesthesist.50440613.eng.abstr-s4-t8", "type": "umlsterm", "text": [ "endotracheal intubation" ], "offsets": [ [ 419, 442 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021932" } ] } ]

[]

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[ { "id": "DerAnaesthesist.50440631.eng.abstr-passage-0", "type": "abstract", "text": [ "Objective . To demonstrate the safety of autologous blood donation in an obstetric practice ." ], "offsets": [ [ 0, 93 ] ] } ]

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[ { "id": "DerAnaesthesist.50440634.eng.abstr-passage-0", "type": "abstract", "text": [ "The following double-blind , randomised study dealt with three questions : ( 1 ) Is a multidimensional psychometric rating scale suitable for the measurement of mood before anaesthesia ? ( 2 ) What are the effects of the new benzodiazepine-like drug zolpidem on preoperative mood compared with phenobarbital ? ( 3 ) Is the combination with Promethazine suggestive ?" ], "offsets": [ [ 0, 365 ] ] } ]

[ { "id": "DerAnaesthesist.50440634.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "psychometric" ], "offsets": [ [ 103, 115 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033920" } ] }, { "id": "DerAnaesthesist.50440634.eng.abstr-s1-t2", "type": "umlsterm", "text": [ "scale" ], "offsets": [ [ 123, 128 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0175659" } ] }, { "id": "DerAnaesthesist.50440634.eng.abstr-s1-t3", "type": "umlsterm", "text": [ "measurement" ], "offsets": [ [ 146, 157 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242485" } ] }, { "id": "DerAnaesthesist.50440634.eng.abstr-s1-t4", "type": "umlsterm", "text": [ "mood" ], "offsets": [ [ 161, 165 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026516" } ] }, { "id": "DerAnaesthesist.50440634.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "benzodiazepine-like" ], "offsets": [ [ 225, 244 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005064" }, { "db_name": "UMLS", "db_id": "C0053218" } ] }, { "id": "DerAnaesthesist.50440634.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "drug" ], "offsets": [ [ 245, 249 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013227" } ] }, { "id": "DerAnaesthesist.50440634.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "zolpidem" ], "offsets": [ [ 250, 258 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0078839" } ] }, { "id": "DerAnaesthesist.50440634.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "mood" ], "offsets": [ [ 275, 279 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026516" } ] }, { "id": "DerAnaesthesist.50440634.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "phenobarbital" ], "offsets": [ [ 294, 307 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0031412" } ] }, { "id": "DerAnaesthesist.50440634.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "Promethazine" ], "offsets": [ [ 340, 352 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033405" }, { "db_name": "UMLS", "db_id": "C0699545" } ] } ]

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[ { "id": "DerAnaesthesist.50440634.eng.abstr-s1-r1-t3.1-t4.1", "type": "measurement_of", "arg1_id": "DerAnaesthesist.50440634.eng.abstr-s2-t3", "arg2_id": "DerAnaesthesist.50440634.eng.abstr-s2-t4", "normalized": [] }, { "id": "DerAnaesthesist.50440634.eng.abstr-s1-r2-t3.1-t4.1", "type": "measures", "arg1_id": "DerAnaesthesist.50440634.eng.abstr-s2-t3", "arg2_id": "DerAnaesthesist.50440634.eng.abstr-s2-t4", "normalized": [] }, { "id": "DerAnaesthesist.50440634.eng.abstr-s1-r3-t1.1-t4.1", "type": "measures", "arg1_id": "DerAnaesthesist.50440634.eng.abstr-s3-t1", "arg2_id": "DerAnaesthesist.50440634.eng.abstr-s2-t4", "normalized": [] }, { "id": "DerAnaesthesist.50440634.eng.abstr-s1-r4-t1.1-t3.1", "type": "measures", "arg1_id": "DerAnaesthesist.50440634.eng.abstr-s3-t1", "arg2_id": "DerAnaesthesist.50440634.eng.abstr-s2-t3", "normalized": [] }, { "id": "DerAnaesthesist.50440634.eng.abstr-s1-r5-t1.1-t2.1", "type": "uses", "arg1_id": "DerAnaesthesist.50440634.eng.abstr-s3-t1", "arg2_id": "DerAnaesthesist.50440634.eng.abstr-s2-t2", "normalized": [] } ]

[ { "id": "DerAnaesthesist.50440651.eng.abstr-passage-0", "type": "abstract", "text": [ "Oxygen radicals and oxygen radial mediators are thought to be important components in the development of acute lung injury , sepsis , and multiple organ failure . Injured patients , patients with pulmonary diseases , and multiple trauma patients also showed an elevated lipid peroxidation , indicating increased oxidant stress . N-Acetylcysteine ( NAC ) has been used as an antioxidant in a wide variety of experiments . NAC has been suggested to act by raising concentrations of cysteine , and hence glutathione , and by scavenging of oxidant species [ 1 , 11 , 17 , 29 ] . The present study was designed to investigate whether the application of NAC in intubated patients has an effect on concentrations of reduced glutathione in plasma and bronchoalveolar lavage fluid ( BAL ) and on the lipid peroxidation products malondialdehyde and conjugated dienes . Because NAC has been widely used as a mucolytic drug for the treatment of lung diseases , the influence on tracheobronchial mucus was studied , too ." ], "offsets": [ [ 0, 1008 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.50440687.eng.abstr-passage-0", "type": "abstract", "text": [ "The safety and tolerance of neuroleptanaesthesia ( NLA ) , balanced anaesthesia ( BAL ) , and intravenous anaesthesia with propofol ( IVA ) were analysed for the first time in a prospective , randomised clinical trial ." ], "offsets": [ [ 0, 219 ] ] } ]

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[ { "id": "DerAnaesthesist.50440695.eng.abstr-passage-0", "type": "abstract", "text": [ "Induced hypotension is an accepted technique to reduce intraoperative blood loss and thereby ensures satisfactory operating conditions , especially in microscopic interventions . Sodium nitroprusside ( NP ) , which is often used for induced hypotension , was reported to inhibit platelet aggregation in vitro . Impairment of platelet function implies a higher bleeding risk , which would make the use of NP for induced hypotension questionable ." ], "offsets": [ [ 0, 445 ] ] } ]

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[ { "id": "DerAnaesthesist.50440700.eng.abstr-passage-0", "type": "abstract", "text": [ "In clinical practice , the administration of supplementary albumin often depends on the measured plasma concentration of total protein ( TPC ) . A TPC of less than 5 g/dl is generally accepted as an indication for albumin therapy , assuming an albumin concentration of less than 2.5 g/dl . However , a physiological relation between TPC and albumin cannot be expected in critically ill patients , and thus , measurement of TPC may be misleading as an indicator for the use of albumin . Therefore , we investigated the sensitivity and specificity of TPC testing for diagnosing hypoalbuminaemia requiring treatment ." ], "offsets": [ [ 0, 614 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440705.eng.abstr-passage-0", "type": "abstract", "text": [ "This case report describes cerebral monitoring of intracranial haemodynamics using transcranial Doppler sonography ( TCD ) and jugular bulb oxygen saturation ( SjO2) by fiberoptic jugular bulb oximetry during cardiac arrest following cardiac surgery involving cardiopulmonary bypass ( CPB ) . CPB for aortic valve replacement and coronary artery bypass grafting was performed in a 63-year-old patient previously operated upon for heart disease . Mean blood flow velocity was measured in the middle cerebral artery using a bidirectional 2 MHz TCD system . SjO2 was measured using a fiberoptic thermodilution catheter placed in the right jugular bulb via the right internal jugular vein under radiographic control . At the end of the operation , low cardiac output syndrome and cardiac arrest occurred , which required reopening of the thorax and cardiopulmonary resuscitation ( CPR ) until CPB could be resumed . Following extrathoracic cardiac resuscitation , systolic \" spikes \" , loss of the diastolic flow profile , and no increase in SjO2 were recorded by the monitors , indicating cerebral circulatory arrest . However , a normal flow profile with increasing diastolic portions and an increase in SjO2 to 52% were seen following optimisation of the open thorax cardiac resuscitation . This monitoring may be able to give information to optimise therapy during CPR to avoid ischaemic cerebral injury ." ], "offsets": [ [ 0, 1405 ] ] } ]

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[ { "id": "DerAnaesthesist.50440709.eng.abstr-passage-0", "type": "abstract", "text": [ "A pre-term infant weighing 900 g , gestational age 25 weeks , developed an acute abdomen . Intravenous lines had been inserted previously in the left ( silasticcatheter ) and right ( 24 G cannula ) saphenous veins in the neonatal intensive care unit . During surgical exploration , a perforation of the terminal ileum was found . The operation consisted in partial resection of the perforated ileum with an end-to-end anastomosis and a double-lumen colostomy . Major blood loss during the procedure caused serious haemodynamic problems . Despite transfusion of erythrocyte ( 100 ml ) , thrombocytes ( 75 ml ) , and albumin ( 50 ml ) , the patient developed bradycardia and hypotension . Administration of atropine , adrenaline , and calcium IV had no effect . The operation could be finished only with extrathoracic resuscitation . When the drapes were removed , livid , swollen lower limbs raised the suspicion of an acute thrombosis of the inferior vena cava . After insertion of a 24 G IV cannula into a vein of the right upper arm , the circulation stabilised after rapid transfusion of 40 ml blood and 25 ml thrombocytes and resuscitation was successful . Paediatricians and anaesthesiologists must consider the risk of thrombosis of the vena cava . If venous lines in the lower limbs are not visible to the anaesthesiologist during the operation , venipuncture of veins of an upper limb is recommended before starting the surgical procedure . Due to the high incidence of vena cava thrombosis caused by central venous lines and the difficulty of peripheral venipuncture in pre-termintanty , a safe venous line should be inserted if necessary by pre-operative venesection ." ], "offsets": [ [ 0, 1678 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.50440743.eng.abstr-passage-0", "type": "abstract", "text": [ "The possibility that a patient during general anaesthesia is aware of the operation going on and aware of severe pain that might be remembered postoperatively must be very alarming to patients and anaesthetists alike . Furthermore , there is experimental evidence showing that conscious recall of intraoperative events is only the tip of an iceberg ; it seems very probable that there is even a higher incidence of unconscious perception during general anaesthesia . Therefore , the following stages of intraoperative awareness must be distinguished : ( 1 ) conscious awareness with explicit recall and with severe pain ; ( 2 ) conscious awareness with explicit recall but no complaints of pain ; ( 3 ) conscious awareness without explicit recall and possible implicit recall ; ( 4 ) subconscious awareness without explicit recall and possible implicit recall ; ( 5 ) no awareness . The incidence of conscious awareness with explicit recall and severe pain has been estimated at less frequent than 1/3000 general anaesthetics . Conscious awareness with explicit recall but no complaints of pain has been reported in the literature with an incidence of 0.5-2%. With 7-72% , conscious awareness without explicit recall and possible implicit recall shows a very wide range of variation and its occurrence probably depends on the anaesthetic drugs used . Subconscious awareness with possible implicit recall has an incidence of up to 80% , but there are many methodological problems in demonstrating implicit memory of intraoperative events . Reports of intraoperative awareness do not come exclusively from cardiac surgery and obstetrics , but also from all other operative specialities . Postoperatively , patients who experienced intraoperative awareness may develop a so-called post-traumatic stress syndrome . Symptoms involve re-experiencing the event awake or in dreams , sleep disturbances , depression , avoidance of stimuli associated with the event . The probability of the development of the post-traumatic stress syndrome seems to coincide with the experience of severe pain . When a patient complains of intraoperative awareness postoperatively the anaesthesiologist should discuss the event frankly with the patient . When the symptoms of the post-traumatic stress syndrome persist a psychotherapy should follow . Causes for intraoperative awareness may be : equipment failure , too-light anaesthesia , e.g. for a caesarean section or for emergency surgery in severely injured or polytraumatized patients , during cardiac surgery , bronchoscopy or difficult intubation . There is interindividual variability in anaesthetic effect ; for example , chronic drug or alcohol abuse or overweight may make increased anaesthetic doses necessary . They are at risk for intraoperative awareness . Some general anaesthetics or anaesthetic procedures , e.g. the combination of a relaxant and N2O, opioid mono-anaesthetics , or opioids combined with benzodiazepines , seem to involve a higher risk of intraoperative awareness than do volatile anaesthetics . The bases of litigation are medical malpractice , breach of contract by the anaesthesiologist or lack of informed consent from the patient . Therefore , patients who are at risk of intraoperative awareness should be given detailed information on this special risk before the operation ." ], "offsets": [ [ 0, 3342 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.50440755.eng.abstr-passage-0", "type": "abstract", "text": [ "Strabismus surgery in children is associated with a high incidence of postoperative nausea and vomiting ( PONV ) ." ], "offsets": [ [ 0, 114 ] ] } ]

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[ { "id": "DerAnaesthesist.50440761.eng.abstr-passage-0", "type": "abstract", "text": [ "Various in vitro models have been introduced for comparative examinations of post-dural-puncture trauma and measurement of liquor leakage through puncture sites . These models allow simulation of subarachnoid , but not of peridural , pressure . A new two-chamber-model realizes the simulation of both subarachnoid and peridural pressure and allows observation of in vitro punctures with video-documentation . Frame grabbing and ( computer-aided ) image analysis show new aspects of spinal puncture effects . Therefore , post-dural-puncture trauma and retraction can be objectively visualized by this method , which has not previously been demonstrated ." ], "offsets": [ [ 0, 653 ] ] } ]

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[ { "id": "DerAnaesthesist.50440770.eng.abstr-passage-0", "type": "abstract", "text": [ "Parenteral nutrition required following surgery or injury should not only meet post-aggression caloric requirements but also match the specific metabolic needs so as not to worsen the metabolic disruptions already present in this situation . The primary objective of parenteral nutrition is body protein maintenance or restoration by reduction of protein catabolism or promotion of protein synthesis or both . Whether all parenteral energy donors , i.e. , glucose , fructose , other polyols , and lipid emulsions , are equally capable of achieving this objective continues to be a controversial issue . The objective of the present study was to answer the following questions : ( 1 ) Do glucose and fructose differ in their effects on the metabolic changes seen following surgery or injury , the changes in glucose metabolism in particular ? ( 2 ) Can the observation of poorer glucose utilization in the presence of lipids be confirmed in ICU patients ?" ], "offsets": [ [ 0, 954 ] ] } ]

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[ { "id": "DerAnaesthesist.50440785.eng.abstr-passage-0", "type": "abstract", "text": [ "For surgical removal of a malignant choroid melanoma , it is necessary to reduce systolic blood pressure to around 50-60 mmHg in order to prevent choroidal haemorrhages . However , blood pressure reduction is associated with the risk of cerebral ischaemia . We report a patient with a malignant choroid melanoma in whom waves I and II of the brainstem auditory evoked potentials ( BAEP ) disappeared during surgery under controlled arterial hypotension and hypothermia ( 31.1 ° C ) . The waves could be recorded again immediately after the mean arterial pressure was increased from 48 to 77 mmHg . The oesophageal temperature had dropped by 0.3 ° C at this time . The 2-channel electroencephalogram ( EEG ) showed no irregularities during this time period . A bilateral , reversible , apparently blood-pressure-dependent loss of waves I and II during arterial hypotension despite a normal EEG has to our knowledge not been previously described in the literature . The isolated loss of waves I and II with maintenance of waves III , IV , and V is unusual . The literature contains reports of acoustic neurinoma patients in whom only wave V could be recorded . This is regarded as an indication of continued impulse conduction despite the loss of waves I to IV . Others have observed a patient with temporary and reversible loss of BAEP wave I due to vasospasm of the internal auditory artery that apparently occurred during or shortly after manipulation of the internal auditory meatus . Assuming anatomic peculiarities in the blood supply to the generators of the BAEP waves , a stenosis of the basilar artery could be considered as the cause of the bilateral reversible loss of waves I and II . Another potential source could be the induced hypothermia , but this does not seem very likely because the patient's temperature was 0.3 ° C lower at the return of the waves than at their loss ." ], "offsets": [ [ 0, 1890 ] ] } ]

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[ { "id": "DerAnaesthesist.50440789.eng.abstr-passage-0", "type": "abstract", "text": [ "The needle type introduced by Edward Tuohy for continuous spinal anaesthesia in 1944 is still used as the standard instrument for epidural anaesthesia up to the present day . Puncture of the dura and severance of the epidural catheter are the typical , though rare , complications of this procedure , giving rise to most of the actions brought for damage suffered during obstetic anaesthesia . The cerebral spinal fluid loss caused by thick needles can have serious consequences , including subdural and intracranial haematoma , cranial nerve pareses , labyrinthine hearing impairments and pneumocephalus ." ], "offsets": [ [ 0, 606 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440809.eng.abstr-passage-0", "type": "abstract", "text": [ "The routine use of succinylcholine for endotracheal intubation is being increasingly questioned . Initial studies have suggested that a combination of propofol and alfentanil without a muscle relaxant can provide good intubating conditions . However , most of these initial studies either did not have a double-blind design or did not include a control group with muscle relaxants . In this study , intubation conditions using fentanyl/propofol without a muscle relaxant were compared with the combinations of fentanyl/propofol/succinylcholine and sodium thiopental/succinylcholine ." ], "offsets": [ [ 0, 583 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.50440818.eng.abstr-passage-0", "type": "abstract", "text": [ "Increasing numbers of monitors at the anaesthesiologist's workplace , providing more than 20 different parameters of the patient's condition , have already made it impossible to record all the values in a handwritten form . Consequently , this most common method of record-keeping must be incomplete and inaccurate . In recent years computerised data-acquisition systems have been introduced into clinical practice in order to produce more reliable records . But after a 7-year experience in the use of such a system in cardiac anaesthesia , we have recognised certain problems that remain to be solved before automated record-keeping will achieve wider acceptance . The first is the handling problem , which was discussed in a previous paper [ 11 ] . The second major problem is the appearance of artifacts , caused mainly by mechanical manipulations during the operation . In this paper , 300 courses of anaesthesia that were recorded on-line during different cardiac surgery procedures were examined and the incidence as well as the kind of artifacts occurring were evaluated . Algorithms were developed for each haemodynamic parameter to suppress these artifacts automatically by a subsequent analysing process ; the efficiency of that \" artifact filter \" was validated in 35 of the 300 cases . Based on more than 30,000 values for each parameter , the incidence of artifacts was 3%-7% . However , only 0.1%-0.5% of the artifacts could not be eliminated by the filter . The method described here provided acceptable graphic printouts of the most important haemodynamic parameters ( Figs . 1b and 2b ) and would also be suitable to serve as an input filter for automatically running anaesthesia data-examination processes , which are currently being developed in our clinic ." ], "offsets": [ [ 0, 1778 ] ] } ]

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[ { "id": "DerAnaesthesist.50440843.eng.abstr-passage-0", "type": "abstract", "text": [ "The mortality of patients with acute respiratory distress syndrome ( ARDS ) is still above 50% despite continuous progress in intensive care medicine . Recent therapy regimens such as the extra corporeal life support ( ECLS ) , permissive hypercarbia , high-frequency ventilation techniques and inhaled nitric oxide ( NO ) are being applied . All of the above techniques are aimed at different parts of the problems caused by ARDS . This study was designed to evaluate the possible additive benefits of superimposed high-frequency jet ventilation ( SHFJV ) and inhaled NO ." ], "offsets": [ [ 0, 573 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440850.eng.abstr-passage-0", "type": "abstract", "text": [ "For cardio-pulmonary resuscitation there are standardized treatment concepts , but there have been few prospective investigations examining the efficacy of prehospital advanced trauma life support and its effect on the outcome in patients with severe head injury and multiple trauma treated within the German emergency system . The results of this study underline the importance of intensive prehospital treatment and highlight some problems that should be taken into account in future in the training of emergency physicians ." ], "offsets": [ [ 0, 527 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440859.eng.abstr-passage-0", "type": "abstract", "text": [ "The axillary brachial plexus block is a well-known technique for intra- and postoperative analgesia and sympathetic blockade in hand and microsurgery . The aim of this study was to show the influence of the axillary brachial plexus block on the blood flow as a side effect ." ], "offsets": [ [ 0, 274 ] ] } ]

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[ { "id": "DerAnaesthesist.50440863.eng.abstr-passage-0", "type": "abstract", "text": [ "Clinical course . We present a potentially fatal case of acute methaqualone ( M ) poisoning with very low serum concentrations of M but extremly high levels of its metabolite , 2-methyl-3-(2-hydroxymethyl-phenyl)-4 ( 3H ) -chinazoline ( Met-1). A 23-year-old man was admitted to the intensive care unit 2 days after ingestion of 4-5 g M in an suicidal attempt . On admission he was somnolent and poorly responsive to painful stimuli . Physical examination revealed a heart rate of 95 bpm , a blood pressure of 125/65 mmHg , and a normal body temperature . His chest was clear to auscultation , respirations were shallow , and the skin was cyanotic . The electrocardiogram was unremarkable . The chest radiograph showed a normal heart size without pulmonary infiltrates or venous congestion . The pupils were dilated but reactive to light . The neurologic examination was further remarkable for increased limb reflexes , myoclonia , and positive pyramidal signs . During the next 2 days the patient became comatose and developed respiratory insufficiency due to non-cardiogenic pulmonary oedema , which was confirmed by chest radiograph and haemodynamic investigations by means of right heart catheterisation . He required mechanical ventilation for 6 days . Finally , he recovered completely and was discharged in good condition ." ], "offsets": [ [ 0, 1330 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440875.eng.abstr-passage-0", "type": "abstract", "text": [ "Angio-oedema is a recognised complication of angiotensin converting enzyme ( ACE ) inhibitor therapy , occurring in 0.1% to 0.5% of patients taking captopril , enalapril , or lisinopril . This is the first report of severe angio-oedema complicating therapy with quinopril , a new , long-acting drug ." ], "offsets": [ [ 0, 300 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.50440880.eng.abstr-passage-0", "type": "abstract", "text": [ "Neoplastic or traumatic lesions of the brain stem or the upper spinal cord frequently cause respiratory insufficiency necessitating permanent mechanical ventilation . If the integrity of the diaphragm and its nerves is not affected , adequate ventilation can be achieved by electric stimulation of the phrenic nerves [ 1 , 3 , 5 , 6 ] . Diaphragm pacing systems mean the patients can be independent of ventilator treatment . This is a psychological advantage for the patient , giving him or her the option of living in less specialized medical care units and perhaps even at home [ 4 , 9 ] ." ], "offsets": [ [ 0, 591 ] ] } ]

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[ { "id": "DerAnaesthesist.50440884.eng.abstr-passage-0", "type": "abstract", "text": [ "A separation of the individual latex layers is a known complication of endotracheal armoured tubes manufactured by immersion technique . This can result in herniation into the lumen with obstruction of the tube . Diffusion of nitrous oxide into the inner hernia considerably intensifies the obstruction . This can lead to life-threatening situations . We observed a similar herniation caused by layer separation with subsequent tube obstruction of silicolatex anaesthesia tubes used in paediatric circuit systems . This is caused by manufacturing defects and above all by damage incurred in reprocessing . Therefore it is important to process the tubes carefully . A too-high drying temperature can cause premature layer separation . The tubes should never be processed more than 80 times . Routine examination of the tubes is imperative , especially at the predilection sites for layer separation ." ], "offsets": [ [ 0, 899 ] ] } ]

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[ { "id": "DerAnaesthesist.60450002.eng.abstr-passage-0", "type": "abstract", "text": [ "Acute respiratory distress syndrome ( ARDS ) is rare but beset with a high mortality rate . In recent years , however , a trend towards higher survival rates has been observed . High inspiratory oxygen concentrations , large tidal volumes , and high peak inspiratory airway pressures applied during mechanical ventilation have been identified as harmful to the lung and can contribute to the progression of ARDS . This had led to reconsideration of the sequelae of ventilatory therapy . Mechanical ventilation and other adjunctive strategies in ARDS have changed from the conventional approach aiming at normalisation of physiological ventilatory parameters to an elaborated approach that intends to protect the ventilated lung , prevent oxygen toxicity , recruit the infiltrated atelectatic and consolidated lung and reduce the anatomical and alveolar dead space . This new approach consists of various forms of pressure-controlled mechanical ventilation with PEEP and permissive hypercapnia , body position changes , and inhalation of nitric oxide . Should these procedures fail to improve impaired gas exchange , extracorporeal membrane oxygenation is an additional therapeutic option . None of these therapeutic procedures , however , has been tested against traditional standard treatment in a classical randomised controlled trial . The following review focuses on the latest insights into the pathophysiology , diagnosis , and treatment of ARDS ." ], "offsets": [ [ 0, 1453 ] ] } ]

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[ { "id": "DerAnaesthesist.60450019.eng.abstr-passage-0", "type": "abstract", "text": [ "Performed at the end of the mummification process , the \" mouth-opening \" ritual was a ceremony for the spiritual resurrection of the dead Pharaoh . The techniques used are astonishingly similar to modern emergency-room procedures . For example , the mouth-opening device was made of meteoric iron . In the Egypt of that time , the use of iron was very unusual and the higher levels of nickel in meteoric iron contributed to the stability of the instrument . There are other signs of medically sound methods in the mouth-opening ritual . Symbolically , the mummy's teeth were extracted , the eyes opened with a special device , and gold capsules inserted , perhaps in the sense of a breathing tube . There is a possibility that this ritual contains a forgotten synopsis of knowledge gained empirically in connection with the Egyptian cult of royal resurrection ." ], "offsets": [ [ 0, 862 ] ] } ]

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[]

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"DerAnaesthesist.60450019.eng.abstr-s6-t8", "normalized": [] }, { "id": "DerAnaesthesist.60450019.eng.abstr-s6-r50-t2.1-t8.1", "type": "location_of", "arg1_id": "DerAnaesthesist.60450019.eng.abstr-s6-t2", "arg2_id": "DerAnaesthesist.60450019.eng.abstr-s6-t8", "normalized": [] }, { "id": "DerAnaesthesist.60450019.eng.abstr-s6-r53-t4.2-t8.1", "type": "affects", "arg1_id": "DerAnaesthesist.60450019.eng.abstr-s6-t4", "arg2_id": "DerAnaesthesist.60450019.eng.abstr-s6-t8", "normalized": [] } ]

[ { "id": "DerAnaesthesist.60450022.eng.abstr-passage-0", "type": "abstract", "text": [ "Due to its low blood : gas partition coefficient ( 0.69 ) and its neutral odor , sevoflurane ( S ) is suitable for inhalational induction of anaesthesia . At the moment halothane ( H ) is preferentially used for this purpose due to its non-irritating odor and the smoothness of anaesthetic action . However , experience is limited with the use of S in children , and concern exists about potential renal toxicity of its metabolite , i.e. fluoride . Therefore , we compared S and H in an open , randomized phase III trial ." ], "offsets": [ [ 0, 522 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.60450031.eng.abstr-passage-0", "type": "abstract", "text": [ "Sevoflurane is a \" new \" volatile inhaled anaesthetic . Owing to its lower blood-gas solubility coefficient , emergence from anaesthesia is faster with sevoflurane than with isoflurane , enflurane , or halothane . Sevoflurane undergoes metabolic biodegradation , releasing inorganic fluoride ions that could produce nephrotoxicity . In this study , we compared serum inorganic fluoride concentrations ( IFCs ) in patients receiving either sevoflurane or enflurane . Furthermore , indices of renal function were evaluated until the 3rd postoperative day ." ], "offsets": [ [ 0, 554 ] ] } ]

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[ { "id": "DerAnaesthesist.60450037.eng.abstr-passage-0", "type": "abstract", "text": [ "Objectives . The new volatile anaesthetic desflurane is characterized by very low blood-gas and tissue-blood partition coefficients , so that rapid induction of anaesthesia and shorter recovery times can be expected . The aim of this investigation was to compare the effects of desflurane and isoflurane on haemodynamics and recovery time when used as part of a balanced anaesthesia technique for elective surgery ." ], "offsets": [ [ 0, 415 ] ] } ]

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[]

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"issue_in", "arg1_id": "DerAnaesthesist.60450037.eng.abstr-s3-t5", "arg2_id": "DerAnaesthesist.60450037.eng.abstr-s3-t6", "normalized": [] }, { "id": "DerAnaesthesist.60450037.eng.abstr-s3-r15-t2.1-t1.1", "type": "interacts_with", "arg1_id": "DerAnaesthesist.60450037.eng.abstr-s3-t2", "arg2_id": "DerAnaesthesist.60450037.eng.abstr-s3-t1", "normalized": [] }, { "id": "DerAnaesthesist.60450037.eng.abstr-s3-r16-t5.1-t4.1", "type": "conceptual_part_of", "arg1_id": "DerAnaesthesist.60450037.eng.abstr-s3-t5", "arg2_id": "DerAnaesthesist.60450037.eng.abstr-s3-t4", "normalized": [] } ]

[ { "id": "DerAnaesthesist.60450047.eng.abstr-passage-0", "type": "abstract", "text": [ "Does propofol or thiopentone enhance the effect of nondepolarizing muscle relaxants ? We evaluated the effects of propofol and thiopentone on the pharmacodynamics of atracurium and alcuronium in 43 surgical patients ( ASA I and II ) under general anaesthesia ." ], "offsets": [ [ 0, 260 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.60450059.eng.abstr-passage-0", "type": "abstract", "text": [ "Portofemoro-axillary bypass systems are commonly used to treat adverse haemodynamic effects during the anhepatic phase of orthotopic liver transplantation ( OLT ) . However , low shunt flows may reduce the efficacy of these bypass systems . In order to improve veno-venous bypass management , a percutaneous cannulation technique ( PCT ) was used to insert large-bore catheters ( 21 F ) into the left femoral and subclavian veins . This study prospectively addresses the complications of the PCT in 195 adult patients undergoing 203 OLTs ." ], "offsets": [ [ 0, 539 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.60450066.eng.abstr-passage-0", "type": "abstract", "text": [ "This is a report of a case of a subdural haematoma with resulting paraplegia after attempted spinal anaesthesia . Epidural and subdural haematomas are rare complications after central neural blockade . The complication described here was the result of an unsuccessful attempt to puncture the spinal channel . The patient was a 72-year-old woman with a fracture of the left femoral neck , which it was intended to stabilize operatively . Findings that made lumbar spinal puncture difficult were severe overweight , and lordosis and scoliosis of the lumbar spine resulting from degenerative changes . Spinal anaesthesia was suggested because the patient had eaten shortly before and because she suffered from asthma . From the aspect of haemostasis no contraindications were present , and the anaesthesist was experienced in spinal anaesthesia even under difficult anatomical conditions . Several unsuccessful attempts were made to puncture the lumbar spinal channel while the patient was lying on her right side . It was also impossible to reach the spinal channel from a median or left paramedian approach . We used atraumatic pencil-point needles ( Sprotte gauge 24 , 90 mm ) . No blood was aspirated during any of the attempts . The surgical intervention was finally performed under a general anaesthetic in view of the urgency . No significant complications occurred during the operation , and no neurological abnormalities were observed immediately after or in the next 8 h after the operation . At 12 h after the operation a paraparesis was found caudal to L3. After this had been verified by radiological and neurological tests , neurosurgical decompression was carried out as quickly as possible . During the operation a distinct subdural haematoma without any detectable source of bleeding was discovered . Even after surgical revision and evacuation of the remaining haematoma it was not possible to reverse the paraplegia , in spite of rehabilitation measures . Despite a certain fragility of the vessel and pretreatment with pentoxifylline and thromboembolic prophylaxis with low-molecular heparin starting postoperatively , it must be assumed that a vessel accompanying one of the spinal nerves was punctured , possibly , the radiculomedullary vessel of Adamkiewicz . A similar case was published in 1988 by Parker . In the present case it must be assumed that the vessel was punctured during a paramedian approach in the area of the foramen intervertebrale , as the spinal channel was definitely not entered . Although this is an extremely rare complication , we conclude that close neurological controls are essential at least during the first 24 h after surgery , even after an unsuccessful attempt at central neural blockade ." ], "offsets": [ [ 0, 2742 ] ] } ]

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[ { "id": "DerAnaesthesist.60450075.eng.abstr-passage-0", "type": "abstract", "text": [ "The current increase in the cost of health care must be considered as a severe threat to the prehospital emergency services system . Two examples have been selected - the patient with polytrauma and the patient in cardiac arrest - to demonstrate the dilemma between a need for objective data and the requirements of emergency patients . Study results obtained in trauma patients indicating that total prehospital time , including scene time , is correlated to patient outcome have led to the conclusion that at the scene treatment by emergency physicians may be dispensable . It has , however also been demonstrated that the time required for medical treatment at the scene is equivalent to 20% of the total scene time , thus representing only a fraction of the total prehospital time . Correlating the total prehospital time or scene time to outcome therefore appears absurd . The treatment principle of aggressive shock treatment in polytrauma needs critical reevaluation on the basis of results obtained by recent preclinical studies in patients with penetrating torso injuries . Small volume resuscitation could not be demonstrated to improve outcome in polytrauma patients , although a slight improvement in patients with brain injury may be assumed . Endotracheal intubation and early artificial ventilation are proven therapeutic principles in polytraumatized patients . Unfortunately , for ethical reasons randomised carefully controlled comparative studies can not be performed in polytrauma patients unless the patient is fully conscious . The importance of endotracheal intubation and artificial ventilation in unconscious trauma patients becomes apparent under conditions of anaesthesia where the application of the endotracheal tube averts regurgitation , aspiration and concomitant morbidity and mortality . The common causes of cardiovascular collapse and their pathomechanisms , as well as the mechanisms of cardiopulmonary resuscitation , have been widely investigated . Nevertheless , various aspects of their application are still controversial . The most recent study results have recommended initial ventilation prior to thoracic compression . New methods of assisting mechanical cardiopulmonary resuscitation , such as ACD CPR or vest CPR , have shown promising results in animal experiments . However , the importance of results obtained by preclinical randomised controlled investigations in humans need to be confirmed by further studies as to outcome . The efficacy of defibrillation in cases of ventricular fibrillation has been clearly demonstrated , particularly with a view to the interval between ventricular fibrillation and defibrillation . It has further been demonstrated that basic cardiopulmonary resuscitation preserves ventricular fibrillation and thus improves the chance of survival . The present generation of defibrillators has been further improved , particularly by the introduction of biphasic defibrillator wave forms , which may reduce the required energy , as well as possible complications , while offering an increase in the efficacy of defibrillation and a reduction in defibrillator size . Scientific emergency medicine is responsible not only for the development and validation of new methods and concepts , but in particular for their application under quality control conditions . Politicians require an improvement in the quality of the validation of emergency measures , although the instruments available for the investigation of these measures are known to be obsolete ( experimental models , experimental design ) . Additionally , the financial support of research in emergency medicine suffers from being accourded low priority by public research funds such as the German Research Fund . However , in view of the rapid application of experimental results to daily practice it should be emphasized that patients also support research in emergency medicine via their direct financial contributions to the health insurance companies ." ], "offsets": [ [ 0, 3993 ] ] } ]

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[ { "id": "DerAnaesthesist.60450088.eng.abstr-passage-0", "type": "abstract", "text": [ "Following parenteral administration , clonidine has analgesic effects at both cerebral and spinal levels . Patient-controlled analgesia ( PCA ) makes it possible to determine equipotent dosages of analgesics by relating analgesic consumption per time to the levels of analgesia obtained in comparable patient populations . Therefore , we studied the equipotency ratios of clonidine and piritramide and the incidence of undesired side effects in the treatment of postoperative pain in patients undergoing maxillo-facial surgery ." ], "offsets": [ [ 0, 528 ] ] } ]

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[ { "id": "DerAnaesthesist.60450113.eng.abstr-passage-0", "type": "abstract", "text": [ "Polymorphonuclear leukocytes ( PMNL ) constitute the first line of defence in the protection of the host from invading microorganisms . PMNL also contribute to the removal of cellular debris from necrotic tissues during reparative processes . For these purposes PMNL are armed with highly efficient bactericidal mechanisms which , under certain pathophysiological conditions , can be turned against the host himself . A vast body of evidence indicates that PMNL are able to cause lung injury which may be followed by the development of acute respiratory distress syndrome ( ARDS ) . Accordingly , in patients with ARDS blood concentrations of inflammatory activators of PMNL are elevated , cytotoxic mechanisms of PMNL are enhanced and sequestration of these cells has been demonstrated to be inversely proportional to gas exchange . The manifestation of ARDS in leukopenic patients , however , indicates the development of this clinical syndrome independently of the presence of PMNL . The ability to differentiate between PMNL-dependent and PMNL-independent pathways in the pathogenesis of this syndrome is not only of theoretical interest but also of therapeutic significance . Since the patient's systemic inflammatory response may vary according to the stage and type of the underlying disease , an exact qualitative and quantitative analysis of PMNL functions may provide the rationale for new anti-inflammatory drug regimens aimed at modifying the host's response without increasing the risk of infection ." ], "offsets": [ [ 0, 1513 ] ] } ]

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[ { "id": "DerAnaesthesist.60450131.eng.abstr-passage-0", "type": "abstract", "text": [ "The era of modern anaesthesia in Germany began on January 24th , 1847. This day , professor in ordinary Johann Ferdinand Heyfelder anaesthetized a patient with sulphuric ether in the clinic of surgery and ophthalmology of the University of Erlangen . By March 17th , 1847 , Heyfelder had performed 121 surgical procedures under ether . The operations in majority were teeth-extractions , and a few more complex operations such as the treatment of a harelip or of lip cancer or the resection of the shoulder joint . Heyfelder described in detail 108 of these inhalations in a little book entitled The experiments with sulphuric ether . This monograph published in March , 1847 , represents one of the first complete dissertations on sulphuric ether in the German literature . In a special chapter he analyzed the development of various physiological and psychological parameters during etherization . Heyfelder also examined blood and urine of some etherized patients and reported that he did not find any important or specific alterations . In 1847 , Heyfelder was probably the first to apply salt-ether in man . After 4 administrations he concluded that salt ether acted more quickly but shorter than sulphuric ether . Advantageous were its application without problems and ease of induction . Disadvantageous were its high volatility , its price and the difficulty of getting it in a pure form . From December , 1847 , on Heyfelder started to use chloroform . He was now able to perform more major operations , for example the total resection of the hip-joint . In his book The experiments with sulphuric ether , salt ether , and chloroform he describes a great number of anaesthetic administrations using these 3 agents . In his summary Heyfelder concluded , that chloroform was undoubtly superior to sulphuric ether mainly because it was a quicker acting and longer lasting agent and leads to deeper narcosis . Moreover its application was much easier for it needed no special apparatus . However , because of its great anaesthetic potency , Heyfelder particularly demanded great caution in the application of chloroform . Explicitely he expected an assistant for chloroformizations , whose only duty was to supervise the inhalations and the patient - a forerunner of the modern specialized anaesthesiologist ." ], "offsets": [ [ 0, 2314 ] ] } ]

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[ { "id": "DerAnaesthesist.60450140.eng.abstr-passage-0", "type": "abstract", "text": [ "Desflurane is a new volatile anaesthetic with an extremely low blood/gas partition coefficient of 0.42. This should provide a rapid recovery from anaesthesia . Methods . We studied 100 adult patients , ASA class I or II , undergoing elective orthopaedic surgery randomly assigned to anaesthesia with desflurane ( n=50) or isoflurane ( n=50) supplemented by nitrous oxide in oxygen . Clorazepat was given for premedication , fentanyl and thiopental for induction of anaesthesia , followed by maintenance with desflurane or isoflurane as clinically appropriate . Emergence from anaesthesia was measured as well as return of cognitive functions ( extended Aldrete score , digit symbol substitution test , and visual analogue scales [ VAS ] ) . Results . While the demographic characteristics and administrated doses of fentanyl and thiopental were comparable , the recovery profiles in both groups were different . After discontinuation of the volatile anaesthetics , times to extubation and ability to follow simple commands were significantly shorter after desflurane than after isoflurane . Extended Aldrete scores , estimation of the patients ' physical condition , results of the digit symbol substitution test , measuring cognitive functions , and rates of drowsiness and weakness on VAS showed better recovery with less impairment of cognitive function in the desflurane group than in isoflurane patients even 120 min after anaesthesia . VAS pain scores and doses of analgesic drugs given within the first 2 postoperative hours , however , showed no significant differences . Desflurane patients were also judged fit for discharge from the recovery room significantly faster . Conclusions . Our results demonstrate that desflurane anaesthesia , even when supplemented by premedication , intraoperative opioids , and nitrous oxide may offer clinical advantages over isoflurane as far as the post-anaesthetic recovery profile is concerned ." ], "offsets": [ [ 0, 1942 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.60450146.eng.abstr-passage-0", "type": "abstract", "text": [ "Since the introduction of propofol into clinical practice , dreaming during general anaesthesia has been frequently reported with this drug . We investigated the incidence and character of these dreams with regard to distinction from intraoperative awareness and in comparison with habitual dreams or dreams during general anaesthesia with enflurane . Method . A total of 230 patients ( ASA I-II ) undergoing minor elective surgery were randomly assigned to one of two groups . Both groups received the same premedication ( 1 mg flunitrazepam ) the previous evening . After induction using etomidate 2 mg/kg , anaesthesia in group I was maintained using 0.8%-1.5% enflurane supplemented in the sense of \" balanced anaesthesia \" with fentanyl , vecuronium , and nitrous oxide . Anaesthesia in group II was induced with propofol 2 mg/kg . After a saturation phase of approximately 10 mg/kg - h , 5-6 mg/kg - h was administered for maintenance supplemented by fentanyl , Vecuronium , and N2O as in group I. Interviews were conducted preoperatively , just after recovery from anaesthesia , and 24 h later . We inquired about preoperative fears or concerns , sensory perceptions , and the incidence and character ( pleasant , unpleasant , indifferent ) of habitual dreams . After recovery the patients were asked if they had had any conscious perceptions , whether they believe them to be dreams or reality , and repeated the preoperative questions as to common feelings and the character of sensory perceptions . Results . The two groups were not entirely comparable due to the distribution of sex and age , but we did not find any differences in preoperative grades of fear and incidence of dreams . Of the propofol patients , 60% dreamed intraoperatively versus 11% in the enflurane group . No evidence of any intraoperative awareness was found . Because of the low incidence of dreams in the enflurane group , a comparison of detailed information between the groups could not be provided . Except for 1 , all patients in the propofol group had very pleasant dreams compared to their habitual dreams ( 4.5% in the enflurane group ) . One day after surgery 37% of all patients in the propofol group remembered having dreamed intraoperatively . We did not found any correlation to the incidence of habitual dreaming , preoperative fear , age , sex , duration of anaesthesia , or total dose of propofol . Furthermore , intraoperative dreams differed from habitual dreams in character and content . Conclusions . We conclude that sensory experiences during propofol anaesthesia are not stimulus-related perceptions or awareness , but dreams similar to normal ones . In view of the absence of clear signs of stimulus-related response , we presume that dreaming is a specific side effect of propofol . Because of the absence of difficulties , dreaming during propofol anaesthesia appears not to be a disadvantage with regard to the quality of anaesthesia ." ], "offsets": [ [ 0, 2948 ] ] } ]

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"id": "DerAnaesthesist.60450146.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "dreams" ], "offsets": [ [ 195, 201 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013117" } ] }, { "id": "DerAnaesthesist.60450146.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "awareness" ], "offsets": [ [ 249, 258 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004448" } ] }, { "id": "DerAnaesthesist.60450146.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "dreams" ], "offsets": [ [ 291, 297 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013117" } ] }, { "id": "DerAnaesthesist.60450146.eng.abstr-s2-t6", "type": "umlsterm", "text": [ "dreams" ], "offsets": [ [ 301, 307 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013117" } ] }, { "id": "DerAnaesthesist.60450146.eng.abstr-s2-t7", "type": "umlsterm", "text": [ "enflurane" ], "offsets": [ [ 340, 349 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0014277" } ] }, { "id": "DerAnaesthesist.60450146.eng.abstr-s2-t8", "type": "umlsterm", "text": [ "general anaesthesia" ], "offsets": [ [ 315, 334 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002915" } ] }, { "id": "DerAnaesthesist.60450146.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "Method" ], "offsets": [ [ 352, 358 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0025663" }, { "db_name": "UMLS", "db_id": "C0025664" } ] }, { "id": "DerAnaesthesist.60450146.eng.abstr-s4-t1", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 376, 384 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.60450146.eng.abstr-s4-t2", "type": "umlsterm", "text": [ "ASA" ], "offsets": [ [ 387, 390 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004057" } ] }, { "id": "DerAnaesthesist.60450146.eng.abstr-s4-t3", "type": "umlsterm", "text": [ "minor" ], "offsets": [ [ 409, 414 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026193" } ] }, { "id": "DerAnaesthesist.60450146.eng.abstr-s4-t4", "type": 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"type": "umlsterm", "text": [ "enflurane" ], "offsets": [ [ 664, 673 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0014277" } ] }, { "id": "DerAnaesthesist.60450146.eng.abstr-s6-t3", "type": "umlsterm", "text": [ "fentanyl" ], "offsets": [ [ 733, 741 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0015846" } ] }, { "id": "DerAnaesthesist.60450146.eng.abstr-s6-t4", "type": "umlsterm", "text": [ "vecuronium" ], "offsets": [ [ 744, 754 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242531" } ] }, { "id": "DerAnaesthesist.60450146.eng.abstr-s6-t5", "type": "umlsterm", "text": [ "oxide" ], "offsets": [ [ 769, 774 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030015" } ] }, { "id": "DerAnaesthesist.60450146.eng.abstr-s6-t6", "type": "umlsterm", "text": [ "nitrous oxide" ], "offsets": [ [ 761, 774 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0028215" } ] }, { "id": "DerAnaesthesist.60450146.eng.abstr-s7-t1", "type": "umlsterm", "text": [ "propofol" ], 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[]

[]

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[ { "id": "DerAnaesthesist.60450154.eng.abstr-passage-0", "type": "abstract", "text": [ "Absorption of irrigating fluid in transurethral prostatic resection ( TURP ) and percutaneous nephrolitholapaxy ( PNL ) into veins or delayed absorption due to fluid extravasation may result in a TURP syndrome . The measurement of end-tidal breath alcohol concentration ( et AC ) as a monitor of absorption of irrigating fluid labelled with 2% ethanol is limited by the disturbance of infrared sensors by volatile anaesthetics and nitrous oxide ( N2O) ( Fig . 2 ) . An electrochemical sensor is acceptable for this method . The aim of the present study was the evaluation of breath alcohol measurements using an electrochemical sensor device ( Alcomed 3010 , Envitec ) . The stability of the sensor in the presence of volatile anaesthetics was examined using a lung model . In a clinical investigation , the device was then applied to spontaneously breathing or mechanically ventilated patients inhaling volatile anaesthetics during endoscopic urological surgery ." ], "offsets": [ [ 0, 964 ] ] } ]

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[ { "id": "DerAnaesthesist.60450171.eng.abstr-passage-0", "type": "abstract", "text": [ "A 3.5-year-old girl suffered from a thermal injury affecting 37% of the body surface area . The parents , being Jehovah's witnesses , refused permission for their child to receive blood transfusions . As the haemoglobin level was only 7.5% and a necrectomy was planned , the patient was likely to need blood transfusions . Indications for transfusion were defined as clinical signs of hypoxia and/or cardiovascular instability . A judicial declaration was proposed . Hb decreased during the therapy . To stimulate the erythropoiesis erythropoietin and iron were administered . During the clinical course the anaemia worsened . First , a conservative treatment with polyvidoniodine ointment for tanning was started , to avoid an operation during the acute phase after the injury , as in this case it was thought a blood transfusion would definitely be necessary . On the 19th day after the injury a necrectomy of 10% of the body surface was necessary because of fever and leucocytosis not responding to antibiotics . The most likely cause of the symptoms was an infection of the burned area . Hb was 4.6 g/dl%. General anaesthesia was performed with midazolam , ketamine and vecuronium and mechanical ventilation . No blood transfusion was required during the operation . Vital signs were stable during the preoperative period , during anaesthesia and following the operation . There were no signs of tissue hypoxia . Peripheral oxygen saturation ranged between 98% and 100% , lactate and arterial blood gas samples were normal , and the child was awake and cooperative before and after anaesthesia . The lowest Hb was 3.3 g/dl on the 22th day after injury ( 3rd postoperative day ) . In this phase the patient was still playing and riding a tricycle . On the 45th day after injury the child was discharged home with Hb of 10.9 g/dl and reticulocytosis of 33% ." ], "offsets": [ [ 0, 1860 ] ] } ]

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[ { "id": "DerAnaesthesist.60450213.eng.abstr-passage-0", "type": "abstract", "text": [ "Patients with a prior myocardial infarction ( MI ) have a high risk of perioperative reinfarction compared with the normal population ( 5%-8% vs. 0.1%-0.7%) [ 10 ] . According to Rao [ 13 ] , a reduction of this risk is possible when patients are monitored invasively and all haemodynamic parameters are kept within the physiological range . In most institutions it is not feasible to treat patients as Rao recommended : this would overstrain both hospital structure and financial resources . We studied the incidence of perioperative MI and other cardiac events in patients with prior MI . During the study period the anaesthesia and intensive care methods of our institution were neither changed nor influenced . In addition to this clinical evaluation , we performed perioperative Holter electrocardiographic monitoring and measured serum levels of the recently introduced marker troponin T ( parts II and III ) ." ], "offsets": [ [ 0, 916 ] ] } ]

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[ { "id": "DerAnaesthesist.60450220.eng.abstr-passage-0", "type": "abstract", "text": [ "Perioperative , mostly silent ischaemia in patients with coronary heart disease is difficult to detect by clinical examinations ." ], "offsets": [ [ 0, 129 ] ] } ]

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[ { "id": "DerAnaesthesist.60450225.eng.abstr-passage-0", "type": "abstract", "text": [ "Diagnosis of a perioperative myocardial infarction ( PMI ) on the basis of measurement of the creatine kinase MB fraction ( CKMB ) alone is not always easy . Surgical traumatisation of muscle fibres can lead to false-positive elevations . Newly introduced laboratory tests for cardiac troponins seem to facilitate the diagnosis of PMI . We measured serum values of cardiac troponin T in 139 patients described in detail in part I and compared them with common diagnostic tools for myocardial infarction ." ], "offsets": [ [ 0, 504 ] ] } ]

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[ { "id": "DerAnaesthesist.60450231.eng.abstr-passage-0", "type": "abstract", "text": [ "Patient-controlled intravenous analgesia ( i.v. -PCA ) represents the gold standard in the management of acute postoperative pain . However , in many countries i.v. -PCA is rarely used . Recent clinical studies demonstrated that intranasal fentanyl titration provides a rapid and safe form and pain management . In the present study we investigated patients ' acceptance and assessment of patient-controlled intranasal analgesia ( PCINA ) and compared it to intravenous PCA and the customarily prescribed pain therapy ." ], "offsets": [ [ 0, 519 ] ] } ]

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[ { "id": "DerAnaesthesist.60450235.eng.abstr-passage-0", "type": "abstract", "text": [ "Intraoperative paradoxical air embolism may occur even if a patent foramen ovale ( PFO ) is excluded by contrast transoesophagal echocardiography ( TEE ) under 20 cmH2O positive airway pressure . It is questionable whether the combination of PEEP and ventilation with a large tidal volume increases the sensivity of contrast TEE in detecting a PFO . Methods . Eighty healthy patients ( ASA status I , II ) scheduled for surgery in the supine position and ranging from 25 to 72 years of age were investigated by TEE , which was performed in the biatrial viewing mode ( short axis ) . Echocardiographic contrast ( 10 ml agitated gelatine solution ) was injected during two different ventilation manoeuvres . Manoeuvre I : Contrast injection during the application of 20 cmH2O positive airway pressure for 5 s. The pressure was released when the right atrium became completely opacified by echo targets . 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 . Manoeuvre II : Contrast injection during ventilation with PEEP ( 15 cmH2O), a tidal volume of 1,200 ml , and a respiratory rate of 6/min. Results . The frequency of a PFO causing a right-to-left interatrial shunt was 8.7% ( 7 cases ) in manoeuvre I and 15% ( 12 cases ) in manoeuvre II . In one case a PFO was diagnosed intraoperatively by chance . Discussion . The use of provocation manoeuvres including ventilation with PEEP and high tidal volumes might improve the ability to detect a PFO presenting with right-to-left interatrial shunt by intraoperative contrast TEE , but does not have 100% sensitivity . However , our results clearly indicate that ventilation with PEEP and high tidal volumes may predispose to paradoxical embolism ." ], "offsets": [ [ 0, 1868 ] ] } ]

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[]

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