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[ { "id": "DerAnaesthesist.70460261.eng.abstr-passage-0", "type": "abstract", "text": [ "In more than 30 years of development of intensive care medicine ( ICM ) , our speciality has acquired moral and ethical standpoints , although not without public pressure and discussions . Special commissions dealing , e.g. , with brain death , terminal care , ethics of foregoing life-sustaining treatment in the critically ill , withholding or withdrawing mechanical ventilation , and other issues have meen formed in a number of medical societies . International consensus conferences have helped to clarify some of the issues . With increasing experience , a multitude of ethical problems have arisen in ICM that have to be dealt with , such as the issue of quality of life . What is an unworthy life ? Are we allowed to make judgments for our patients ? What is cost-effectiveness in ICM ? Other restrictions include bed and equipment shortages in the intensive care unit ( ICU ) , the necessity for triage - undisputed in catastrophe medicine - and how one should proceed in managing elective patients ? In situations of limited ICU bed availability , sicker patients will be admitted , sparing out patients who are less ill for observation and those with poor quality of life and poor prognosis . For the future , it will likely be necessary to define the patients who should be admitted to an ICU more than those who should not be admitted . An ICU treatment entitlement index would be directly proportional to the probability of successful outcome and the quality of the remaining life , and would be inversely related to costs for achieving success . The ICU outcome with survival , hospital mortality , and follow-up of ICU patients is considered . DNR ( do not resuscitate ) , the dying patient , terminal care , terminal weaning - DNT ( do not treat ) - active and passive euthanasia , living wills , quality of life , and cost-effectiveness for ICU patients are defined . Their application in the ICU will be discussed and problems pointed out . Outcome predictions using scores ( APACHE III , SAPS II , MPM ) have been developed based on previous experience , but should only be applied to patient groups and for quality assurance in ICUs . The most frequent and difficult problem in the ICU is the vegetative state , which requires an exact diagnosis . The differential diagnosis from other comatose states such as coma , brain death , and locked-in-syndrome is depicted . The ethics of interrupting life-sustaining treatment in critically ill patients have been worked out by a Task Force on Ethics of the Society of Critical Care Medicine ( 1990 ) . A consensus was found that the patient may judge to forego therapy ; ethically it is then appropriate to withhold or withdraw therapy . According to the consensus , withdrawing an already initiated treatment should not necessarily be regarded as more problematic than a decision not to initiate treatment . In my mind , however , there is a great difference between withdrawing or withholding , e.g. , ventilation . A dissentive opinion by some members of the Task Force stated that hydration and nutrition other than high-technology or parenteral nutrition are key components of patient care , and should not be equated with medical intervention . The ethical problems associated with active euthanasia ( physician-assisted suicide or death ) as practised in the Netherlands are also discussed . In most countries this practice seems unacceptable . From 30 years experience in ICM , there are many more ethical questions and case reports without clear solutions . Care decisions for single patients in unacceptable situations should be made after medical evaluation by the intensivist with the medical team and , if possible , by the patient and/or his or her surrogate . Legislation and solutions cannot be expected for single patients , but ethics committees could be helpful in decision-making ." ], "offsets": [ [ 0, 3867 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.70460275.eng.abstr-passage-0", "type": "abstract", "text": [ "Objective : Thirty years ago , cardiopulmonary resuscitation ( CPR ) was primarily developed for otherwise healthy individuals who experienced sudden cardiac arrest . Today , CPR is widely viewed as an emergency procedure that can be attempted on any person who undergoes a cessation of cardiorespiratory function . Therefore , the appropriateness of CPR has been questioned as a matter of the outcome , the patient's preferences , and the cost . The objective of this article is to analyse ethical issues in prehospital resuscitation . Arguments : CPR is bound by moral considerations that surround the use of any medical treatment . According to Beauchamp and Childress , the hierarchy of justification in biomedical ethics consists of ethical theories , principles , rules , and particular judgements and actions . The decision to start CPR is based on the medical judgement that a person is suffering from circulatory arrest . The decision is justified by the moral rule that the victim of a cardiac arrest has the right to survive and to receive CPR . Moral rules are more specific to contexts and are based on ethical principles . The principle of beneficence means the provision of benefits for the promotion of welfare . Talking about beneficence in resuscitation means once again reporting stories of success , as many victims of pre- and in-hospital sudden death have been saved in the past . Nevertheless , resuscitative efforts still remain unsuccessful in the majority of cases , involving the principle of nonmaleficence . There is potential harm in CPR . Survivors may recover cardiac function , but sustain severe hypoxic brain damage , at worst surviving without awakening for months or years . In particular , post-traumatic CPR is associated with an extremely poor outcome , leading to the issue of futility . However , futility should be defined in a strict fashion , as there might be an individual chance of survival . The principle of respect for autonomy means the right of a patient to accept or reject medical treatment , which continues in emergency conditions and after the patient has lost consciousness . The time frame in CPR requires medical decision-making within seconds , and CPR is usually initiated without the patient's involvement . If the patient's wish's can be ascertained later on , life-sustaining therapies might be withdrawn at that time . Terminally ill but still competent patients should be encouraged to write a no-CPR document , which does not deny patients relief from severe symptoms , but might facilitate withholding resuscitative efforts at the scene . The principle of justice affects priorities in the allocation of health care resources . The decision made for a particular patient might delay or prevent emergency treatment in other patients who could receive greater benefit . Conclusions : The standard of care remains the prompt initiation of CPR . However , ethical principles such as beneficene , nonmaleficence , autonomy , and justice have to be applied in the unique setting of emergency medicine . Physicians have to consider the therapeutic efficacy of CPR , the potential risks , and the patient's preferences ." ], "offsets": [ [ 0, 3182 ] ] } ]

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[ { "id": "DerAnaesthesist.70460287.eng.abstr-passage-0", "type": "abstract", "text": [ "Objectives : Due to its low solubility and negligible metabolism , desflurane is assumed to be especially suitable for application by low-flow anaesthetic techniques . The aim of this clinical investigation was the development of a standardised dosing scheme for low-flow and minimal-flow desflurane anaesthesia . Methods : One hundred six ASA status I-II patients were assigned to six groups according to the duration of the initial high-flow phase , fresh gas flow , and fresh-gas desflurane concentration . The median age , height , body weight , and constitution of the groups was comparable . After an initial high-flow phase using 4.4 l/min , the fresh gas flow was reduced to 0.5 l/min ( minimal-flow anaesthesia ) or 1.0 l/min ( low-flow anaesthesia ) . Inspired nitrous oxide concentrations were maintained at 60% to 70% . Using different standardised schemes of vaporizer settings , inspired desflurane concentrations were applied in the range from 3.4% to 8.7% , i.e. , between 1 and 1.5 MAC . Inspired and expired desflurane concentrations were measured continuously by the side-stream technique and recorded on-line . Venous blood samples were taken immediately prior to induction and 45 min after flow reduction for measurement of carboxyhaemoglobin ( COHb ) concentration ) . Results : In the 10- to 15-min initial phase during which a high fresh gas flow of 4.4 l/min was used , the inspired desflurane concentration reached values in the range of 90%-95% of the fresh gas concentration . In low-flow anaesthesia this concentration could be maintained without any alteration of the vaporizer setting , whereas in minimal-flow anaesthesia with flow reduction the fresh gas concentration had to be increased by 1% to 2% : The quotient calculated by division of the inspired desflurane concentration by its fresh gas concentration ( Q=CI/CF) ranges between 0.65 and 0.75 in minimal-flow and between 0.80 and 0.85 in low-flow anaesthesia . If use was made of the wide output range of the desflurane vaporizer , the inspired concentration could be increased rapidly by about 5% in 8 min , although the flow was kept constant at 0.5 l/min . Compared with its value prior to induction ( 2.13 +/- 1.05% ) , the COHb concentration decreased statistically significantly by about 0.7% during the 1st hour of minimal-flow anaesthesia ( 1.42 +/- 1.01% ) . In no case was a COHb concentration observed that exceeded threatening or even toxic values , although the soda lime was changed routinely only once a week . Conclusions : The pharmacokinetic properties of desflurane , resulting in especially low individual uptake , and the wide output range of the vaporizer facilitate the use of low-flow anaesthetic techniques in routine clinical practice . Even in minimal-flow anaesthesia , the duration of the initial high-flow phase can be shortened to min . If the flow is reduced to 1 l/min , the inspired desflurane concentration achieved in the initial high-flow phase can be maintained without any alteration of the vaporizer setting . In minimal-flow anaesthesia , however , with flow reduction to 0.5 l/min , the fresh gas concentration has to be increased to a value 1%-2% higher than the inspired nominal value . Due to the wide dialling range of the desflurane vaporizer , the amount of vapour delivered into the breathing system can be increased to about 110 ml/min even at a flow of 0.5 l/min . The large amount of agent that can be delivered into the system even under low-flow conditions , together with the very low individual uptake , results in a time-constant that is sufficiently short for the clinically required rapid increase in inspired desflurane concentrations . The short time-constant of low-flow desflurane anaesthesia improves the control of the anaesthetic concentration . If all measures are taken to safely avoid inadvertent drying out of the soda lime , there is no evidence that low-flow anaesthesia with desflurane is liable to increase the risk of accidental ca" ], "offsets": [ [ 0, 3997 ] ] } ]

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[ { "id": "DerAnaesthesist.70460294.eng.abstr-passage-0", "type": "abstract", "text": [ "The effect of aprotinin ( 2000000 IU as a bolus +500000 JU/h until the end of the operation ) on transfusion requirements and coagulation parameters in orthotopic liver transplantation ( study group : n=9; placebo group : n=9) was investigated in a randomised , double-blind study . Coagulation parameters were monitored intraoperatively using a mobile laboratory . In contrast to the published results , no effect on transfusion requirements could be demonstrated . However , aprotinin showed a positive effect on some coagulation parameters in the reperfusion phase . The mechanism appeared to be inhibition of the contact activation of the intrinsic system with less thrombin generation in the study group ." ], "offsets": [ [ 0, 710 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.70460303.eng.abstr-passage-0", "type": "abstract", "text": [ "Impaired adrenal function during perioperative stress carries the risk of acute cortisol ( Cs ) deficiency ( Addisonian crisis ) , which may be critical without Cs supplementation . Thus , with evidence of dysfunction of the adrenal glands perioperative substitution is indicated . However , it is unclear whether unilateral adrenalectomy may attenuate the adrenocorticoid response . Glucocorticosteroids are potent agents with several well-known side effects . The purpose of the present study was to evaluate if routine Cs supplementation is justified and necessary in patients undergoing adrenalectomy during nephrectomy for renal-cell cancer ." ], "offsets": [ [ 0, 647 ] ] } ]

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[ { "id": "DerAnaesthesist.70460309.eng.abstr-passage-0", "type": "abstract", "text": [ "The concept of small-volume resuscitation , the rapid infusion of a small volume ( 4 ml/kg BW ) of hyperosmolar 7.2-7.5% saline solution for the initial therapy of severe hypovolemia and shock was advocated more than a decade ago . Numerous publications have established that hyperosmolar saline solution can restore arterial blood pressure , cardiac index and oxygen delivery as well as organ perfusion to pre-shock values . Most prehospital studies failed to yield conclusive results with respect to a reduction in overall mortality . A meta-analysis of preclinical studies from North and South America , however , has indicated an increase in survival rate by 5.1% following small-volume resuscitation when compared to standard of care . Moreover , small-volume resuscitation appears to be of specific impact in patients suffering from head injuries with increased ICP and in severest trauma requiring immediate surgical intervention ." ], "offsets": [ [ 0, 938 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.70460329.eng.abstr-passage-0", "type": "abstract", "text": [ "Introduction : Recently , a compact multisensor device 0.5 mm in diameter has become available with a miniaturised Clark electrode for measuring blood oxygen tension and two optical fibres for measuring CO2 tension , pH , and temperature ( Paratrend 7 , Biomedical Sensors , High Wycombe , UK ) . We used this new probe for continuous blood gas monitoring in the jugular bulb as an alternative to the commonly used fiberoptic spectrophotometric oximetric measurement of haemoglobin saturation ." ], "offsets": [ [ 0, 494 ] ] } ]

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[ { "id": "DerAnaesthesist.70460335.eng.abstr-passage-0", "type": "abstract", "text": [ "Objectives : Due to its unique pharmacokinetics , the new esterase-metabolised opioid remifentanil results in rapid post-anaesthesia recovery . The aim of this clinical investigation was to compare recovery times after remifentanil anaesthesia in combination with hypnotic concentrations of either propofol or isoflurane . Dosages used in the study protocol were based on recommendations by the pharmaceutical manufacturer . Methods : Patients ( ASA status I-II ) scheduled for elective arthroscopy were included in this trial . Without premedication in the morning , anaesthesia was induced identically in both groups : remifentanil bolus ( 1 µg/kg), start of remifentanil-infusion ( 0.5 µg/kg/min), followed immediately by propofol ( ca. 2 mg/kg ) . For maintenance of anaesthesia remifentanil ( 0.25 µg/kg/min) was combined with either a propofol infusion of 0.1 mg/kg/min or 0.5 MAC isoflurane ( =0 . 6 vol . % ) in O2/air. Anaesthetic delivery was discontinued simultaneously with termination of surgery and recovery times were recorded . Results : A total of 40 patients were studied at random in two groups of 20 each with comparable demographic data and anaesthetic technique ( Tables 1 and 2 ) . In both groups emergence was very rapid . Recovery times were significantly shorter for remifentanil-isoflurane than for remifentanil-propofol ( Table 3 ) : spontaneous ventilation 5.1 vs 8.1 min ( P 0.05 ) , extubation 5.5 vs. 8.6 min ( P 0.02 ) , post-anaesthesia recovery score > =9 of 10 points 6.2 vs 11.3 min ( P 0.01 ) , and arrival at PACU 16.2 vs 19.2 min ( P 0.01 ) . Mild to moderate shivering was noted in 40% of all patients ( 9 cases following isoflurane , 7 following propofol ) . Conclusions : Using the manufacturer's recommended dosages , emergence after remifentanil anaesthesia is more rapid with 0.5 MAC isoflurane than with 0.1 mg/kg/min propofol . These results are most probably due to the different pharmacological properties of both co-anaesthetics , especially the applied dosages , and to different interactions with remifentanil . Present clinical experience suggests that a further dose reduction , especially for propofol , is possible . For both remifentanil groups emergence was remarkably rapid between return of consciousness and the awake state ( on-off phenomenon ) , which might contribute to post-anaesthesia safety ." ], "offsets": [ [ 0, 2361 ] ] } ]

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[ { "id": "DerAnaesthesist.70460339.eng.abstr-passage-0", "type": "abstract", "text": [ "Objective : Recent evidence suggests a possible role for Haeme oxygenase ( HO ) -derived carbon monoxide ( CO ) in the regulation of vascular tone through elevation of cyclic 3 ' -5 ' guanosine monophosphate ( cGMP ) . Previous work from our laboratory has shown that blockade of the HO pathway by tin-protoporphyrin-IX ( SnPP ) after resuscitation from haemorrhage leads to a specific and profound increase in portal resistance while neither systemic nor hepatic arterial resistance are affected . We therefore investigated the organ-specific expression pattern of the stress-inducible protein haeme oxygenase-1/heat shock protein 32 after haemorrhage and resuscitation ." ], "offsets": [ [ 0, 672 ] ] } ]

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[ { "id": "DerAnaesthesist.70460385.eng.abstr-passage-0", "type": "abstract", "text": [ "Mivacurium is a short-acting , nondepolarising muscle relaxant of the benzylisoquinoline type that undergoes rapid breakdown by plasma cholinesterase . After 2.5 times the ED95 ( 0.2 mg/kg ) , tracheal intubation can be accomplished within 2-3 min following injection . The ensuing DUR 25% ( i.e. , time from injection to 25% recovery of control twitch tension ) is three times as long as with succinylcholine . The principal side effects of mivacurium are facial flushing and a transient fall in blood pressure due to moderate histamine release following doses 3-4 times the ED95. In patients with end-stage liver or renal disease as well as those with atypical plasma cholinesterase , the duration of action of mivacurium is prolonged ." ], "offsets": [ [ 0, 738 ] ] } ]

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"type": "umlsterm", "text": [ "intubation" ], "offsets": [ [ 202, 212 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021925" } ] }, { "id": "DerAnaesthesist.70460385.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "injection" ], "offsets": [ [ 258, 267 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021485" } ] }, { "id": "DerAnaesthesist.70460385.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "tracheal intubation" ], "offsets": [ [ 193, 212 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021932" } ] }, { "id": "DerAnaesthesist.70460385.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "DUR" ], "offsets": [ [ 282, 285 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0206176" } ] }, { "id": "DerAnaesthesist.70460385.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "time" ], "offsets": [ [ 299, 303 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040223" } ] }, { "id": "DerAnaesthesist.70460385.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "injection" ], "offsets": [ [ 309, 318 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021485" } ] }, { "id": "DerAnaesthesist.70460385.eng.abstr-s3-t4", "type": "umlsterm", "text": [ "control" ], "offsets": [ [ 338, 345 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0243148" } ] }, { "id": "DerAnaesthesist.70460385.eng.abstr-s3-t5", "type": "umlsterm", "text": [ "times" ], "offsets": [ [ 372, 377 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040223" } ] }, { "id": "DerAnaesthesist.70460385.eng.abstr-s3-t6", "type": "umlsterm", "text": [ "succinylcholine" ], "offsets": [ [ 394, 409 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038627" } ] }, { "id": "DerAnaesthesist.70460385.eng.abstr-s4-t1", "type": "umlsterm", "text": [ "mivacurium" ], "offsets": [ [ 442, 452 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0066621" } ] }, { "id": "DerAnaesthesist.70460385.eng.abstr-s4-t2", "type": "umlsterm", "text": [ "transient" ], "offsets": [ [ 479, 488 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040704" } ] }, { "id": "DerAnaesthesist.70460385.eng.abstr-s4-t3", "type": "umlsterm", "text": [ "blood" ], "offsets": [ [ 497, 502 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005767" }, { "db_name": "UMLS", "db_id": "C0005768" }, { "db_name": "UMLS", "db_id": "C0005835" } ] }, { "id": "DerAnaesthesist.70460385.eng.abstr-s4-t4", "type": "umlsterm", "text": [ "pressure" ], "offsets": [ [ 503, 511 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033095" } ] }, { "id": "DerAnaesthesist.70460385.eng.abstr-s4-t5", "type": "umlsterm", "text": [ "histamine" ], "offsets": [ [ 528, 537 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0019588" } ] }, { "id": "DerAnaesthesist.70460385.eng.abstr-s4-t6", "type": "umlsterm", "text": [ "release" ], "offsets": [ [ 538, 545 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0541720" } ] }, { "id": "DerAnaesthesist.70460385.eng.abstr-s4-t7", "type": "umlsterm", "text": [ "times" ], "offsets": [ [ 566, 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[]

[]

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[ { "id": "DerAnaesthesist.70460389.eng.abstr-passage-0", "type": "abstract", "text": [ "Background : We prospectively used the laryngeal mask airway ( LM ) in eye surgery to evaluate : 1 ) the limits of safe handling ; 2 ) the feasibility of its use in long operative procedures , and 3 ) whether patients with higher anaesthetic risk ( hypertension , asthma , children ) may profit from the LM . Methods : In 792 patients leak pressure , cuff volume , duration of anaesthesia , and complications were noted ; 33 were children under 10 years of age , 100 had hypertension or severe asthma . In 54 patients cuff volume was increased to measure its influence on leak pressure ; in 241 leak pressure was also measured at the end of the procedure ; in 31 cuff pressure was measured under standard conditions over time ; in 7 dead space was evaluated with the BANALYZER program ; and in 300 blind endotracheal suction was attempted through the LM . Results : Limits for the safe use of the LM were a leak pressure 12 cm H2O combined with insufficient spontaneous ventilation ( CO2et > 7 vol . % ; n=14), dislocation with gastric inflation ( n=2), and bronchial secretions ( n=1), as blind suctioning of the trachea through the LM was possible in only 1 out of 300 attempts . These limits could be recognised before the start of the operation in most cases . Laryngospasm or closure of the glottis ( n=36, 4.5% ) was treatable and did not necessitate abandoning the use of the LM . Mean leak pressure was 17.7 +/- 4.8 cm H2O, showing a comparable distribution in adults and in children and being improved mainly by position changes of the LM , but not by changes in cuff volume . No gas leak occurred when the individual peak inspiratory pressure was equal to or lower than the measured leak pressure except in children . Dead space was almost halved by the LM compared to a face mask ( 90 +/- 13 vs. 162 +/- 31 ml ; P 0.05 ) , allowing spontaneous breathing to be adequate even when manual assistance of ventilation was not possible ( n=14, 1.8% ) . In patients with sufficiently high leak pressures , the LM was safely used for long operations ( up to 240 min ) , as leak pressure did not change over time . When only a low leak pressure could be achieved , deep breaths could be delivered by prolongation of the inspiratory time , thereby preventing atelectasis if tidal volume was limited . Cuff pressure rose to about 100 cm H2O within 60 min and should be monitored . In children , air was aspirated intermittently out of the stomach in procedures longer than 30 min ; in adults , we monitored and buffered gastric contents where necessary . In patients at risk , the LM stimulates the circulation and bronchial reactivity less than an endotracheal tube . Children could be discharged earlier from the recovery room ( 0.45-1.5 h vs. > =2 h after neuromuscular relaxation and intubation ) . Conclusion : Limits for the use of the LM in eye surgery are delineated . Within these limits , the LM offers control over the airway comparable to that of an endotracheal tube with less stimulation . The LM has to be applied by an experienced user , and has advantages in eye surgery ." ], "offsets": [ [ 0, 3088 ] ] } ]

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"normalized": [ { "db_name": "UMLS", "db_id": "C0184661" }, { "db_name": "UMLS", "db_id": "C0025664" } ] }, { "id": "DerAnaesthesist.70460389.eng.abstr-s1-t6", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 209, 217 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.70460389.eng.abstr-s1-t7", "type": "umlsterm", "text": [ "anaesthetic" ], "offsets": [ [ 230, 241 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002932" } ] }, { "id": "DerAnaesthesist.70460389.eng.abstr-s1-t8", "type": "umlsterm", "text": [ "risk" ], "offsets": [ [ 242, 246 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0035647" } ] }, { "id": "DerAnaesthesist.70460389.eng.abstr-s1-t9", "type": "umlsterm", "text": [ "hypertension" ], "offsets": [ [ 249, 261 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0020538" } ] }, { "id": "DerAnaesthesist.70460389.eng.abstr-s1-t10", "type": "umlsterm", "text": [ "asthma" ], "offsets": [ [ 264, 270 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004096" } ] }, { "id": "DerAnaesthesist.70460389.eng.abstr-s1-t11", "type": "umlsterm", "text": [ "children" ], "offsets": [ [ 273, 281 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0008059" } ] }, { "id": "DerAnaesthesist.70460389.eng.abstr-s1-t12", "type": "umlsterm", "text": [ "laryngeal mask" ], "offsets": [ [ 39, 53 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0162645" } ] }, { "id": "DerAnaesthesist.70460389.eng.abstr-s1-t13", "type": "umlsterm", "text": [ "eye surgery" ], "offsets": [ [ 71, 82 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038901" } ] }, { "id": "DerAnaesthesist.70460389.eng.abstr-s1-t14", "type": "umlsterm", "text": [ "operative procedures" ], "offsets": [ [ 170, 190 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0543467" }, { "db_name": "UMLS", "db_id": "C0038895" } ] }, { "id": "DerAnaesthesist.70460389.eng.abstr-s1-t15", "type": "umlsterm", "text": [ "laryngeal mask airway" ], 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[]

[]

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[ { "id": "DerAnaesthesist.70460403.eng.abstr-passage-0", "type": "abstract", "text": [ "The mucociliary escalator of the lung is an important protective transport system by means of which inhaled particles and microorganisms are removed from the tracheobronchial system . In general , it is assumed that anaesthetics inhibit mucociliary clearance [ 3 , 5 , 6 , 19 , 27 ] . In the present prospective study the effect of combination anaesthesia with isoflurane , fentanyl , vecuronium , and nitrous oxide-oxygen mixture on bronchial mucus transport velocity ( BTV ) was investigated ." ], "offsets": [ [ 0, 495 ] ] } ]

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[ { "id": "DerAnaesthesist.70460408.eng.abstr-passage-0", "type": "abstract", "text": [ "The development of cardiopulmonary bypass ( CPB ) to support the systemic circulation during cardiac surgical procedures became a clinical reality in 1953. Although the use of CPB for the treatment of post-infarction cardiogenic shock met with little success , intra-aortic balloon counterpulsation was used successfully in 1968 to reduce ischaemic injury in a patient with cardiogenic shock . Today , a broad spectrum of circulatory assist devices for short- and long-term application is available . Three major indication groups for the use of support devices are established . In low-cardiac-output syndrome after cardiac surgical procedures , short-term devices are utilised to enable myocardial recovery . In transplantation candidates suffering from drug-resistant pump failure , the implantation of long-term devices as a bridge to heart transplantation is indicated , and in NYHA class IV patients with contraindications to heart transplantation , the implantation of long-term devices as an alternative to transplantation is under discussion . In the literature , post-cardiotomy support survival is less than 30% on average . About 70% of mechanically bridged patients have survived to undergo heart transplantation and were transplanted with over 90% survival . Major problems during mechanical support are infection , bleeding , and thrombembolism . In view of patients ' natural course without support , these clinical results are favourable ." ], "offsets": [ [ 0, 1456 ] ] } ]

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[ { "id": "DerAnaesthesist.70460419.eng.abstr-passage-0", "type": "abstract", "text": [ "We performed a prospective multi-center study in order to determine the causes of 30-day perioperative mortality ." ], "offsets": [ [ 0, 114 ] ] } ]

[ { "id": "DerAnaesthesist.70460419.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "causes" ], "offsets": [ [ 72, 78 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0015127" } ] }, { "id": "DerAnaesthesist.70460419.eng.abstr-s1-t2", "type": "umlsterm", "text": [ "mortality" ], "offsets": [ [ 103, 112 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026566" }, { "db_name": "UMLS", "db_id": "C0026565" } ] } ]

[]

[]

[]

[ { "id": "DerAnaesthesist.70460428.eng.abstr-passage-0", "type": "abstract", "text": [ "A 22-year-old male suffering from neuropathic pain in his right leg had sufficient analgesia with oral tilidin 300 mg per day . Nevertheless , the general practitioner decided to change the therapy to transdermal fentanyl . Having cut a fentanyl patch ( 50 µg/h) into pieces , he applied one-fourth of the patch ; 60 min later the patient developed signs of opioid intoxication , including heavy sedation , nausea and respiratory depression . After the patch was removed another 60 min later , the patient made a complete recovery . The risks following inappropriate application of transdermal fentanyl are discussed ." ], "offsets": [ [ 0, 618 ] ] } ]

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[]

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"DerAnaesthesist.70460428.eng.abstr-s3-t3", "arg2_id": "DerAnaesthesist.70460428.eng.abstr-s3-t7", "normalized": [] }, { "id": "DerAnaesthesist.70460428.eng.abstr-s3-r42-t4.1-t1.1", "type": "interacts_with", "arg1_id": "DerAnaesthesist.70460428.eng.abstr-s3-t4", "arg2_id": "DerAnaesthesist.70460428.eng.abstr-s5-t1", "normalized": [] }, { "id": "DerAnaesthesist.70460428.eng.abstr-s3-r43-t3.1-t5.2", "type": "result_of", "arg1_id": "DerAnaesthesist.70460428.eng.abstr-s3-t3", "arg2_id": "DerAnaesthesist.70460428.eng.abstr-s3-t5", "normalized": [] }, { "id": "DerAnaesthesist.70460428.eng.abstr-s3-r44-t3.1-t7.1", "type": "degree_of", "arg1_id": "DerAnaesthesist.70460428.eng.abstr-s3-t3", "arg2_id": "DerAnaesthesist.70460428.eng.abstr-s3-t7", "normalized": [] }, { "id": "DerAnaesthesist.70460428.eng.abstr-s3-r45-t4.1-t3.1", "type": "diagnoses", "arg1_id": "DerAnaesthesist.70460428.eng.abstr-s3-t4", "arg2_id": "DerAnaesthesist.70460428.eng.abstr-s3-t3", "normalized": [] }, { "id": "DerAnaesthesist.70460428.eng.abstr-s3-r46-t3.1-t5.2", "type": "diagnoses", "arg1_id": "DerAnaesthesist.70460428.eng.abstr-s3-t3", "arg2_id": "DerAnaesthesist.70460428.eng.abstr-s3-t5", "normalized": [] }, { "id": "DerAnaesthesist.70460428.eng.abstr-s3-r47-t1.1-t3.1", "type": "treats", "arg1_id": "DerAnaesthesist.70460428.eng.abstr-s5-t1", "arg2_id": "DerAnaesthesist.70460428.eng.abstr-s3-t3", "normalized": [] }, { "id": "DerAnaesthesist.70460428.eng.abstr-s3-r48-t5.2-t7.1", "type": "result_of", "arg1_id": "DerAnaesthesist.70460428.eng.abstr-s3-t5", "arg2_id": "DerAnaesthesist.70460428.eng.abstr-s3-t7", "normalized": [] }, { "id": "DerAnaesthesist.70460428.eng.abstr-s3-r49-t7.1-t3.1", "type": "associated_with", "arg1_id": "DerAnaesthesist.70460428.eng.abstr-s3-t7", "arg2_id": "DerAnaesthesist.70460428.eng.abstr-s3-t3", "normalized": [] } ]

[ { "id": "DerAnaesthesist.70460430.eng.abstr-passage-0", "type": "abstract", "text": [ "Spinal anaesthesia for outpatients is a method that is not favoured in several reports without having representative data . It was our desire to investigate whether this method could be used without having dangerous side effects ." ], "offsets": [ [ 0, 230 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.70460434.eng.abstr-passage-0", "type": "abstract", "text": [ "Introduction : There is no data available on the action of etomidate on ion currents in human neuronal cells . Therefore the effects of etomidate on a human neuronal delayed rectifer potassium current were investigated ." ], "offsets": [ [ 0, 220 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.70460481.eng.abstr-passage-0", "type": "abstract", "text": [ "Cisatracurium ( 51W89) is one of the ten stereoisomers of atracurium , accounting for about 15% of the racemate . The ED95 of cisatracurium was determined to be about 50 µg/kg ( cation , molecular weight 929 ) , while the ED95 of atracurium ( besylate salt , molecular weight 1245 ) was 250 µg/kg. Thus , on a molar basis in adult patients , cisatracurium is about 3.5 times as potent as the racemic atracurium mixture . We compared atracurium with cisatracurium in healthy adult patients and found an almost identical pharmacodynamic profile . In children , an ED95 of about 40 µg/kg was determined , while a 1-min-longer onset of cisatracurium was found in geriatric than in young adult patients . The presence of chronic renal failure did not prolong the duration of action of cisatracurium . The recovery of neuromuscular transmission from a cisatracurium infusion of up to 145 h was investigated in intensive care unit patients . Their time from the end of infusion to a train-of-four ratio > 0.7 ( 68 +/- 18 min ) was on average only some 70% longer than after an infusion of cisatracurium for 2 h in normal surgical patients . In another study , no signs of histamine release nor any clinically relevant cardiovascular effects of cisatracurium were found in doses up to eight times ED95." ], "offsets": [ [ 0, 1294 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.70460486.eng.abstr-passage-0", "type": "abstract", "text": [ "Cisatracurium ( 51W89, Nimbex , Glaxo-Wellcome ) , an intermediate-acting non-depolarizing neuromuscular blocking agent , is a stereoisomer of atracurium . Histamine releasing propensities and serum tryptase level have been investigated after administration of cisatracurium ( 3xED95 , 5xED95 ) or vecuronium ( 3xED90 ) in surgical patients . Methods : After approval by our institutional review board , 62 patients ( ASA I-II ) were randomly assigned to three groups to receive either 3xED95 or 5xED95 cisatracurium , or 3xED90 vecuronium as a rapid bolus . A prick test was done the day before by scarification of the skin in the forearm . After premedication with 2 mg lormetazepam , anaesthesia was induced with thiopentone ( 4-12 mg/kg ) and maintained with O2/N2O and isoflurane ( 1.5-2 vol . % ) . Six minutes after thiopentone , the patients received the relaxant , and after further 6 min 0.1-0.2 mg fentanyl was given and the trachea was intubated . Heart rate ( HR ) and blood pressure ( BP ) were monitored every minute . Blood samples for histamine were withdrawn 5 min prior 3 and 5 min after each drug administration ( thiopentone , relaxants ) . Plasma histamine was measured by radioimmunoassay ( RIA ) with a sensitivity of approximately 10 pg/ml . Additionally , serum tryptase was measured by RIA at baseline ( -10 and -1 min ) and 15 and 60 min after the relaxant administration . Levels for histamine > 1000 pg/ml and for tryptase > 2 µg/ml were considered significant . Cutaneous signs of histamine release were documented . Results : Ten patients showed a positive prick-test reaction . Only after thiopentone some cutaneous signs ( 4 flush , 1 erythema ) of histamine release were observed . There were no cutaneous signs of histamine release correlating with cardiovascular changes . Analysis of the blood samples demonstrated no significant increase in the histamine level in all three groups . Only in 1 patient was a significant higher histamine level ( 1133 pg/ml ) measured 5 min after 5xED95 cisatracurium . All measurements of serum tryptase were within the physiological limits . Discussion : In this study , with the particular time course of drug administration , neither cisatracurium nor vecuronium increased plasma histamine levels . Only after 5xED95 cisatracurium was 1 elevated histamine level documented after 5 min . In several studies increased histamine levels have been described , but without clinical manifestations . It is known that cutaneous signs can occur without increased plasma histamine levels due to the structural heterogeneity of mast cells . The cutaneous reactions in this study were caused by thiopentone . The tryptase values were within normal limits even in the patient with histamine release . No relationship between the positive results in the prick test and the incidence of cutaneous reactions and/or histamine release for drugs used in the induction of anaesthesia was observed . Whether cisatracurium has a potential for immunologic release is unknown ." ], "offsets": [ [ 0, 3027 ] ] } ]

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"DerAnaesthesist.70460486.eng.abstr-s1-t6", "type": "umlsterm", "text": [ "neuromuscular blocking agent" ], "offsets": [ [ 91, 119 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027866" } ] }, { "id": "DerAnaesthesist.70460486.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "Histamine" ], "offsets": [ [ 156, 165 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0019588" } ] }, { "id": "DerAnaesthesist.70460486.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "tryptase" ], "offsets": [ [ 199, 207 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0147080" } ] }, { "id": "DerAnaesthesist.70460486.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "administration" ], "offsets": [ [ 243, 257 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001554" } ] }, { "id": "DerAnaesthesist.70460486.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "cisatracurium" ], "offsets": [ [ 261, 274 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0530103" } ] }, { "id": "DerAnaesthesist.70460486.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "vecuronium" ], "offsets": [ [ 298, 308 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242531" } ] }, { "id": "DerAnaesthesist.70460486.eng.abstr-s2-t6", "type": "umlsterm", "text": [ "surgical" ], "offsets": [ [ 323, 331 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038895" } ] }, { "id": "DerAnaesthesist.70460486.eng.abstr-s2-t7", "type": "umlsterm", "text": [ "patients" ], "offsets": [ [ 332, 340 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "DerAnaesthesist.70460486.eng.abstr-s2-t8", "type": "umlsterm", "text": [ "Histamine releasing" ], "offsets": [ [ 156, 175 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0019595" } ] }, { "id": "DerAnaesthesist.70460486.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "Methods" ], "offsets": [ [ 343, 350 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0025663" }, { "db_name": "UMLS", "db_id": "C0025664" } ] }, { "id": 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[]

[]

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[ { "id": "DerAnaesthesist.70460493.eng.abstr-passage-0", "type": "abstract", "text": [ "Recent studies have shown different results concerning the effects of smoking on neuromuscular blocking agents . Some reports indicate that smokers need higher doses of vecuronium , but are more sensitive to atracurium . The aim of this study was to evaluate the effects of smoking on onset and recovery time after a single 0.6 mg/kg intubating dose of rocuronium an analog of vecuronium ." ], "offsets": [ [ 0, 389 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.70460504.eng.abstr-passage-0", "type": "abstract", "text": [ "Transoesophageal echocardiography ( TEE ) is recognised as a semi-invasive technique that has an increasing impact as a diagnostic tool in anaesthesia and intensive care medicine . However , adequate assessment of TEE is based on knowledge of basic echocardiographic principles and their limitations and sufficient educational training of the user . TEE has an established role in various clinical circumstances . It often saves time-consuming investigations for the diagnosis of aortic injuries in trauma patients . It is also useful in patients undergoing cardiac valve repair or congenital heart surgery with regard to assessment of the operative success . In patients with severe hypotension TEE may identify the cause , and thereby facilitate successful patient management . Moreover , TEE has an impact on the diagnosis of endocarditis and pathologic findings within the heart and pericardial sac . TEE-associated diagnosis and decision-making may lead to an improved clinical outcome , which in turn may lead to subsequent cost reduction ." ], "offsets": [ [ 0, 1046 ] ] } ]

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[] }, { "id": "DerAnaesthesist.70460504.eng.abstr-s8-r3-t1.1-t2.1", "type": "measures", "arg1_id": "DerAnaesthesist.70460504.eng.abstr-s8-t1", "arg2_id": "DerAnaesthesist.70460504.eng.abstr-s8-t2", "normalized": [] } ]

[ { "id": "DerAnaesthesist.70460516.eng.abstr-passage-0", "type": "abstract", "text": [ "There is still a significant lack of treatment and rehabilitation facilities for chronic pain patients in Germany today . Most of all the treatment of low back pain and widespread pain syndromes or panalgesia is time consuming and complicated . The main problem of anaesthesiological pain clinics is the increase of these complex pain syndromes in the last years . The definition of chronic pain is a contiuous noxious input modulated and compounded by the prolonged or recurrent nature of chronic state and further complicated by a multitude of economic and psychosocial factors . It is now clear that no one discipline or mode will suffice . Only a multidisciplinary and intensive approache will prevail , as discussed in this article . Unfortunately these multidisciplinary pain units are nearly not existing in Gemany just as little as control of the effectiveness of pain treatment ." ], "offsets": [ [ 0, 888 ] ] } ]

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[ { "id": "DerAnaesthesist.70460528.eng.abstr-passage-0", "type": "abstract", "text": [ "The sensitivity of ambulatory electrocardiography ( Holter ECG ) for detecting ischaemia is relatively low . A case report of an inferior infarction missed by three-lead Holter monitoring that included a modified lead aVF especially places its sensitivity for detecting inferior ischaemia and infarction in question . Therefore , the present study evaluated the sensitivity of nine bipolar Holter leads for detecting isolated inferior Q-wave infarctions , and compared the sensitivity of the modified leads II , III , and aVF of the Holter ECG with the sensitivity of the \" corresponding \" leads of the standard ECG ." ], "offsets": [ [ 0, 617 ] ] } ]

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[ { "id": "DerAnaesthesist.70460532.eng.abstr-passage-0", "type": "abstract", "text": [ "Background : The purpose of this study was to determine obstetrical pain management practices for labour for spontaneous and operative vaginal deliveries since there were no comparative German data available for the past 10 years . Methods : A mail survey was sent to the chief anaesthetists of all hospitals in North Rhine-Westfalia designated to have obstetrical beds . The confidential and standardised questionnaire consisted of 24 mainly multiple-choice questions relating to general issues and methods of analgesia and anaesthesia for vaginal deliveries . Results : In all , 118 completed replies to 258 sent questionnaires were received , giving a response rate of 46% . Among the 118 hospitals there were 79,157 vaginal deliveries annually . All participating hospitals practiced either systemic analgesics/spasmolytics and/or regional-anaesthetic methods ( Table 2 ) . Perineal local infiltration ( 23.7% of vaginal deliveries , in 99% of cases performed by the obstetrician ) and epidural analgesia ( 23.2% of vaginal deliveries , in 81% of cases performed by an anaesthetist ) were the commonest regional-anaesthetic methods . Pudendal nerve blocks were performed in 18.5% of vaginal deliveries ( Table 1 ) . Of all participating hospitals , 97% provided a 24-h epidural service . The method of epidural anaesthesia was widely homogeneous in all 118 hospitals ( Table 3 ) . Other methods of regional analgesia ( i.e. , epidural infusions or patient-controlled epidural analgesia ) were performed only rarely . Conclusions : The methods of obstetrical analgesia and anaesthesia are on a high level and show a broad homogeneity in all hospitals . Overall , the results indicate , in comparison to former studies and in common with other countries , steadily increasing use of regional anaesthesia performed by anaesthetists in contrast to decreasing numbers of local infiltrations performed by obstetricians ." ], "offsets": [ [ 0, 1918 ] ] } ]

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[]

[]

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[] }, { "id": "DerAnaesthesist.70460532.eng.abstr-s13-r3-t1.1-t2.1", "type": "uses", "arg1_id": "DerAnaesthesist.70460532.eng.abstr-s13-t1", "arg2_id": "DerAnaesthesist.70460532.eng.abstr-s13-t2", "normalized": [] } ]

[ { "id": "DerAnaesthesist.70460536.eng.abstr-passage-0", "type": "abstract", "text": [ "Bacteraemia and septicaemia are generally thought to be relative or absolute contraindications for central neural axis ( CNA ) blocks . Postulated mechanisms for haematogenous infection of the central nervous system ( CNS ) caused by subarachnoid or epidural puncture might be an accidental vessel puncture , a change of pressure in the subarachnoid space , and the induction of a \" locus minoris resistentiae . \" Infectious complications of diagnostic lumbar puncture , spinal or epidural anaesthesia are very rare . Although in animals meningitis can be induced by subarachnoid puncture during bactaeremia , there is no study that proves an increased risk for bacteraemic patients . Transient bacteraemia is common , especially in urological and obstetrical-gynecological procedures that are often done in regional anaesthesia , but the incidence of infectious complications is low . This review investigates the few published cases in which a haematogenous infection of the CNS may have been caused by regional anaesthesia . Based on current knowledge , bacteraemia cannot be an absolute , but only a relative contraindication for CNA blocks . Antibiotic chemoprophylaxis should be given before the puncture and the patients must be closely followed after the anaesthesia , particularly for the development of spinal epidural abscess . Because of the possibly increased risk of infectious complications , informed consent should be obtained from the patient ." ], "offsets": [ [ 0, 1462 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.70460583.eng.abstr-passage-0", "type": "abstract", "text": [ "Objective : To investigate the incidence of postoperative nausea and vomiting ( PONV ) depending on the administration time of ondansetron ." ], "offsets": [ [ 0, 140 ] ] } ]

[ { "id": "DerAnaesthesist.70460583.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "Objective" ], "offsets": [ [ 0, 9 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018017" } ] }, { "id": "DerAnaesthesist.70460583.eng.abstr-s1-t2", "type": "umlsterm", "text": [ "incidence" ], "offsets": [ [ 31, 40 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0220856" }, { "db_name": "UMLS", "db_id": "C0021149" } ] }, { "id": "DerAnaesthesist.70460583.eng.abstr-s1-t3", "type": "umlsterm", "text": [ "postoperative" ], "offsets": [ [ 44, 57 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0032790" } ] }, { "id": "DerAnaesthesist.70460583.eng.abstr-s1-t4", "type": "umlsterm", "text": [ "nausea" ], "offsets": [ [ 58, 64 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027497" } ] }, { "id": "DerAnaesthesist.70460583.eng.abstr-s1-t5", "type": "umlsterm", "text": [ "vomiting" ], "offsets": [ [ 69, 77 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042963" } ] }, { "id": "DerAnaesthesist.70460583.eng.abstr-s1-t6", "type": "umlsterm", "text": [ "PONV" ], "offsets": [ [ 80, 84 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0520909" } ] }, { "id": "DerAnaesthesist.70460583.eng.abstr-s1-t7", "type": "umlsterm", "text": [ "administration" ], "offsets": [ [ 104, 118 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001554" } ] }, { "id": "DerAnaesthesist.70460583.eng.abstr-s1-t8", "type": "umlsterm", "text": [ "time" ], "offsets": [ [ 119, 123 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040223" } ] }, { "id": "DerAnaesthesist.70460583.eng.abstr-s1-t9", "type": "umlsterm", "text": [ "ondansetron" ], "offsets": [ [ 127, 138 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0061851" } ] }, { "id": "DerAnaesthesist.70460583.eng.abstr-s1-t10", "type": "umlsterm", "text": [ "postoperative nausea" ], "offsets": [ [ 44, 64 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0520904" } ] } ]

[]

[]

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[ { "id": "DerAnaesthesist.70460588.eng.abstr-passage-0", "type": "abstract", "text": [ "To test the hypothesis that the efficacy of local anaesthetics to block nerve conduction is related the time of day ( TOD ) of drug application , we retrospectively analysed data from previous experiments on tachyphylaxis . During the course of these experiments , as a measure of drug efficacy we determined the minimal blocking concentration ( cm ) of bupivacaine in rabbit aortic nerves at several TODs . The special in situ preparation used permitted study of local anaesthetic pharmacodynamics without the influence of pharmacokinetics , making it possible to investigate the chronopharmacodynamics of these drugs by relating cms to the respective TODs of their measurement ." ], "offsets": [ [ 0, 680 ] ] } ]

[ { "id": "DerAnaesthesist.70460588.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "anaesthetics" ], "offsets": [ [ 50, 62 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002932" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s1-t2", "type": "umlsterm", "text": [ "nerve" ], "offsets": [ [ 72, 77 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027769" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s1-t3", "type": "umlsterm", "text": [ "time" ], "offsets": [ [ 104, 108 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040223" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s1-t4", "type": "umlsterm", "text": [ "drug" ], "offsets": [ [ 127, 131 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013227" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s1-t5", "type": "umlsterm", "text": [ "tachyphylaxis" ], "offsets": [ [ 208, 221 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039242" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s1-t6", "type": "umlsterm", "text": [ "local anaesthetics" ], "offsets": [ [ 44, 62 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002934" }, { "db_name": "UMLS", "db_id": "C0002921" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s1-t7", "type": "umlsterm", "text": [ "nerve conduction" ], "offsets": [ [ 72, 88 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027788" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "measure" ], "offsets": [ [ 270, 277 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0079809" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "drug" ], "offsets": [ [ 281, 285 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013227" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "concentration" ], "offsets": [ [ 330, 343 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0086045" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "bupivacaine" ], "offsets": [ [ 354, 365 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0006400" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "rabbit" ], "offsets": [ [ 369, 375 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0034493" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s2-t6", "type": "umlsterm", "text": [ "nerves" ], "offsets": [ [ 383, 389 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027769" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "anaesthetic" ], "offsets": [ [ 470, 481 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002932" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "pharmacodynamics" ], "offsets": [ [ 482, 498 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0243145" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "pharmacokinetics" ], "offsets": [ [ 524, 540 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0031327" }, { "db_name": "UMLS", "db_id": "C0031328" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s3-t4", "type": "umlsterm", "text": [ "drugs" ], "offsets": [ [ 613, 618 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013227" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s3-t5", "type": "umlsterm", "text": [ "measurement" ], "offsets": [ [ 667, 678 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242485" } ] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s3-t6", "type": "umlsterm", "text": [ "local anaesthetic" ], "offsets": [ [ 464, 481 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002934" }, { "db_name": "UMLS", "db_id": "C0002921" } ] } ]

[]

[]

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"arg1_id": "DerAnaesthesist.70460588.eng.abstr-s3-t6", "arg2_id": "DerAnaesthesist.70460588.eng.abstr-s3-t3", "normalized": [] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s3-r10-t3.2-t2.1", "type": "affects", "arg1_id": "DerAnaesthesist.70460588.eng.abstr-s3-t3", "arg2_id": "DerAnaesthesist.70460588.eng.abstr-s3-t2", "normalized": [] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s3-r11-t6.2-t1.1", "type": "uses", "arg1_id": "DerAnaesthesist.70460588.eng.abstr-s3-t6", "arg2_id": "DerAnaesthesist.70460588.eng.abstr-s3-t1", "normalized": [] }, { "id": "DerAnaesthesist.70460588.eng.abstr-s3-r12-t5.1-t2.1", "type": "measurement_of", "arg1_id": "DerAnaesthesist.70460588.eng.abstr-s3-t5", "arg2_id": "DerAnaesthesist.70460588.eng.abstr-s3-t2", "normalized": [] } ]

[ { "id": "DerAnaesthesist.70460592.eng.abstr-passage-0", "type": "abstract", "text": [ "Aim : The aim of this study was to investigate whether the plasma levels of the circulating adhesion molecules sICAM-1 and sE-selectin could serve as early predictors of developing sepsis and its severity ." ], "offsets": [ [ 0, 206 ] ] } ]

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[ { "id": "DerAnaesthesist.70460599.eng.abstr-passage-0", "type": "abstract", "text": [ "Reproduction of an ancient Egyptian mouth-opening device raises certain technological and historical questions . The most effective variation has proven to be a device made of strip iron built exactly according to the proportions given in the Hunefer papyrus . This device allows quick and safe intubation of intubation dummy CLA 8 without a supplementary light source . Originally , the device was a metal instrument made of meteoric iron , apparently produced only in small numbers . To date , the form of production remains a mystery , since the smelting and processing of iron was totally uncommon in ancient Egypt . Based on the material structure of the device and certain portrayals in graves in Deir el-Medina , mouth-opening as it was actually performed reveals a methodology that can be reconciled with modern pre-clinical polytrauma management . In principle , this indicates that the introduction of artificial respiration thousands of years ago would have been possible ." ], "offsets": [ [ 0, 984 ] ] } ]

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[ { "id": "DerAnaesthesist.70460613.eng.abstr-passage-0", "type": "abstract", "text": [ "The PhysioFlex anaesthesia machine is designed to operate as a quantitative closed system . The gas in the system is circulated at 70 litres per minute . With its small soda lime canister and the integration of all components in a thermal insulating case it fulfils all prerequisites for excellent climatisation of the anaesthetic gases . The extent of warming and humidifying of the anaesthetic gases was monitored during extended neurosurgical operations using long tubes to the patient ( 3 m each ) in an cold operating room ( 17-18 °C)." ], "offsets": [ [ 0, 540 ] ] } ]

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[]

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"DerAnaesthesist.70460613.eng.abstr-s4-t6", "arg2_id": "DerAnaesthesist.70460613.eng.abstr-s4-t5", "normalized": [] }, { "id": "DerAnaesthesist.70460613.eng.abstr-s4-r19-t2.1-t5.3", "type": "affects", "arg1_id": "DerAnaesthesist.70460613.eng.abstr-s4-t2", "arg2_id": "DerAnaesthesist.70460613.eng.abstr-s4-t5", "normalized": [] }, { "id": "DerAnaesthesist.70460613.eng.abstr-s4-r20-t2.1-t1.1", "type": "interacts_with", "arg1_id": "DerAnaesthesist.70460613.eng.abstr-s4-t2", "arg2_id": "DerAnaesthesist.70460613.eng.abstr-s4-t1", "normalized": [] }, { "id": "DerAnaesthesist.70460613.eng.abstr-s4-r22-t5.3-t3.2", "type": "occurs_in", "arg1_id": "DerAnaesthesist.70460613.eng.abstr-s4-t5", "arg2_id": "DerAnaesthesist.70460613.eng.abstr-s4-t3", "normalized": [] }, { "id": "DerAnaesthesist.70460613.eng.abstr-s4-r23-t1.1-t5.3", "type": "diagnoses", "arg1_id": "DerAnaesthesist.70460613.eng.abstr-s4-t1", "arg2_id": "DerAnaesthesist.70460613.eng.abstr-s4-t5", "normalized": [] }, { "id": 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"arg2_id": "DerAnaesthesist.70460613.eng.abstr-s4-t5", "normalized": [] }, { "id": "DerAnaesthesist.70460613.eng.abstr-s4-r32-t2.1-t5.1", "type": "affects", "arg1_id": "DerAnaesthesist.70460613.eng.abstr-s4-t2", "arg2_id": "DerAnaesthesist.70460613.eng.abstr-s4-t5", "normalized": [] }, { "id": "DerAnaesthesist.70460613.eng.abstr-s4-r33-t3.2-t5.2", "type": "performs", "arg1_id": "DerAnaesthesist.70460613.eng.abstr-s4-t3", "arg2_id": "DerAnaesthesist.70460613.eng.abstr-s4-t5", "normalized": [] }, { "id": "DerAnaesthesist.70460613.eng.abstr-s4-r34-t1.1-t5.1", "type": "diagnoses", "arg1_id": "DerAnaesthesist.70460613.eng.abstr-s4-t1", "arg2_id": "DerAnaesthesist.70460613.eng.abstr-s4-t5", "normalized": [] }, { "id": "DerAnaesthesist.70460613.eng.abstr-s4-r35-t5.3-t3.1", "type": "associated_with", "arg1_id": "DerAnaesthesist.70460613.eng.abstr-s4-t5", "arg2_id": "DerAnaesthesist.70460613.eng.abstr-s4-t3", "normalized": [] } ]

[ { "id": "DerAnaesthesist.70460616.eng.abstr-passage-0", "type": "abstract", "text": [ "Continuous spinal anaesthesia ( CSA ) is a further means of central nerve block for anaesthesia besides single-shot spinal ( SSS ) , combined spinal/epidural , and epidural anaesthesia ." ], "offsets": [ [ 0, 186 ] ] } ]

[ { "id": "DerAnaesthesist.70460616.eng.abstr-s1-t1", "type": "umlsterm", "text": [ "nerve" ], "offsets": [ [ 68, 73 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027769" } ] }, { "id": "DerAnaesthesist.70460616.eng.abstr-s1-t2", "type": "umlsterm", "text": [ "single-shot" ], "offsets": [ [ 104, 115 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0087136" } ] }, { "id": "DerAnaesthesist.70460616.eng.abstr-s1-t3", "type": "umlsterm", "text": [ "spinal anaesthesia" ], "offsets": [ [ 11, 29 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002928" } ] }, { "id": "DerAnaesthesist.70460616.eng.abstr-s1-t4", "type": "umlsterm", "text": [ "nerve block" ], "offsets": [ [ 68, 79 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027741" } ] }, { "id": "DerAnaesthesist.70460616.eng.abstr-s1-t5", "type": "umlsterm", "text": [ "epidural anaesthesia" ], "offsets": [ [ 164, 184 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002913" } ] } ]

[]

[]

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[ { "id": "DerAnaesthesist.70460622.eng.abstr-passage-0", "type": "abstract", "text": [ "S-Ropivacaine is a new , long-acting amide local anaesthetic . It is the first local anaesthetic to be on the market as a single isomer . Its pharmacodynamic and pharmacokinetic profile is similar to that of bupivacaine . In vitro and in vivo experiments have shown ropivacaine to be less cardiotoxic than bupivacaine . When given epidurally , both local anaesthetics are equally effective in producing sensory block , but motor block seems to be less pronounced in the case of ropivacaine ." ], "offsets": [ [ 0, 491 ] ] } ]

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[ { "id": "DerAnaesthesist.70460659.eng.abstr-passage-0", "type": "abstract", "text": [ "Due to its important physiological and pathophysiological actions , the pluripotent signaling molecule nitric oxide ( NO ) is increasingly of interest in clinical medicine . Despite increasing use by anaesthetists in inhalational therapy for intensive care patients with respiratory distress syndrome , the potential interactions of anaesthetic agents and NO have thus far received little attention . The literature available to date on this topic is somewhat controversial , and highlights the need for additional research in this area . This review summarises the pertinent literature in this area for the anaesthetist and describes potential mechanisms by which anaesthetics may interfere with the synthesis and/or effects of NO in the human body ." ], "offsets": [ [ 0, 751 ] ] } ]

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[ { "id": "DerAnaesthesist.70460683.eng.abstr-passage-0", "type": "abstract", "text": [ "Objective : The data of 60 postoperatively sedated and ventilated patients were studied for analysis of oesophageal , bladder , and rectal temperatures . The purpose of the investigation was to clarify whether changes of oesophageal temperature are adequately reflected by bladder and rectal temperatures and whether the rate of rewarming has an influence on the accuracy of the latter two sites ." ], "offsets": [ [ 0, 397 ] ] } ]

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[ { "id": "DerAnaesthesist.70460689.eng.abstr-passage-0", "type": "abstract", "text": [ "Two groups of 15 patients each with disseminated intravascular coagulation in association with septic disease were treated with low-molecular-weight heparin ( lmw-heparin ) in different dosages ( group I : 1,5-5 IE/kg body weight ( BW ) per hour ; group II : 8-15 IE/kg BW ) . We studied the levels of D-dimer , thrombin-antithrombin III complex ( TAT ) , prothrombin fragments 1 and 2 ( PTF ) , and global tests of coagulation like prothrombin time ( PT ) , activated partial thromboplastin time ( PTT ) , thrombin time ( TT ) and platelet count , plasminogen activation ( PA ) and fibrinogen concentration to estimate the success of heparin therapy in the two groups . TT and fibrinogen concentration were not suitable to follow the course of the coagulation disorder . PT , PTT , platelet count progressively PA , D-dimer , TAT , and PTF normalised progressively after heparinisation . However , only the last three parameters were sensitive enough to show different effects of variable dosages of lmw-heparin . D-dimer , TAT , and PTF levels declined in proportion with heparin concentrations , and thus appear to be the most useful parameters for monitoring the therapeutic effect of heparin in septic coagulopathies ." ], "offsets": [ [ 0, 1223 ] ] } ]

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"DerAnaesthesist.70460689.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "thrombin-antithrombin" ], "offsets": [ [ 312, 333 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040018" } ] }, { "id": "DerAnaesthesist.70460689.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "thrombin-antithrombin" ], "offsets": [ [ 312, 333 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003438" }, { "db_name": "UMLS", "db_id": "C0003440" } ] }, { "id": "DerAnaesthesist.70460689.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "TAT" ], "offsets": [ [ 348, 351 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0052128" }, { "db_name": "UMLS", "db_id": "C0039756" } ] }, { "id": "DerAnaesthesist.70460689.eng.abstr-s2-t5", "type": "umlsterm", "text": [ "prothrombin" ], "offsets": [ [ 356, 367 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033706" } ] }, { "id": "DerAnaesthesist.70460689.eng.abstr-s2-t6", "type": "umlsterm", "text": [ "tests" ], "offsets": [ [ 407, 412 ] ], "normalized": [ { 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[]

[]

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[ { "id": "DerAnaesthesist.70460697.eng.abstr-passage-0", "type": "abstract", "text": [ "The increased consumption of \" ecstasy \" ( MDMA , 3,4-methylenedioxy-methamphetamine) has also increased the number of life-threatening intoxications . From a Medline search of the years 1992-1996 , reports were registered and evaluated . Besides cerebral , cardiorespiratory , renal , and hepatic symptoms , hyperthermia syndromes such as malignant hyperthermia , neuroleptic malignant syndrome , or the serotonin syndrome were common . In addition to a discussion of the intoxication symptoms and their acute and intensive-care therapy , the psychological and physiological effects of \" ecstasy \" will be described . Some historical considerations of the topic are included in this review ." ], "offsets": [ [ 0, 692 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.70460715.eng.abstr-passage-0", "type": "abstract", "text": [ "Objectives : This study was conducted to evaluate a modified technique of interskalene brachial plexus anaesthesia ( ISB ) and postoperative catheter analgesia for shoulder surgery . The original method described by Winnie bears some rare but life-threatening complications ( inadvertent subarachnoid or intra-arterial injection , pneumothorax ) ." ], "offsets": [ [ 0, 347 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.70460751.eng.abstr-passage-0", "type": "abstract", "text": [ "Thoracic epidural anaesthesia ( TEA ) faces growing interest as an adjuvant anaesthetic and postoperative analgesic regimen . The procedure allows a specific blockade of nociceptive reflex arches and may exert beneficial effects on stress-induced alterations of organ function . Myocardial blood flow to areas at risk is improved , and paradoxical reactions of atherosclerotic coronary arteries after sympathetic stimulation are suppressed . After cardiac surgery , TEA improved postoperative recovery and resulted in better haemodynamic stability and allowed earlier extubation . During vascular surgery , the graft occlusion rate was significantly decreased . The improved pulmonary function after TEA is due to superior pain relief which allows the patients to breathe and cough sufficiently . After upper abdominal surgery , TEA leads to improved recovery of gastrointestinal function which reduces the risk of bacterial translocation . Although lumbar epidural anaesthesia is preferred by many anaesthesiologists as there is no risk of traumatizing the spinal cord , many positive effects are forgone . With insufficient rostral spread of a lumbar epidural block above the fifth thoracic level , cardiac complications can occur due to reflex activation of sympathetic outflow in unblocked thoracic regions . When the contraindications are carefully observed , TEA can be safely performed in most patients ." ], "offsets": [ [ 0, 1411 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.70460771.eng.abstr-passage-0", "type": "abstract", "text": [ "Objective : To study the influence of dopexamine on pulmonary shunt and hypoxic pulmonary vasoconstriction during major thoracic surgery with one-lung ventilation ( OLV ) . Design : Prospective , randomised , placebo-controlled study . Setting : University hospital . Patients : Twenty adult patients undergoing elective pulmonary resection . Anaesthesia : General anaesthesia was performed using propofol , fentanyl , N2O and vecuronium . Volume-controlled ventilation was performed to maintain normocapnia over the whole investigation period . During OLV , the tidal volume was reduced and the respiratory rate was increased to avoid a peak airway pressure exceeding 40 cm H2O. Furthermore the FiO2 was increased to 1,0 and the external PEEP was removed during OLV . Interventions : The patients received either dopexamine at 2 µg/kg/min ( group A , n=10) or 0,9% saline as control ( group B , n=10) after assessing the baseline values . Measurement and results : The following cardiorespiratory variables were recorded : Heart rate , mean arterial pressure and mean pulmonary arterial pressure . Cardiac output was measured by thermodilution using a continuous cardiac output thermodilution catheter . Arterial and mixed venous blood gas analysis were measured from simultaneously drawn samples . Cardiac index ( CI ) , systemic vascular resistance index , pulmonary vascular resistance index , oxygen delivery index ( DO2I), oxygen consumption index and the venous admixture were calculated using standard formula . Furthermore , pressure-flow-curves were constructed to analyse flow independent changes in the pulmonary vascular resistance . Data were recorded at the following times : After induction of anaesthesia in stable haemodynamics during two-lung ventilation ( baseline values , T0), intraoperatively during one-lung ventilation ( T1) and postoperatively after re-establishing two-lung ventilation ( T2). Patients characteristics , data from the preoperative lung function testing and surgical procedures did not differ significantly between the groups . CI increased in the dopexamine group from 2,5 +/- 1,2 l - min-1 - m-2 ( T0) to 3,6 +/- 0,9 l - min-1 - m-2 ( T1) and 4,0 +/- 1,3 l - min-1 - m-2 ( T2). The course of the intrapulmonary right-to-left shunting did not differ between the groups . In the dopexamine-treated group the DO2I increased from 430 +/- 143 ml - min - m-2 ( T0) to 652 +/- 255 ml - min - m-2 ( T1) and 653 +/- 207 ml - min - m-2 ( T2). Regarding the pressure-flow-curves there was no difference during OLV between the two groups indicating no major blocking effect of dopexamine on hypoxic pulmonary vasoconstriction . Conclusion : It is concluded that dopexamine can be used to improve haemodynamics and oxygen delivery during thoracic surgery without increasing venous admixture during one-lung ventilation ." ], "offsets": [ [ 0, 2851 ] ] } ]

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[ { "id": "DerAnaesthesist.70460776.eng.abstr-passage-0", "type": "abstract", "text": [ "The objective of this prospective , randomised study was to investigate the incidence of postoperative nausea and/or vomiting ( PONV ) during the first 24 h postoperatively . For a quality assurance study on PONV , we compared two established general anaesthetic procedures in 239 patients undergoing four different types of surgery ( subtotal thyroidectomy , laparotomy for gynaecological procedures , laparoscopy , and surgery for extra-abdominal procedures ) ." ], "offsets": [ [ 0, 463 ] ] } ]

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[ { "id": "DerAnaesthesist.70460783.eng.abstr-passage-0", "type": "abstract", "text": [ "Pheochromocytomas are functionally active , catecholamine-secreting tumours of chromaffin tissue . The mainstay of pharmacological therapy is preoperative treatment with oral phenoxybenzamine . This drug irreversibly alkylates alpha-1-adrenergic receptors on vascular smooth muscle and renders them nonfunctional , thereby causing vasodilatation . The duration of action of a single dose is approximately 24 h . Therefore , postoperative hypotension is a hazard of therapy with phenoxybenzamine if adequate plasma volume repletion is not provided . Prazosin , a short-acting , competitive alpha-1 blocker , has been used preoperatively , but has been criticized for its failure to adequately prevent perioperative hypertensive episodes ." ], "offsets": [ [ 0, 737 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.70460801.eng.abstr-passage-0", "type": "abstract", "text": [ "Unnoticed , minor damage to the unidirectional respiratory valves of the Draeger respiratory circuit may lead to intermittent and unpredictable malfunction , resulting in rebreathing and hypercapnia . The damage may be so minor that normal visual and functional test routines may be insufficient to detect it . We report one case of a potential life-threatening malfunction of the inspiratory valve and also propose economical solutions utilizing altered construction , modified machine-check procedures , or a simple instrument that adds only one step to the machine-check procedure . The general problem of minor but functionally important damage to parts of ventilatory equipment - so-called borderline damage - may not be limited to this particular model or manufacturer . Most users of ventilatory equipment believe that equipment that goes through normal check procedures is either fully functional or non-functional . In reality , this is not the case . Intermittent malfunctions due to slightly damaged equipment may be missed with normal machine-check procedures . This problem results in a significant but incalculable increased in risk to patients . Because of unclear reproduceability of intermittent malfunctions caused by borderline damage , there also is an increased forensic risk for the anaesthesiologist . The risk of mechanical malfunction might be displaced by software problems in new-generation ventilators in the market ." ], "offsets": [ [ 0, 1445 ] ] } ]

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[ { "id": "DerAnaesthesist.70460829.eng.abstr-passage-0", "type": "abstract", "text": [ "The extent of myocardial damage occurring during acute myocardial infarction is time dependent , and there is abundant evidence from most clinical trials that mortality reduction is greatest in patients treated early with thrombolytic agents , although beneficial effects have been shown with treatment initiated up to 12 h after onset of symptoms . All studies on prehospital thrombolysis have conclusively shown the practicability and safety of patient selection and administration of the thrombolytic agent . The accuracy of diagnosis in the prehospital setting was comparable to trials of in-hospital thrombolysis , e.g. , in the Myocardial Infarction Triage and Intervention Project ( MITI ) 98% of the patients enrolled had subsequent evidence of acute myocardial infarction . With regard to time savings , all randomized studies showed positive results . The smallest time gain was observed in the MITI trial : prehospital-treated patients received thrombolytic therapy an average of 33 min earlier than those treated in hospital . In the European Myocardial Infarction Project ( EMIP ) the difference in time between prehospital and hospital treatment was a median of 55 min . However , none of these trials was able to show a significant short-term mortality difference between the two groups . Only a meta analysis of five randomized studies with a combined median time gain of about 60 min showed a significant 17% reduction in short-term mortality for patients who received thrombolytic therapy in the prehospital phase . In the Grampian Region Early Anistreplase Trial ( GREAT ) , a study performed in a more rural area than other studies , the time gain by prehospital initiation of thrombolysis was a median of 130 min . GREAT was the only study to date reporting a significant mortality benefit for prehospital-treated patients after 3 months and 1 year . In conclusion , prehospital thrombolysis is feasible and safe . Patients with acute myocardial infarction can be correctly identified and treated with thrombolytic agents in the prehospital setting with the same rate of complications as expected for in-hospital thrombolysis , provided basic resuscitation equipment including a defibrillator is available . The results of randomized studies comparing the results of prehospital and in-hospital thrombolysis seem to justify the prehospital institution of thrombolytic therapy , especially in rural areas where transport times to the hospital are long and the expected time gain is largest . The choice of the thrombolytic agent seems to be of minor importance and should follow prehospital practicability ( bolus injection ) and costs . Aspirin should be given to all prehospital patients with suspected myocardial infarction regardless of thrombolytic therapy ." ], "offsets": [ [ 0, 2783 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.70460850.eng.abstr-passage-0", "type": "abstract", "text": [ "Anxiolysis with drugs and psychoprophylaxis are both recognised methods of preoperative preparation . The beneficial effects of anxiolytics , however , appear to be difficult to prove . In this study a comparison was made of heart rate ( HR ) , blood pressure ( BP ) , and norepinephrine , epinephrine , and cortisol levels . In group I 19 children recieved only psychological treatment , while in group II 21 children received 0.2 mg/kg midazolam orally . Measuring points were directly before medication , 30 min afterward , and at induction of anaesthesia . During the observation period the patients ( 5-10 years old ) remained calm . At the beginning of the study the parameters of all patients were within a normal range ; 30 min after premedication the HR and BP were significantly higher in group I than in group II . In contrast to group I , epinephrine levels in group II were lower at the beginning of anaesthesia than before premedication . In both groups , norepinephrine levels were the same at induction of anaesthesia as before premedication . Cortisol decreased only in patients who received midazolam . HR , BP , as well as humoral stress parameters indicate that midazolam in a dose of 0.2 mg/kg orally is sufficient to reduce preoperative stress in children ." ], "offsets": [ [ 0, 1279 ] ] } ]

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[ { "id": "DerAnaesthesist.70460856.eng.abstr-passage-0", "type": "abstract", "text": [ "Today , noise pollution is an evident and ubiquitous problem even in intensive care units . Noise can disturb the physiological and psychological balance in patients and staff . Especially intubated patients and those breathing spontaneously through a T-piece are exposed to the noise emitted by the nebuliser used to humidity the respiratory gas . This may make patients feel uncomfortable . To reduce noise pollution in the ICU a modified T-piece has been developed and investigated . In order to heat and humidity the respiratory gas a Conchaterm III unit ( Kendall company ) and a thermo flow cylinder ( De Vilbiss company ) is necessary . While respiratory gas is flowing , water is sucked out of the heated thermoflow cylinder and nebulised according to the Venturi-Bernoulli principle . To adjust the oxygen concentration of the respiratory gas a plastic ring must be turned to either close ( 98% oxygen ) or open a valve allowing room air to mix ( 40% oxygen ) . Noise pollution of the unit varies with admixture of room air . With a new device - a special oxygen - air mixing chamber - the oxygen concentration of the respiratory gas can be adjusted outside the thermoflow cylinder , hardly producing any noise pollution . Therefore the principle of nebulisation could be changed to humidification . A thermoflow cylinder without the nebulisation unit allows the respiratory gas to flow through the thermoflow cylinder over heated and evaporating water , hardly causing any noise pollution . In both types of T-pieces the temperature of the respiratory gas is controlled and corrected by the Conchaterm unit . As the result of these modifications , noise pollution has been reduced from 70 dB ( A ) to 55 dB ( A ) . In the modified T-piece , the quality of humidification has been evaluated with a fresh gas flow of 22 l/min and at a gas temperature of 37 ° C , not only collecting condensed water but also lost water . The modified T-piece allows a physiological humidification of the respiratory gas . The modified T-piece is a simple and efficacious substitute . Patients and staff are protected from adverse noise effects and patient well-being might be improved ." ], "offsets": [ [ 0, 2177 ] ] } ]

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"arg1_id": "DerAnaesthesist.70460856.eng.abstr-s18-t2", "arg2_id": "DerAnaesthesist.70460856.eng.abstr-s15-t4", "normalized": [] }, { "id": "DerAnaesthesist.70460856.eng.abstr-s15-r9-t4.2-t2.1", "type": "interacts_with", "arg1_id": "DerAnaesthesist.70460856.eng.abstr-s15-t4", "arg2_id": "DerAnaesthesist.70460856.eng.abstr-s18-t2", "normalized": [] }, { "id": "DerAnaesthesist.70460856.eng.abstr-s15-r10-t4.2-t1.1", "type": "interacts_with", "arg1_id": "DerAnaesthesist.70460856.eng.abstr-s15-t4", "arg2_id": "DerAnaesthesist.70460856.eng.abstr-s18-t1", "normalized": [] } ]

[ { "id": "DerAnaesthesist.70460860.eng.abstr-passage-0", "type": "abstract", "text": [ "Post-dural puncture headache ( PDPH ) is a significant complication of spinal anaesthesia . Diameter and tip of the needle as well as the patient's age have been proven to be important determinants . The question of whether post-operative recumbency can reduce the risk of PDPH has not been answered uniformly . And besides , some studies referring to this subject reveal methodical failures , for example , as to clear definition and exact documentation of post-operative immobilization . Furthermore , fine-gauge needles ( 26G or more ) have not been investigated yet . The first aim of our study was therefore to examine the role of recumbency in the prevention of PDPH under controlled conditions using thin needles . Secondly , we wanted to confirm the reported prophylactic effect of needles with a modified , atraumatic tip ( Whitacre and Atraucan ) by comparing them to Quincke needles of identical diameter . Most of the former investigators compared Quincke with atraumatic needles of different size regardless of the known influence of the diameter on PDPH ." ], "offsets": [ [ 0, 1069 ] ] } ]

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[ { "id": "DerAnaesthesist.70460867.eng.abstr-passage-0", "type": "abstract", "text": [ "In this article 34 randomized controlled trials examining peripherally mediated opioid effects after knee surgery are discussed . All studies examined small doses of morphine injected intraarticularly at the end of knee surgery , but not all studies did show an analgesic effect of the peripheral opioid . Because of differing study designs a meta-analysis of the data is not possible ." ], "offsets": [ [ 0, 386 ] ] } ]

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[ { "id": "DerAnaesthesist.70460890.eng.abstr-passage-0", "type": "abstract", "text": [ "A healthy 38-year-old woman suffered a sudden cardiac arrest 2 days after a vaginal hysterectomy . Although standard cardiac life support ( CPR ) was instituted immediately after the event , it was not possible to re-establish a spontaneous circulation for about 40 min . Systemic intravenous thrombolytic therapy with slow injection of 1.5 million IU urokinase was performed as a final life-maintaining measure because of the high probability that the underlying cause was a pulmonary embolus ; 10 min later ( after 60 min of ongoing CPR ) the patient regained a stable circulation . She survived without neurological deficit in spite of the long duration of CPR ." ], "offsets": [ [ 0, 665 ] ] } ]

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[ { "id": "DerAnaesthesist.70460915.eng.abstr-passage-0", "type": "abstract", "text": [ "For ethical and socio-economical reasons ( cost-explosion in transfusion-medicine , patient's individual destiny ) , devepolment and consistent application of allogeneic transfusion sparing techniques in surgery is a chal- lenge to anesthesiologists , surgeons and blood-bankers . The combination of different techniques , i.e. autologous predonation , hemodilution , choice of anesthetic regimen , deliberate hypotension , application of anti-fibrinolytic agents and autotransfusion of intraoperatively saved blood allow for avoidance of allogeneic blood transfusion even in patients presenting important intraoperative hemorrhage ." ], "offsets": [ [ 0, 633 ] ] } ]

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[]

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]

[ { "id": "DerAnaesthesist.70460938.eng.abstr-passage-0", "type": "abstract", "text": [ "In this prospective study we investigated the efficacy of microcatheter spinal anaesthesia in comparison with a combined spinal-epidural technique in trauma patients ." ], "offsets": [ [ 0, 167 ] ] } ]

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[ { "id": "DerAnaesthesist.70460943.eng.abstr-passage-0", "type": "abstract", "text": [ "In an investigation of infection control methods for respirator systems in 89 randomly selected German intensive care units as a part of the NIDEP study ( Nosocomial Infections in Germany - Surveillance and Prevention ) , it was found that respirator systems were exchanged daily in about 50% of the intensive care units . However , Craven et al. found that changing circuits ( including tubing and exhalation valve and the attached humidifier ) every 24 h rather than every 48 h was independently associated with the occurrence of nosocomial pneumonia . On the basis of these results and recent studies , the current situation in the literature was analyzed in order to make recommendations for exchanging ventilator circuits ." ], "offsets": [ [ 0, 728 ] ] } ]

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[ { "id": "DerAnaesthesist.70460949.eng.abstr-passage-0", "type": "abstract", "text": [ "In order to perform accurate low-flow anaesthesia ventilation , it is desirable to avoid the influence of fresh gas flow ( FGF ) and inspiration duration ( ID ) on the resulting minute volume ( MV ) . The Sulla 808V anaesthesia ventilator ( Draeger , Luebeck , Germany ) is originally not equipped with a fresh-gas decoupling ( FGD ) device . Therefore , changes of FGF and ID settings applied during controlled ventilation may lead to alterations of the resulting MV . Recently , a low-cost FGD device ( Carbamed , Bern-Liebefeld , Switzerland ) has been developed , which can be inserted into the circle system . We investigated the effect of this device on MV in the Sulla 808V anaesthesia apparatus ." ], "offsets": [ [ 0, 704 ] ] } ]

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[ { "id": "DerAnaesthesist.70460953.eng.abstr-passage-0", "type": "abstract", "text": [ "Neurogenic pulmonary edema ( NPE ) is a rare but always life-threatening complication in patients with central nervous system lesions . NPE is evident if patients shortly after cerebral lesions suddenly develop pulmonary edema and other causes of the symptoms , such as aspiration of gastric content , congestive heart failiure and direct toxic exposure , are ruled out ." ], "offsets": [ [ 0, 371 ] ] } ]

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[ { "id": "DerAnaesthesist.70460964.eng.abstr-passage-0", "type": "abstract", "text": [ "We report the case of a 22-year-old woman who underwent two-step scoliosis surgery without allogeneic transfusion , although the intraoperative blood loss ( 3500 ml ) during the first procedure was higher than the calculated blood volume ( 3250 ml ) . Preoperatively the patient had donated four units of autologous blood . Intraoperatively blood-saving methods were combined . During the first operation acute normovolemic hemodilution ( target hemoglobin 9.0 g/dl ) was applied and during the second operation controlled hypotension ( systolic blood pressure 80 mmHg ) . Intraoperative autotransfusion was used in both procedures . During the first operation severe normovolemic anemia ( minimal hemoglobin 3.5 g/dl ) was accepted while the patient was ventilated with FiO2 1.0. The hemoglobin concentration was 8.6 g/dl after the first procedure and had increased to 11.6 g/dl 4 weeks after the second procedure . No severe complications occurred during the postoperative phase . This case report shows that also in surgical procedures with extreme blood loss any allogeneic transfusion can be avoided by the combination of blood-saving methods , acceptance of low intraoperative transfusion trigger and ventilation with 100% oxygen ." ], "offsets": [ [ 0, 1237 ] ] } ]

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[ { "id": "DerAnaesthesist.70460969.eng.abstr-passage-0", "type": "abstract", "text": [ "Wegener's granulomatosis is a distinct clinicopathologic entity characterized by granulomatous vasculitis of the upper and lower respiratory tract and glomerulonephritis . This disease can present as a clinical picture which resembles sepsis and adult respiratory distress syndrome ( ARDS ) . Wegener's disease requires immunosuppression which can have detrimental consequences when used in sepsis . The following case report illustrates the diagnostic difficulties encountered by intensiv care physicians treating severe pulmonary failure and multiple organ dysfunction in Wegener's granulomatosis appearing as ARDS with sepsis . Case report : A 19-year-old female patient had developed acute respiratory and renal failure after a prolonged period ( many months ) of antibiotic resistant otitis , sinusitis and mastoiditis . The patient had required intubation at another hospital and there was a history of tension pneumothorax and cardiopulmonary resuscitation during mechanical ventilation . Emergency extracorporeal membrane oxygenation ( ECMO ) for acute hypercapnic and hypoxic respiratory failure was instituted and the patient was transported to our institution while on ECMO . The patient was treated empirically for suspected pulmonary and systemic infection and received hydrocortisone ( 0,18 mg/kg/h ) as part of a protocol-driven treatment of septic shock in addition to antibiotic and antimycotic regime . The use of ECMO was required for 10 and mechanical ventilation for another 50 days after admission . After successfull extubation , central nervous system dysfunction became evident with a somnolent and generally unresponsive patient . When the hydrocortisone dose was gradually tapered , the clinical status of the patient further deteriorated , pulmonary gas exchange worsened and she developed renal failure with proteinura and hematuria . A renal biopsy was performed demonstrating vasculitis and focal segmental glomerulonephritis , a systemic granulomatous vasculitis was suspected ; the serum was tested for anti-proteinase 3 antibodies ( PR3-ANCA) and turned out to be positive ( 17.5 U/ml ; normal range 7 U/ml ) . The morphologic findings from renal biopsy , the positive test for antiproteinase 3 antibodies and the pulmonary-renal involvement with evidence of multisystem disease established the diagnosis of Wegener's granulomatosis . Immunosuppressive therapy with cyclophosphamide and prednisolon was instituted resulting in rapid improvement with recovery of pulmonary , renal and central nervous system function within two weeks . The use of ECMO in this patient served as a life - saving immediate measure usefull to \" buy time \" until a definite diagnosis could be established . ARDS represents an uniform pulmonary reaction to a large number of different noxious stimuli and disease entities . This case demonstrates that intensiv care physicians caring for critically ill patients with ARDS should include even rare causes of pulmonary injury into their differential diagnosis ." ], "offsets": [ [ 0, 3020 ] ] } ]

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"DerAnaesthesist.70460969.eng.abstr-s1-t6", "type": "umlsterm", "text": [ "respiratory tract" ], "offsets": [ [ 129, 146 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0282335" } ] }, { "id": "DerAnaesthesist.70460969.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "disease" ], "offsets": [ [ 177, 184 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012634" } ] }, { "id": "DerAnaesthesist.70460969.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "sepsis" ], "offsets": [ [ 235, 241 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0243026" } ] }, { "id": "DerAnaesthesist.70460969.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "adult" ], "offsets": [ [ 246, 251 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001675" } ] }, { "id": "DerAnaesthesist.70460969.eng.abstr-s2-t4", "type": "umlsterm", "text": [ "syndrome" ], "offsets": [ [ 273, 281 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039082" } ] }, { "id": "DerAnaesthesist.70460969.eng.abstr-s2-t5", "type": 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[ { "id": "DerAnaesthesist.70460974.eng.abstr-passage-0", "type": "abstract", "text": [ "Supported by two case reports we show that resistance to atracurium can develop postoperatively . Both patients had septic complications after elective thoracic surgery . A 39-year-old patient developed a bronchial fistula and a superinfection of the remaining thoracic cavity after pneumonectomy . At the time of rethoracotomy the neuromuscular blocking potency of atracurium had changed drastically : onset time was lengthened ( 7 vs. 3.5 min ) , recovery period ( DUR 10% ) was reduced ( 14 vs. 28 min ) and the maintenance dose had to be trippled ( 14.3 vs. 5.0 µg/kg per minute ) . Following superior lobe resection in a 56-year-old patient , middle lobe gangrene occurred which had to be removed . In contrast to the first anaesthesia the intubation dose of atracurium had to be increased significantly ( 70 vs. 40 mg ) , and even with this amount the neuromuscular blocking effect was not complete . Furthermore to accomplish a convenient state of relaxation the maintenance dose had to be raised considerably ( 11.8-16.5 vs. 5.5 µg/kg per minute ) . These reports show that even within a short period of time resistance to atracurium can develop and we must suppose that the severe inflammatory reactions caused these changes ." ], "offsets": [ [ 0, 1235 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.70461026.eng.abstr-passage-0", "type": "abstract", "text": [ "The pharmacological profile of ketamine : Until recently , clinically available ketamine was a racemic mixture containing equal amounts of two enantiomers , ( S ) - and ( R ) -ketamine . The pharmacological profile of racemic ketamine is characterized by the socalled dissociative anesthesic state and profound sympathomimetic properties . Among the different sites of action , N-methyl-d-aspartate ( NMDA ) -receptor antagonism is considered to be the most important neuropharmacological mechanism of ketamine . Effects on opiate receptors , monoaminergic and cholinergic transmitters , and local anesthetic effects are obvious as well . Following intravenous administration , a rapid onset of action is seen within 1 min , lasting for about 10 min . The anaesthetic state is terminated due to redistribution , followed by hepatic and renal elimination with a half-life period of 2-3 h . For alternative administration , the intramuscular and oral route is also appropriate . The most important adverse effects are hallucinations and excessive increases in blood pressure and heart rate . These reactions can be attenuated or avoided by combining of ketamine with sedative or hypnotic drugs like midazolam and/or propofol . During controlled ventilation , increases in intracranial pressure are unlikely to occur ." ], "offsets": [ [ 0, 1315 ] ] } ]

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[ { "id": "DerAnaesthesist.70461050.eng.abstr-passage-0", "type": "abstract", "text": [ "We report two cases of unexpected courses of inhalation anaesthesia with sevoflurane and enflurane which were caused by the presence dry soda lime ." ], "offsets": [ [ 0, 148 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.70461054.eng.abstr-passage-0", "type": "abstract", "text": [ "All volatile anesthetics undergo chemical breakdown to multiple , partly identified degradation products in the presence of dry soda lime . These chemical reactions are highly exothermic , ranging from 100 ° C for halothane to 120 ° C for sevoflurane . The increase in temperature correlates with the moisture content of the soda lime , being maximal below 5% . Sevoflurane and isoflurane were exposed to dry soda lime in a circle system . The anaesthetic gas was condensed in a series of cold temperature traps and the degradation products of the volatile anesthetics were analysed using GC/MS . Surprisingly , neither sevoflurane nor its degradation products could be measured in the gas-flow emerging from the soda lime during the first 15-20 min of exposure . After 20 minutes , larger quantities of methanol , compounds C and D as well as compounds A and B were detected . After 40-60 min of exposure , sevoflurane's degradation markedly decreased and unaltered sevoflurane emerged from the soda lime canister . Additionally , using isoflurane in the same experimental set-up resulted in various degradation products due to its reaction with dry soda lime . Obviously , all volatile anesthetics are prone to such a reaction . In conclusion , sevoflurane and isoflurane react with dry soda lime . These reactions are caused by the presence of two components of soda lime , sodium hydroxide and potassium hydroxide . A modification of soda lime to prevent its reaction with volatile anaesthetics is discussed ." ], "offsets": [ [ 0, 1513 ] ] } ]

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[ { "id": "DerAnaesthesist.70461064.eng.abstr-passage-0", "type": "abstract", "text": [ "There are some case reports about excessive heat production in the absorbent canister when sevoflurane or enflurane are washed into a circle containing dried soda lime . This observation was often made in the DRAeGER ISO 8 circle system with the gas inlet upstream of the soda lime canister with the gas-flow from bottom to top ." ], "offsets": [ [ 0, 329 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.70461071.eng.abstr-passage-0", "type": "abstract", "text": [ "The various components of commercial soda lime ( sodium hydroxide , potassium hydroxide , calcium hydroxide , barium hydroxide ) were studied in terms of their reactivity with sevoflurane at its boiling point ( 59 ° C ) . A simple closed system , a reflux cooler , served as a model . Analyses were performed by GC/MS . Besides sevoflurane , we identified four compounds : A , B , C , and D. Free methanol , formaldehyde and formic acid could not be found . Presumably methanol is transferred from an intermediate formalin-semiacetal of the hexafluorisopropanol . Calcium hydroxide and barium hydroxide showed little reaction with sevoflurane , whereas larger amounts of reaction products were observed with sodium hydroxide and potassium hydroxide . The alkali hydroxides of sodalime are presumably responsible for its reaction with halogenated inhalation anaesthetics . We therefore conclude that decomposing reactions of halogenated inhalation anesthetics with dry soda lime could be prevented by using a newly developed soda lime ." ], "offsets": [ [ 0, 1035 ] ] } ]

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[ { "id": "DerAnaesthesist.70461076.eng.abstr-passage-0", "type": "abstract", "text": [ "For incidents of malignant hyperthermia ( MH ) outside the hospital , a high number of unrecorded cases must be reckoned with because of an insufficient knowledge of emergency services and poor identification and documentation that make it impossible to classify acute situations under the diagnosis of malignant hyperthermia crisis . As a result , there are no statistical data in this field , and only case reports with a broad spectrum of suspected trigger mechanisms have been published . The case described in this report is a proved example of a non-anesthesia-related triggering of MH in a 21-year-old man who had had an anesthetic-induced MH manifestation in childhood , which was confirmed with an in vitro contracture test . After visiting a restaurant , he became unconscious and convulsive after consuming a high level of alcohol ( 2.9permil ) . The first cardiocirculatory arrest occurred directly before hospitalization . After admission , the patient showed a full-blown MH episode whose subsequent fatality was unavoidable in spite of adapted and optimal therapy . Suspected trigger mechanisms seem to be multifactoral ( excessive alcohol consumption , over-heating , mental stress ) as a forensic investigation did not point to any particular signs of typical trigger substances . The case demonstrates again that an MH attack might be triggered under certain non-anaesthesia-related situations . For patients with an MH disposition , additional information on their behavior outside the hospital is required ." ], "offsets": [ [ 0, 1527 ] ] } ]

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"DerAnaesthesist.70461076.eng.abstr-s1-t11", "type": "umlsterm", "text": [ "malignant hyperthermia" ], "offsets": [ [ 17, 39 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0024591" } ] }, { "id": "DerAnaesthesist.70461076.eng.abstr-s1-t12", "type": "umlsterm", "text": [ "emergency services" ], "offsets": [ [ 166, 184 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0700036" } ] }, { "id": "DerAnaesthesist.70461076.eng.abstr-s1-t13", "type": "umlsterm", "text": [ "malignant hyperthermia" ], "offsets": [ [ 303, 325 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0024591" } ] }, { "id": "DerAnaesthesist.70461076.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "case reports" ], "offsets": [ [ 404, 416 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0007320" } ] }, { "id": "DerAnaesthesist.70461076.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "non-anesthesia-related" ], "offsets": [ [ 552, 574 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002903" } ] }, { "id": "DerAnaesthesist.70461076.eng.abstr-s3-t2", "type": "umlsterm", "text": [ "man" ], "offsets": [ [ 609, 612 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0025266" }, { "db_name": "UMLS", "db_id": "C0024554" } ] }, { "id": "DerAnaesthesist.70461076.eng.abstr-s3-t3", "type": "umlsterm", "text": [ "contracture" ], "offsets": [ [ 716, 727 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009917" } ] }, { "id": "DerAnaesthesist.70461076.eng.abstr-s3-t4", "type": "umlsterm", "text": [ "test" ], "offsets": [ [ 728, 732 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0076174" } ] }, { "id": "DerAnaesthesist.70461076.eng.abstr-s3-t5", "type": "umlsterm", "text": [ "in vitro" ], "offsets": [ [ 707, 715 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021135" } ] }, { "id": "DerAnaesthesist.70461076.eng.abstr-s4-t1", "type": "umlsterm", "text": [ "restaurant" ], "offsets": [ [ 752, 762 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0035255" } ] }, { "id": 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[]

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[ { "id": "DerAnaesthesist.7046s003.eng.abstr-passage-0", "type": "abstract", "text": [ "Among anaesthetic drugs , ketamine occupies a special position . Biochemically , ketamine is a racemate consisting of equal shares of two optical enantiomers . Pharmacological investigations show differences between those enantiomers in both qualitative and quantitative properties . Furthermore , clinical superiority of S- ( + ) -ketamine has been described in different therapeutic studies with regard to anaesthetic potency , the extent of analgesia , effects and side effects during and after the operation , and undiserable psychological dysfunction . On a neuropharmacological basis , the clinical superiority of S- ( + ) -ketamine is due to its effect on NMDA receptors in central nervous tissue , opioid receptors on both central and peripheral levels , and noradrenergic , dopaminergic , and serotoninergic mechanisms . The main problems associated with the ketamine racemate in clinical use are desirable psychological dysfunction and a prolonged period of arousal . There are grounds for the assumption that the use of S- ( + ) -ketamine will minimise those problems without reducing anaesthetic potency or restricting the advantages of ketamine anaesthesia ." ], "offsets": [ [ 0, 1171 ] ] } ]

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"type": "umlsterm", "text": [ "dysfunction" ], "offsets": [ [ 544, 555 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0031847" } ] }, { "id": "DerAnaesthesist.7046s003.eng.abstr-s4-t7", "type": "umlsterm", "text": [ "side effects" ], "offsets": [ [ 468, 480 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001688" } ] }, { "id": "DerAnaesthesist.7046s003.eng.abstr-s5-t1", "type": "umlsterm", "text": [ "-ketamine" ], "offsets": [ [ 629, 638 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0022614" } ] }, { "id": "DerAnaesthesist.7046s003.eng.abstr-s5-t2", "type": "umlsterm", "text": [ "NMDA" ], "offsets": [ [ 663, 667 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0079883" } ] }, { "id": "DerAnaesthesist.7046s003.eng.abstr-s5-t3", "type": "umlsterm", "text": [ "nervous" ], "offsets": [ [ 689, 696 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027769" } ] }, { "id": "DerAnaesthesist.7046s003.eng.abstr-s5-t4", "type": "umlsterm", "text": [ "tissue" ], "offsets": 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"db_name": "UMLS", "db_id": "C0022614" } ] }, { "id": "DerAnaesthesist.7046s003.eng.abstr-s6-t2", "type": "umlsterm", "text": [ "use" ], "offsets": [ [ 898, 901 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042153" } ] }, { "id": "DerAnaesthesist.7046s003.eng.abstr-s6-t3", "type": "umlsterm", "text": [ "dysfunction" ], "offsets": [ [ 930, 941 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0031847" } ] }, { "id": "DerAnaesthesist.7046s003.eng.abstr-s6-t4", "type": "umlsterm", "text": [ "period" ], "offsets": [ [ 958, 964 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0025344" } ] }, { "id": "DerAnaesthesist.7046s003.eng.abstr-s6-t5", "type": "umlsterm", "text": [ "arousal" ], "offsets": [ [ 968, 975 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003808" } ] }, { "id": "DerAnaesthesist.7046s003.eng.abstr-s7-t1", "type": "umlsterm", "text": [ "use" ], "offsets": [ [ 1024, 1027 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042153" } ] }, { "id": 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[]

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[ { "id": "DerAnaesthesist.7046s008.eng.abstr-passage-0", "type": "abstract", "text": [ "Although ketamine has been in clinical use for 3 decades , the neuropharmacological basis of its analgesic , anaesthetic , sympathomimetic , and psychotomimetic effects is still a subject of controversial discussion and intensive investigational efforts . In recent years , however , new experimental approaches to its effects on the cellular and molecular level and the availability of pure ketamine enantiomers contributed substantially to the understanding of its complex neuropharmacology . This article reviews the current knowledge of ketamine effects on ligand-operated and voltage-operated transmembrane ion channels , G-protein-coupled receptors , transmitter uptake , and the NO-cGMP system in neurons . With regard to its potential clinical relevance and supposed relative role among the complex mechanisms involved in pain perception , analgesia , anaesthesia , and psychotomimesis , the contributions of recent experimental and clinical findings to the identification of major target sites of ketamine are summarised . In contrast to the uncertainty surrounding the potential role of opioid receptors , there is now considerable evidence that NMDA antagonism is a central mechanism that contributes to the amnesic , analgesic , anaesthetic , and psychotomimetic as well as the neuroprotective actions of ketamine . Moreover , the involvement of non-NMDA glutamate receptors , muscarinic and nicotinic cholinergic transmission , interactions with 5-HT receptors , and L-Type Ca2+ channels may account for some of its anaesthetic and neuroprotective properties ." ], "offsets": [ [ 0, 1573 ] ] } ]

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"glutamate" ], "offsets": [ [ 1367, 1376 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0220839" }, { "db_name": "UMLS", "db_id": "C0017789" } ] }, { "id": "DerAnaesthesist.7046s008.eng.abstr-s6-t2", "type": "umlsterm", "text": [ "transmission" ], "offsets": [ [ 1426, 1438 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040722" } ] }, { "id": "DerAnaesthesist.7046s008.eng.abstr-s6-t3", "type": "umlsterm", "text": [ "interactions" ], "offsets": [ [ 1441, 1453 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0037420" } ] }, { "id": "DerAnaesthesist.7046s008.eng.abstr-s6-t4", "type": "umlsterm", "text": [ "5-HT" ], "offsets": [ [ 1459, 1463 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0036751" } ] }, { "id": "DerAnaesthesist.7046s008.eng.abstr-s6-t5", "type": "umlsterm", "text": [ "anaesthetic" ], "offsets": [ [ 1529, 1540 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002932" } ] }, { "id": "DerAnaesthesist.7046s008.eng.abstr-s6-t6", "type": "umlsterm", "text": [ "glutamate receptors" ], "offsets": [ [ 1367, 1386 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0061465" } ] }, { "id": "DerAnaesthesist.7046s008.eng.abstr-s6-t7", "type": "umlsterm", "text": [ "5-HT receptors" ], "offsets": [ [ 1459, 1473 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0034838" } ] } ]

[]

[]

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[ { "id": "DerAnaesthesist.7046s020.eng.abstr-passage-0", "type": "abstract", "text": [ "The present review summarises the main actions of racemic ketamine and ketamine enantiomers on central nervous system receptors . The primary CNS action of ketamine appears to be a non-competitive block of N-methyl-D-aspartate receptors . Although numerous other receptors ( e.g. , GABA , nicotinic acetylcholine , opiate , voltage-operated channels ) have been reported to interact with ketamine , their role in inducing dissociative anaesthesia is still under discussion . In humans , characteristic electroencephalographic ( EEG ) changes after administration of ketamine are dose-dependent increases in delta , theta , and beta power . In equipotent doses S- ( + ) -ketamine induces similar EEG changes . However , in comparison to racemic ketamine and S- ( + ) -ketamine , R- ( - ) -ketamine does not suppress the EEG to the same extent . Former studies suggested that ketamine is a proconvulsive agent ; however , recent studies have demonstrated anticonvulsive and even neuroprotective properties . In humans , low-dose ketamine has no influence on early cortical peaks of somatosensory evoked potentials ( SEP ) . Larger doses induce increases in SEP amplitude while latencies are unchanged . Recent data indicate that analgesia induced by low-dose ketamine may be quantitated by specific pain-related SEP . Significant reductions of pain-induced cortical potentials may be correlated with subjective pain ratings . Brain-stem auditory evoked potentials ( AEP ) are not influenced by ketamine . Interestingly , in contrast to many other anaesthetics , middle- latency AEP were not altered by racemic and S- ( + ) -ketamine . This observation may indicate insufficient suppression of auditory stimulus processing during ketamine anaesthesia . Motor evoked responses to transcranial electrical or magnetic stimulation in humans are not markedly suppressed by ketamine ." ], "offsets": [ [ 0, 1875 ] ] } ]

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[ { "id": "DerAnaesthesist.7046s047.eng.abstr-passage-0", "type": "abstract", "text": [ "A key question in cellular neuroprotection is how pharmacologic agents may protect neurons when applied after injury in clinically relevant concentrations . Of special importance is the N-methyl-D-aspartate ( NMDA ) antagonist ketamine , which offers the potential for regulation of intracellular calcium levels and pathophysiological NO induction by blocking excessive NMDA-receptor stimulation . This may reduce progressive neuronal degeneration and cell death . Initial evidence for ketamine's neuroprotective effects came from cell culture studies demonstrating increased neuronal and astroglial viability , preserved cellular morphology , and reduced cell swelling subsequent to anoxia-hypoxia or glutamate injury and ketamine application . Moreover , ketamine was found to protect cellular energy status after ischaemic insults and maintained ATP production , glucose metabolism , and mitochondrial transmembrane potentials . Subsequent studies have revealed ketamine's regulating effects on intracellular ion homeostasis , thus stabilising neuronal electrophysiological functions . In addition , ketamine was reported to maintain a glutamate-associated induction of intrinsic-neuronal protective nerve growth factors , and recent evidence suggests that S ( + ) -ketamine has a greater neuroprotective potential than ketamine racemate . S ( + ) - ketamine demonstrated a unique neuroregenerative potential that was associated with greater re-outgrowth of axonal neurites after mechanical injury and increased expression of growth-associated proteins after glutamate damage . S ( + ) -ketamine has a two- to four-fold higher affinity for the phencyclidine receptor of the NMDA receptor complex than ketamine racemate , and it is conceivable that the induction of a differentiated pattern of genes induces cellular growth activities via ketamine-mediated NMDA-receptor activation or blockade . However , further investigations elucidating ketamine's effects in animals and humans have to be performed before final decisions regarding a potential application of ketamine as a neuroprotective agent in the clinical setting can be made ." ], "offsets": [ [ 0, 2138 ] ] } ]

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[ { "id": "DerAnaesthesist.7046s055.eng.abstr-passage-0", "type": "abstract", "text": [ "The phencyclidine derivative ketamine is a non-competitive N-methyl-D-aspartate ( NMDA ) receptor antagonist with the thalamo-neocortical projection system as the primary site of action . Racemic ketamine consists of the enantiomers S ( + ) -ketamine and R ( - ) -ketamine . Racemic ketamine has never been considered an adequate anaesthetic agent in neurosurgical patients since it produces regionally specific stimulation of cerebral metabolism ( CMRO2) and increases cerebral blood flow ( CBF ) and intracranial pressure ( ICP ) . However , recent experiments suggest that both tracemic ketamine and S ( + ) -ketamine may reduce infarct size in animal models of incomplete cerebral ischaemia and brain injury . This experimental protective effect appears to be related to decreases in Ca++ influx and maintenance of brain tissue magnesium levels due to NMDA and quisqualate receptor blockade by ketamine . Studies in dogs have shown that racemic ketamine ( 2.0 mg/kg ) increases CBF in the presence of the cerebral vasodilator N2O. In contrast , studies in rats without background anaesthesia showed increases in CBF after racemic ketamine ( 100 mg/kg i.p. ) . This suggests that the cerebrovascular effects of racemic ketamine are related to the pre-existing cerebrovascular tone induced by background anaesthetics . Cerebrovascular CO2 reactivity was maintained regardless of the baseline cerebrovascular resistance . There are several mechanisms by which racemic ketamine may increase CBF . It induces dose-dependent respiratory depression with consequent mild hypercapnia in spontaneously ventilating subjects . This produces vasodilation due to the intact cerebrovascular CO2 reactivity . Racemic ketamine also induces regional neuroexcitation , which leads to stimulation of cerebral glucose consumption in the limbic , extrapyramidal , auditory , and sensory-motor systems . This regional neuroexcitation with increased CMRO2 produces increases in CBF that can be blocked by infusion of barbiturates or benzodiazepines . However , increases in CBF with racemic ketamine ( 1 mg/kg ) may also occur during normocapnia and without changes in CMRO2. This effect is related to some additional direct cerebral vasodilating potency of racemic ketamine based on a mechanism involving blockade of Ca++ channels . The effects of racemic ketamine on CBF autoregulation have not been investigated systematically . However , studies in rats have shown that CBF autoregulation was maintained with low- and high-dose S ( + ) -ketamine . Infusion of racemic ketamine alters intracranial volume and ICP . Studies in spontaneously ventilating pigs with and without intracranial hypertension have shown that racemic ketamine ( 0.5-5.0 mg/kg ) produces increases in PaCO2 and ICP . In contrast , identical experiments with mechanical ventilation and controlled PaCO2 showed no changes in ICP following racemic ketamine infusion . This implies that increases in ICP are related to inadequate ventilation with consecutive hypercapnia and increases in intracranial blood volume . However , mechanical ventilation may not be sufficient to control ICP following racemic ketamine . Experiments in mechanically ventilated dogs indicate that racemic ketamine ( 2 mg/kg ) increases cerebral blood volume and ICP even in the presence of normoventilation , a response that is reversible by hyperventilation or the administration of diazepam . Studies in patients have shown that racemic ketamine ( 2.0 mg/kg ) reduces CBF in the presence of cerebral vasodilators like halothane or N2O. In contrast , studies in unanaesthetised humans showed increases in CBF after racemic ketamine ( 2-3 mg/kg ) . This observation is consistent with animal studies and suggests that the cerebrovascular effects of racemic ketamine are related to the pre-existing cerebrovascular tone induced by background anaesthetics ." ], "offsets": [ [ 0, 3882 ] ] } ]

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"type": "umlsterm", "text": [ "projection" ], "offsets": [ [ 138, 148 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033363" }, { "db_name": "UMLS", "db_id": "C0016538" } ] }, { "id": "DerAnaesthesist.7046s055.eng.abstr-s2-t1", "type": "umlsterm", "text": [ "ketamine" ], "offsets": [ [ 196, 204 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0022614" } ] }, { "id": "DerAnaesthesist.7046s055.eng.abstr-s2-t2", "type": "umlsterm", "text": [ "-ketamine" ], "offsets": [ [ 241, 250 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0022614" } ] }, { "id": "DerAnaesthesist.7046s055.eng.abstr-s2-t3", "type": "umlsterm", "text": [ "-ketamine" ], "offsets": [ [ 263, 272 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0022614" } ] }, { "id": "DerAnaesthesist.7046s055.eng.abstr-s3-t1", "type": "umlsterm", "text": [ "ketamine" ], "offsets": [ [ 283, 291 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0022614" } ] }, { "id": "DerAnaesthesist.7046s055.eng.abstr-s3-t2", "type": 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[]

[]

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[ { "id": "DerAnaesthesist.7046s061.eng.abstr-passage-0", "type": "abstract", "text": [ "This review focuses on the significance of S- ( + ) -ketamine as a neuroprotective agent . Evidence in the literature supporting or contradicting a neuroprotective or even therapeutic role of ketamine in global cerebral ischaemia is critically reviewed , and data from an ongoing study in a rat global cerebral ischaemia model ( 15 min ischaemia with S ( + ) -ketamine administered 15 min after reperfusion ) are reported . The number of experimental studies available so far limited , however , and therefore results cannot be considered conclusive at the present time . Only at higher ketamine dosages was protection found reliably , especially in models of complete forebrain ischaemia lasting over 10 min . In our own study , only after 90 mg/kg S ( + ) -ketamine was there significantly better preservation of cortical neurons than without treatment ; 30 and 60 mg/kg did not produce this effect ." ], "offsets": [ [ 0, 902 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.7046s065.eng.abstr-passage-0", "type": "abstract", "text": [ "As the mechanism of action of ketamine , particularly its non-competitive antagonism at the N-methyl-d-aspartate receptor ( NMDA ) , has become better understood , the use of the drug as a neuroprotective agent has received increasing interest . Although the potential prometabolic effects of ketamine might be counterproductive to neuroprotection , the increase in intracranial pressure it has repeatedly been reported to produce does not appear to be relevant clinically under certain conditions , e.g. in patients with normocapnia and a stable blood pressure . Also , the drug has been shown to be anticonvulsant in clinically applied doses rather than epileptogenic , as was previously assumed . These insights have opened up entirely new perspectives for the use of ketamine as a neuroprotective agent . But as both in vitro and in vivo studies are inconclusive , the benefits of the drug are still controversial . In addition , the potential neurotoxicity attributed to extremely high ketamine doses is poorly understood . Consequently , well controlled animal experiments and studies in humans would be necessary to establish the role of ketamine and its more potent enantiomer S- ( + ) -ketamine in combination with other neuroprotective measures and to shed light on its true neuroprotective potential and its possible neuroregenerative effects ." ], "offsets": [ [ 0, 1355 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.7046s074.eng.abstr-passage-0", "type": "abstract", "text": [ "The shift of age distribution within the population of industrialized societies has led to an increased need of treating diseases in elderly patients and at the same time in a higher number of patients bearing an increased operative risk . Today , the development of surgical techniques and intensive care treatment enables us to carry out numerous procedures in geriatric patients . Innovative surgical techniques like minimal invasive surgery with minor trauma due to the surgical approach changed patient's categories , also . Taken together with other procedures causing less operative stress indications for patients who were not operable previously have changed . New developments such as organ transplantation and immunosuppression also generated totally new groups of patients with very distinct conditions for the operative procedure . Vanishing indications or selection of patients as in peptic ulcer disease changed the surgical approach completely : Negative selection has shifted elective operative interventions in ulcer disease to emergency procedures . Contrasting experiences made in most other countries and especially in the third world , in Germany economic restrictions have not been encountered as of yet . Economical conditions , an increase in surgical procedures in elderly patients and advances in medical science will continue to change the surgical patient's characteristics profoundly . From the physicians viewpoint we have to actively participate in this development by personal interaction with the patient , by interdisciplinary cooperation and prompt social and political action ." ], "offsets": [ [ 0, 1614 ] ] } ]

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[ { "id": "DerAnaesthesist.7046s080.eng.abstr-passage-0", "type": "abstract", "text": [ "Besides other reasons , cost containments mandate the rational use of preoperative screening tests which should be adapted to the risk of the individual patient . Since the perioperative cardiac risk increases with age , elderly patients in particular require a thorough evaluation of their perioperative risk . Routine ECG , however , is not indicated in patients under 45 years of age who do not present with signs or history of preexisting cardiac diseases but should be performed on a routine basis in all patients over 45 years of age . The validity of an ergometer test as a preoperative indicator of myocardial ischemia is limited due to a high incidence of false negative results . By preoperative routine chest radiography previously unknown findings are only detected in a small number of patients ; thus , in patients of ASA-risk groups I-II younger than 74 years of age routine chest-x-ray cannot be justified . In patients whose perioperative cardiac risk as assessed clinically and by ECG is ambiguous , dipyridamole-thallium-myocardial scintigraphy ( DTMS ) and dobutamine-stress-echocardiography may contribute valuable information regarding the prediction of perioperative adverse cardiac events . In that respect , dobutamine-stress-echocardiography appears to be superior to DTMS . The laboratory tests required in patients of different ASA-risk groups and according to their age are presented in an overview ." ], "offsets": [ [ 0, 1429 ] ] } ]

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[ { "id": "DerAnaesthesist.7046s085.eng.abstr-passage-0", "type": "abstract", "text": [ "Perioperative morbidity and mortality in noncardiac surgery are mainly due to cardiovascular complications . Therefore , perioperative risk assessment is crucial to avoid these adverse events . In patients above the age of 40 years , the ECG is a basic investigation , often providing hints for cardiovascular diseases . Stress testing and , in special cases , stress echocardiography or scintigraphy ( the latter only in those patients , in which exercise is impossible ) can detect significant coronary artery disease . The vascularization reduced the perioperative risk in particular in those patients with unstable angina or severe coronary artery disease . However , prophylactic revascularization the stable patient does not improve overall outcome , because the risk of the revascularizing procedure must be added to the risk of noncardiac surgery . Other diagnostic procedures like echocardiography , chest roentgenogram , routine scintigraphy , halter ECG or halter blood pressure measurement do not add information to the perioperative risk assessment , although these techniques might be very relevant in evaluating other coexisting diseases ( heart failure ; valve lesions , in particular aortic stenoses etc. ) and can be useful to improve medical treatment preoperatively ( e.g. normalization of blood pressure ) ." ], "offsets": [ [ 0, 1328 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.7046s099.eng.abstr-passage-0", "type": "abstract", "text": [ "The perioperative morbidity and mortality is mainly influenced by the type and duration of surgery as well as the patient's preoperative state of health . Anesthesia per se , however , may also result in severe perioperative ( patho ) physiological changes , which may be both desired ( e.g. analgesia , vasodilation in vascular surgery ) or detrimental ( e.g. hypothermia , ventilatory depression ) and which may differ depending on the anesthetic technique used ( e.g. general anesthesia vs. regional anesthesia ) . Yet , all anesthestic techniques have in common , that their effects are not limited to the duration of the surgical intervention , but may expand far into the postoperative period . Therefore , many trials have been performed in the past aiming to compare the impact of different anesthetic techniques on the incidence of postoperative techniques , no significant advantage of one or the other technique has been identified up to now with respect to postoperative mortality or severe morbidity . This finding may be due to at least three factors . 1 ) Many side-effects related to anesthesia - due to close postoperative monitoring - are detected and treated early in the postoperative phase ( e.g. in the recovery room ) , thereby preventing serious complications . 2 ) Postoperative mortality related exclusively to anesthesia probably is so low , that huge patient numbers would be required to demonstrate any significant differences between different techniques . 3 ) Besides the factor ' anesthesia ' , may other factors contribute to the anesthesia related morbidity and mortality ( e.g. the factor ' anesthetist ' ) which are hardly quantified . The fact that clear advantages for a single technique have not yet been demonstrated must not , however , result in anesthetic ' nihilism ' . Rather there may be good reasons in the individual patient ( e.g. lack of a recovery room ) , to prefer a certain anesthetic technique or drug over another , in order to lower the individual risk of anesthesia . Whether the use of a certain technique - e.g. spinal or epidural anesthesia - may contribute to a reduction of specific postoperative surgical complications ( e.g. rate of reocclusion subsequent to peripheral vascular surgery ) is presently under investigation ." ], "offsets": [ [ 0, 2288 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.7046s109.eng.abstr-passage-0", "type": "abstract", "text": [ "Historically , recovery rooms were established in order to reduce complications in the period immediately following surgery and anaesthesia , utilising staffing and equipment resources economically . To minimise the incidence of postoperative complications remains the main task of post anaesthesia care units ( PACU ) . However , especially in hospitals with a high degree of surgical emergencies , the scope of tasks and procedures within the PACU has expanded . Facing restricted capacities in intensive therapy ( ITU ) and high dependency units ( HDU ) the PACU serves as a buffer ; intensive care functions can be covered here until the patient can be admitted to an intensive care unit . In this context , the PACU also has a switch function ; postoperatively , the patient is evaluated here and the level for further treatment determined : ITU , HDU , or normal ward . The PACU period can be utilised to improve the patient's condition ( upgrade function ) enabling continuation of treatment on a lower level ( HDU instead of ITU , normal ward instead of HDU ) . This combination of buffer , switch and upgrade function is of special importance when ITU and HDU resources are limited . A new task for the PACU arises from efforts to optimise acute pain therapy ; initial adjustment of continuous infusion systems according to the patients ' needs can be performed here without additional staffing requirements . Finally , the PACU can be used preoperatively for \" tune up \" procedures in high risk patients . The basis for co-operation between anaesthetist and surgeon is the separation of responsibilities in combination with mutual trust . Accordingly , the anaesthetist is responsible for monitoring and maintenance of vital functions . Consequently , the anaesthetist has a professional and organisational responsibility in the PACU . The surgeon can and must rely on notification whenever surgical complications may require his intervention . With increasing comorbidity of patients and complexity of surgical procedures the anaesthetist's responsibility in the immediate perioperative period gains a new quality . The number of surgical procedures requiring intraoperative intensive therapy from the anaesthetist is increasing ; the delivery of anaesthesia becomes a background task during these operations . Thus , the anaesthetist becomes responsible for perioperative patient treatment in the operating room area which divides into three phases : preoperative \" tune up \" in the PACU ( e.g. ) haemodynamic optimisation , starting continuous regional anaesthesia techniques ) , anaesthesia and support of vital functions in the OR , and immediately postoperative treatment in the PACU ." ], "offsets": [ [ 0, 2701 ] ] } ]

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[ { "id": "DerAnaesthesist.7046s143.eng.abstr-passage-0", "type": "abstract", "text": [ "Many patients still suffer from unnessesary pain in the postoperative period . Waiting for new technologies or drugs will not improve the status of acute pain management . The establishment of an acute service is needed to reduce the incidence of postoperative pain . Acute pain therapy is one of the great challenges we have to take up ." ], "offsets": [ [ 0, 338 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.7046s147.eng.abstr-passage-0", "type": "abstract", "text": [ "Nociception is a protective system of the body which prevents it from injury and tissue damage . Human beings respond to noxious stimuli by moving away . They learn by pain to avoid these situations in future . Shortly after major injury , there is a limited analgesic period allowing the body to flee the area of danger , later on , emerging pain compels the body to rest and supports recuperation . While acute pain has a certain meaning , chronic pain does not . It induces a comprehensive suffering including loss of initiative , appetite and vigilance . It reduces life-quality , often accompanied by depressive moods . Acute pain causes changes in the central nervous system leading to an increased sensitivity of nociception ( hyperalgesia ) . During healing , the central processing of noxious stimuli is normalised taking minutes to weeks . Sometimes , unknown factors initiate chronification of pain . Changes on a molecular level in peripheral tissue as well as in the central nervous system induce \" cellular early genes \" [ 24 ] , a synthesis of c-fos , c-jun and other proteins favouring the chronification of pain . All efforts have to be made to depress or interrupt such a development . One of the first steps to pain prophylaxis in a hospital is an optimal surgical technique : incision , extension , limited tissue damage and minimal invasive surgery should guarantee the smallest impairment of the nociceptive system possible . However , nociceptive input is intense and of long duration and leads to central sensibilisation . Postoperative pain has lost its function as surgery anticipates healing . Pain induces a reduction of ventilation , circulation , digestion and increases the risk of other disorders . There is need of aggressive pain treatment for humanitarian reasons and for reasons of late sequelae like permanent pain and increased reduction of function [ 10 ] . This is of pivotal importance in patients with amputations or sympathetic reflex dystrophy ( SRD ) . Antinociception is best provided by regional anaesthesia technique with a combination of local anaesthetics and opioids which results in better outcome [ 2 , 12 ] . Hence , regional anaesthesia techniques are strongly indicated in those patients . Good antinociception may be even more important than it is assumed today . Anand [ 1 ] demonstrated a lower morbidity and mortality in 45 newborns undergoing cardiothoracic surgery , when general anaesthesia was performed with high-dose sufentanil versus halothane supplementary doses of morphine . Anaesthesiologists have to reconsider the quality of general anaesthesia : the antinociception of their regimen ." ], "offsets": [ [ 0, 2658 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.7046s154.eng.abstr-passage-0", "type": "abstract", "text": [ "The administration of epidural opioids is alternatively used in the management of postoperative analgesia . However , the administration is associated with side effects , including respiratory depression , somnolence and pruritus . A rational opioid selection between the hydrophilic and lipophilic opioids morphine , hydromorphone , alfentanil , fentanyl and sufentanil is discussed in this mini-review . Thus , the administration of the lipophilic opioid sufentanil might has some advantages . Notwithstanding , epidural opioid administration alone offers no marked clinical advantages compared to the intravenous route . In future , reduced doses of lipophilic opioids and local anaesthetics like bupivacaine 0.05-0.1% may provide benefits over the use of either drug alone and may offer marked clinical advantages over the intravenous route of opioids alone . The same holds true for 2-adrenoceptor agonists as adjuvants . However , multicenter dose-ranging studies are necessary to determine both the ideal concentrations of the drug combinations and the general outcome . Moreover , we must also determine cost effectiveness for our postoperative analgesic techniques ." ], "offsets": [ [ 0, 1175 ] ] } ]

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[ { "id": "DerAnaesthesist.7046s159.eng.abstr-passage-0", "type": "abstract", "text": [ "Until today , the use of epidural analgesia in obstetrics still remains controversial . In the opinion of many obstetricians the use of an epidural for a healthy laboring parturient is not necessary and can lead to potentially harmful side effects . However , painful labor leads to a maternal stress reaction with the release of epinephrine and norepinephrine . The resulting vasoconstriction of uterine arteries can induce fetal asphyxia in an otherwise healthy fetus or can aggravate asphyxia in already compromised fetusses . Several studies show that epidural analgesia can attenuate the maternal stress reaction and thereby improve maternal and fetal well-being , as long as precautions are taken . The avoidance of maternal hypotension with sufficient volume preload with lactated Ringer's solution or colloids , and decreasing the concentration of local anaesthetics by adding opioids will prevent an increase in instrumental deliveries . With the use of patient-controlled epidural analgesia ( PCEA ) the amount of local anaesthetics can even further be reduced ." ], "offsets": [ [ 0, 1072 ] ] } ]

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[ { "id": "DerAnaesthesist.7046s165.eng.abstr-passage-0", "type": "abstract", "text": [ "Side effects of postoperative epidural analgesia can be controlled by two strategies : Insertion of catheters into the center of the affected spinal segments and coadministration of local anesthestics and opioids . Both techniques will reduce single drug dosage . Additionally synergistic effects will result in excellent analgesia and the risk of side effects and complications will be minimized ." ], "offsets": [ [ 0, 398 ] ] } ]

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[]

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"DerAnaesthesist.7046s165.eng.abstr-s3-t3", "arg2_id": "DerAnaesthesist.7046s165.eng.abstr-s3-t1", "normalized": [] }, { "id": "DerAnaesthesist.7046s165.eng.abstr-s3-r6-t5.1-t1.1", "type": "associated_with", "arg1_id": "DerAnaesthesist.7046s165.eng.abstr-s3-t5", "arg2_id": "DerAnaesthesist.7046s165.eng.abstr-s3-t1", "normalized": [] }, { "id": "DerAnaesthesist.7046s165.eng.abstr-s3-r7-t3.1-t1.1", "type": "evaluation_of", "arg1_id": "DerAnaesthesist.7046s165.eng.abstr-s3-t3", "arg2_id": "DerAnaesthesist.7046s165.eng.abstr-s3-t1", "normalized": [] }, { "id": "DerAnaesthesist.7046s165.eng.abstr-s3-r8-t1.1-t5.1", "type": "associated_with", "arg1_id": "DerAnaesthesist.7046s165.eng.abstr-s3-t1", "arg2_id": "DerAnaesthesist.7046s165.eng.abstr-s3-t5", "normalized": [] }, { "id": "DerAnaesthesist.7046s165.eng.abstr-s3-r9-t1.1-t3.1", "type": "associated_with", "arg1_id": "DerAnaesthesist.7046s165.eng.abstr-s3-t1", "arg2_id": "DerAnaesthesist.7046s165.eng.abstr-s3-t3", "normalized": [] }, { "id": "DerAnaesthesist.7046s165.eng.abstr-s3-r10-t3.1-t5.1", "type": "result_of", "arg1_id": "DerAnaesthesist.7046s165.eng.abstr-s3-t3", "arg2_id": "DerAnaesthesist.7046s165.eng.abstr-s3-t5", "normalized": [] } ]

[ { "id": "DerAnaesthesist.7046s172.eng.abstr-passage-0", "type": "abstract", "text": [ "Background : Intravenous patient-controlled analgesia ( PCA-IV ) has markedly improved postoperative pain-relief . Alternatively , peridural anesthesia has been used successfully in high risk patients with the disadvantage of a more intense postoperative care . In this study we compared the applicability of intravenous vs. peridural patient-controlled analgesia on a general ward ." ], "offsets": [ [ 0, 383 ] ] } ]

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[]

[]

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[ { "id": "DerAnaesthesist.7046s179.eng.abstr-passage-0", "type": "abstract", "text": [ "Postoperative neurological sequelae in patients that have received epidural anaesthesia are not necessarily caused by the epidural anaesthetic technique . As a whole , adverse neurological outcomes following epidural anaesthesia may be subdivided into 3 different ethiological categories . A first category involves events that are not at all caused by the epidural , but merely due to the interference of anaesthesia and/or surgery with a preexisting medical condition . A second category includes mishaps such as backache , arachnoiditis , and post-dural puncture headache that are solely due to the epidural anaesthesia . Finally , epidural anaesthesia may be a contributory factor in the development of post-anaesthetic complications attributable to a pre-existing medical condition that are triggered by anaesthesia , surgery or childbirth . These complications include some of the most dramatic sequelae of major neuraxial blockade , such as spinal epidural abscess , spinal infarction , and spinal hematoma . Although extremely rare , the latter complications often result in permanent major neurological deficits . The present manuscript is a review of the most recent , literature addressing post-anaesthetic sequelae , and will discuss their incidence , pathophysiology , clinical course , diagnosis , prevention , and treatment ." ], "offsets": [ [ 0, 1340 ] ] } ]

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[ { "id": "DerAnaesthesist.7046s187.eng.abstr-passage-0", "type": "abstract", "text": [ "Effects of anaesthesia and analgesia on postoperative morbidity and mortality remain controversial . Numerous studies have demonstrated that epidural anaesthesia and pain relief by epidural analgesia reduces perioperative stress responses and thus may reduce postoperative morbidity and mortality . In patients undergoing vascular surgery , epidural anaesthesia diminished postoperative hypercoagulability . These patients may benefit from less thromboembolic complications as well as a reduced risk of a re-operation . However , regional anaesthesia does not affect cardiopulmonary morbidity or overall mortality significantly in most clinical studies . One reason for this disappointing finding may be the missing integration of improved postoperative pain relief into general surgical care . A multimodal therapeutic approach , which consists of preoperativ patient information , sufficient analgesia , early mobilisation and enteral feeding , may solve this discrepancy . Therefore , prospective controlled studies are needed to assess the influence of this perioperative approach on outcome ." ], "offsets": [ [ 0, 1097 ] ] } ]

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[ { "id": "DerAnaesthesist.80470024.eng.abstr-passage-0", "type": "abstract", "text": [ "Treatment of severe acute respiratory distress syndrome ( ARDS ) with extracorporeal membrane oxygenation ( ECMO ) can be life-saving but requires maximal use of intensive care resources over prolonged periods of time , resulting in high costs . Little is known about the health-related quality of life ( HRQL ) in long-term survivors . This case-controlled retrospective study was designed to assess the health-related quality of life in long-term survivors of ARDS and ECMO-therapy ." ], "offsets": [ [ 0, 485 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.80470039.eng.abstr-passage-0", "type": "abstract", "text": [ "When looking for the possible cause of distortions in values measured for the determination of breath ethanol concentration ( BEC ) in artificially respirated patients , consideration must be given to the humidity and temperature of the gas examined . In the present study , the effects of humidified and warmed and of dry and cold air on the accuracy of a newly developed BEC measuring device , as compared to a reference model and to a conventional system , were examined in a lung model ." ], "offsets": [ [ 0, 491 ] ] } ]

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[ { "id": "DerAnaesthesist.80470045.eng.abstr-passage-0", "type": "abstract", "text": [ "The value of BURP ( =backwards-upwards-rightwards-pressure of the larynx ) was tested as a improvement of the visualisation of the larynx . Simultaneously we wanted to assess the value of different predictive tests of a difficult intubation , which are easy to perform as bedside tests ." ], "offsets": [ [ 0, 287 ] ] } ]

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[ { "id": "DerAnaesthesist.80470054.eng.abstr-passage-0", "type": "abstract", "text": [ "Syringe drivers are used in anaesthetics , intensive care and emergency medicine to deliver small volumes of highly potent drugs with continuous , constant and reproducible flow . For early recognition of interruptions of the drug delivery caused by occlusion of the infusion system , an alarm is triggered as soon as the system pressure exceeds a certain limit . The sensitivity of this alarm depends on the flow rate , type-specific cut-off pressure and the elastic parameters of the infusion system . The sudden release of pressure built up in the system after occlusion occurred can cause delivery of an uncontrolled drug bolus and hence an additional hazard . Methods : Six syringe drivers that are widely used in clinical practice were tested for alarm delay and bolus delivery in the event of an occlusion in the system . First , the alarm pressures at flow rates of 10 , 50 and 100 ml/h were measured . Then the alarm delay time and bolus volumes post-occlusion were assessed , using a basic infusion system ( syringe+single infusion set ) . Finally , several alterations to the system like extension , tap battery with germ filters or branching were made and their impact on alarm delay and bolus volume measured . Results : Because of the great differences in alarm pressures between the devices tested , there were marked differences in the alarm delay at same flow rates . Predictably , there was an indirect proportional link between alarm delay and flow rate . Using the basic infusion system , alarm delays between 23 s and 143 min were measured . In two of the tested syringe drivers , a pressure-release mechanism is activated with the pressure alarm , which prevented bolus application . In the other devices , release of the pressure in the occluded system caused boli of 0.5-7 ml . Variations in the actual syringe volume and insertion of a second connection tube had no impact on alarm delay and bolus volume . Tap batteries , parallel running syringe drivers or trapped air in the system , however , caused marked increase in both alarm delay ( 107% ) and bolus volume ( +147% ) . Discussion : Unidentified occlusions of the system cause grave malfunctioning of syringe drivers . While applying highly potent drugs , the discontinuation of drug delivery with subsequent bolus application can cause vital danger to the patient . As a result of the significant time delays in the pressure alarms , the devices tested do not provide sufficient protection against unrecognized system occlusion . Syringe drivers with adjustable alarm pressure can be set close to the actual infusion pressure . A further important point is that one should aim at a reduction in the elastic properties of the infusion set because of the great impact on alarm delay and bolus volume ." ], "offsets": [ [ 0, 2783 ] ] } ]

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[ { "id": "DerAnaesthesist.80470059.eng.abstr-passage-0", "type": "abstract", "text": [ "Obviously there is a world-wide trend towards regional anaesthesia for caesarean section ( CS ) . Data on the current practice in Germany are lacking ." ], "offsets": [ [ 0, 151 ] ] } ]

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[ { "id": "DerAnaesthesist.80470065.eng.abstr-passage-0", "type": "abstract", "text": [ "Karl Eduard Hammerschmidt was born in Vienna in 1901. There are indications that after studying law he passed on to studies in medicine and surgery in Vienna , though it has to be said there is no trace of his attaining any qualification . After this he worked in various scientific sectors and in recognition of his achievements he was accepted as a member of the Kaiser Leopold Academy of Researchers in Natural Sciences in Bonn . From February 1847 to March 1848 he induced numerous general anaesthetics with ether , working with Dr. J. Weiger , a dentist in Vienna . On 11 July 1847 he published preliminary statistics based on 1560 dental operations performed under ether anaesthesia and also on numerous experiments performed on himself and investigations conducted with ether in animals and in healthy subjects . From the viewpoint of scientific research into and widening of the applications of ether anaesthesia , his most meritorious achievements include the early publication of a staging classification for ether anaesthesia , the introduction of an anaesthetic protocol for patients that also lent itself to data recording for statistical purposes and the early realization that the ability to hear is retained for a very long time during anaesthesia ." ], "offsets": [ [ 0, 1265 ] ] } ]

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[ { "id": "DerAnaesthesist.80470087.eng.abstr-passage-0", "type": "abstract", "text": [ "As far as the law concerning liability is concerned , guidelines , codes of practice , and medical standards are not contrasting concepts , nor do they indicate material differences ; instead , those terms describe more or less precisely the care that a physician is required to exercise when treating patients and that a judge is required to assess in a trial . Guidelines , codes of practice , and standards thus take effect not directly , but indirectly , in that both physician and judge retain a certain discretion in making decisions in a particular case . The current obsession with guideline - primarily based on economic considerations and present in all specialist areas - together with the increasingly detailed rules that are being issued , carries the risk that to medical profession may of its own doing become too restricted , that physicians will become limited in their choice of treatment , and that the criteria by which liability is assessed will become stricter , thus increasing the physician's risk of being held liable under civil or criminal law . We need to prevent a development taking place in which \" medical standards \" become \" standardized medicine \" , leading to a situation in which only what is stipulated in the form of a guideline or a code of practice will be paid for ( and hence only that can be done ) ." ], "offsets": [ [ 0, 1344 ] ] } ]

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[ { "id": "DerAnaesthesist.80470093.eng.abstr-passage-0", "type": "abstract", "text": [ "The aim of this study was to evaluate the quality of pain management in prehospital emergency care and to get more informa- tion about the administration of analgesics in prehospital patients ." ], "offsets": [ [ 0, 193 ] ] } ]

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[ { "id": "DerAnaesthesist.80470111.eng.abstr-passage-0", "type": "abstract", "text": [ "Currently undergoing a clinical trial a new miniaturized monoplane ultrasound probe potentially enhances the practicability of perioperative transesophageal echocardiography ( TEE ) without loss of echocardiographic quality . Methods : In the present prospective study , the nasally inserted miniaturized TEE probe was tested in 12 ventilated patients and compared with a conventional TEE probe . Echocardiographic quality was tested by two independent investigators by analyzing the percentage of the endocardium contour detection ( 50% , 50-75% , 75-100% ) in the left ventricular short- and long-axis views . Results : In 11 patients , more than 50% of endocardium were visualized continuously with both probes . Although the nasal TEE probe was inferior to conventional TEE in detecting lateral endocardium , automated endocardium detection compared well with both methods . Inter- and intraobserver variability in manual measurements of the left ventricular cross-sectional area was below 5% on average and differed non-significantly with regard to the method . In 2 patients , continuous monitoring was aggravated by repeated loss of contact between the miniaturized TEE probe and mucosa . Conclusions : In comparison with conventional TEE , the miniaturized TEE probe provides practicability advantages without significant loss of information for cardiovascular monitoring ." ], "offsets": [ [ 0, 1381 ] ] } ]

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[ { "id": "DerAnaesthesist.80470116.eng.abstr-passage-0", "type": "abstract", "text": [ "We investigated the effects of ultrapurified polymerized bovine hemoglobin ( HBOC-201) on skeletal muscle tissue oxygen tension when applied before establishment of a nearly complete arterial stenosis . Methods : Twelve foxhounds were anaes-thetized IV and mechanically ventilated with 30% oxygen in air . Catheters were inserted into the right femoral artery and vein for measurements of haemodynamic parameters and blood-gas sampling . Arterial blood flow of the left popliteal artery was measured by an electromagnetic flow probe . Skeletal muscle tissue oxygen tension ( tpo2) was measured in the left gastrocnemic muscle using a stepwise-driven polarographic needle probe , creating histograms from 200 single tpO2 measurements . Following isovolaemic haemodilution with Ringer's solution to a target haematocrit of 20% , the animals were randomly assigned to receive either 200 ml of predonated fresh blood ( group 1 ) or 200 ml of HBOC-201 ( MW 32000-500000 ; Hb 13 +/- 1 g - dl-1; group 2 ) . After a 15-min stabili-zation period , a 95% artificial stenosis of the left popliteal artery was established . While animals of group 1 received two applications of 200 ml 6% hetastarch ( HES , 200000 ; 0.5 ) , animals of group 2 received 200 ml Ringer's solution 45 and 75 min after establishment of the arterial stenosis , respectively . Variables were measured at baseline , after haemodilution and application of the respective compound , and 30 , 60 and 90 min after establishment of the stenosis . Results : Demographic data , muscle temperature and arterial blood gases did not differ between groups . With the exception of a higher mean pulmonary artery pressure in HBOC-201-treated animals , haemodynamics did not differ between groups . In both groups oxygen delivery and oxygen consumption of the muscle decreased in parallel to the de- creasing blood flow during arterial stenosis . In contrast , oxygen extraction ratio increased after infusion of HBOC-201 and remained unchanged during stenosis ( P 0.05 ) . In group 1 , the tpO2 decreased during stenosis when compared to baseline ( P 0.001 ) and remained decreased after administration of HES . In contrast , administration of 200 ml of HBOC-201 before establishment of the arterial stenosis sustained the tpO2 values at nearly baseline levels during stenosis . Skeletal muscle tissue oxygen tension was higher after HBOC-201 infusion during stenosis when compared to HES infusion ( P 0.001 ) . Conclusion : These data suggest that haemoglobin solutions can reach poststenotic tis-sues . The increased oxygen extraction after application of HBOC-201 is associated with improved skeletal muscle oxygen tension during severe arterial stenosis ." ], "offsets": [ [ 0, 2710 ] ] } ]

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[ { "id": "DerAnaesthesist.80470136.eng.abstr-passage-0", "type": "abstract", "text": [ "The official German guidelines for prevention of intravascular-device-associated infections were published by the Bundesgesundheitsamt , now called the Robert-Koch-Institut , 12 years ago . The recently published official \" Guidelines for Prevention of Intravascular-Device Associated Infections \" of the Centers for Disease Control and Prevention ( CDC ) are categorized according to scientific evidence . The American guidelines are very detailed and differ in some aspects from the offical German guidelines . The purpose of the present paper is to inform the German-speaking anaesthesiologist about the official CDC guidelines and to provide an update on the prevention of intravascular-device-associated infections ." ], "offsets": [ [ 0, 721 ] ] } ]

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[ { "id": "DerAnaesthesist.80470172.eng.abstr-passage-0", "type": "abstract", "text": [ "All optically active molecules have at least one asymmetric atom in common which is attached to four ligands , that can have different three dimensional positions . Therefore it can be concluded that the resulting isomers are chemically identical in all respects except for the direction with which they rotate plane-polarized light . When the isomer and its corresponding enantiomer are present in equal proportions , they are called racemic mixture , a mixture that does not rotate polarized light , since the optical activities of the two isomers cancel each other . Although the isomers are chemically identical other optically active molecules can interact with these isomers in a geometrically specific way termed stereoselectivity . The human body comprises a chiral environment due to optically active proteins ; thus it is not surprising that enantiomeric drugs exhibit different pharmacological properties , when used as pure optical isomers . Till today most modern anaesthetics have been optical isomers , which are mainly used as racemic mixture ( 1:1 mixture ) . For financial reasons pure isomers were only used for research purposes , but nowadays the wide clinical use of pure isomers is financially feasible due to new production techniques . The terms eutomer and distomer were chosen to indicate the more or less potent form of the drug . The clinical use of pure isomers is only of advisable , if there are significant differences between eutomer and distomer in desired or side effects . Among the modern anaesthetics ketamine , isoflurane , bupivacaine and atracurium exhibit an asymmetric carbon . For most drugs the separation in pure isomers will reduce side effects . For volatile anaesthetics this question is still unanswered , since experimental and clinical results are inconsistent so far ." ], "offsets": [ [ 0, 1822 ] ] } ]

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[ { "id": "DerAnaesthesist.80470184.eng.abstr-passage-0", "type": "abstract", "text": [ "The anaesthetic potency of the ( S ) -ketamine isomer is approximately double that of racemic ketamine . The aim of this study was to compare the recovery of cerebral function after a bolus of 1,3 mg/kg racemic ketamine or 0.65 mg/kg ( S ) -ketamine followed by continuous application of 4 or 2 mg/kgxh over 15 minutes ." ], "offsets": [ [ 0, 320 ] ] } ]

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[ { "id": "DerAnaesthesist.80470193.eng.abstr-passage-0", "type": "abstract", "text": [ "Acute renal failure is a common and severe complication in ICU . Renal laboratory examinations like creatinine and urea are late signs of renal dysfunction : Most of the functional abilities are reduced and there is no time for therapeutical interventions . The aim of this study was to find some earlier sensitive parameters of renal dysfunction and the order of appearance , the cause of acute renal failure and the value of the measured parameters ." ], "offsets": [ [ 0, 452 ] ] } ]

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[ { "id": "DerAnaesthesist.80470202.eng.abstr-passage-0", "type": "abstract", "text": [ "Epidural anaesthesia is extremely useful in providing postoperative analgesia for children after surgery of the lower body . Although results on early pharmacokinetics in children have previously been reported , no data are available on the long-term effects of epidural anaesthesia . The aim of this investigation was the assessment of plasma bupivacaine levels in children with continuous epidural anaesthesia in the postoperative period . A catheter with an outer diameter of 0.63 mm was inserted through a 19G Tuohy cannula into the epidural space . A maximum dose of 0.4 mg/kg/h bupivacaine was administered for continuous epidural infusion . Careful monitoring was performed to detect early signs of local anaesthetic intoxication . Two milliliters of blood were obtained in each patient per day and nepholometric serum measurement were performed to determine 1-acid glycoprotein and albumin levels . Bupivacaine plasma concentrations were assessed according to the method described by Sattler et al. [ 25 ] . Ten children were included in the investigation . The measured albumin and 1-acid glycoprotein concentrations were within the range described by other investigators . At the onset of pain therapy maximum levels of 0.5 µg/ml where recorded after a loading dose of bupivacaine and levels of up to 2.2 µg/ml were achieved following continuous infusion . There were no neurologic complications or signs of lokal anesthetic intoxication . In conclusion our results show that a dose of up to 0.4 mg/kg/h bupivacaine during continuous epidural infusion is not associated with toxic complications . Careful monitoring of the children by experienced staff is mandatory ." ], "offsets": [ [ 0, 1677 ] ] } ]

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[]

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[ { "id": "DerAnaesthesist.80470209.eng.abstr-passage-0", "type": "abstract", "text": [ "Despite advances and technical developments in the area of intensive care medicine is has not been possible to lower the mortality of patients with pulmonary insufficiency . Therefore , alternative ventilation strategies have been developed and applied . One of these ventilation techniques is superimposed high-frequency jet ventilation ( SHFJV ) . For optimal application of SHFJV we designed a special jet-adapter . Methods : This jet-adapter made of plastic consists of a T-piece and four central , small-bore cannulas and can be connected to any commercially available endotracheal tube . Therefore , it does not require reintubation with an endotracheal jet tube when beginning SHFJV . The simultaneous high-frequency and low-frequency jet ventilation is performed over two jet-nozzles that have been designed according to optimal flow dynamic measurements . Two further cannulas are used for continuous airway pressure monitoring and humidification of the applied gases . A pre-warmed and humidified bias flow with exactly defined oxygen concentration is led through the cross-part of the T-piece for gas entrainment . Additionally , the cross-part contains a port that can be opened for endotracheal suctioning or bronchoscopy and makes disconnection of the jet adapter from the endotracheal tube for either purpose unnecessary . Conclusion : The jet adapter can be used : ( 1 ) to apply SHFJV ; ( 2 ) to measure airway pressures continuously ; ( 3 ) to humidify and warm inspired gases ; ( 4 ) to administer medications or add nitrous oxide by the inspiratory route , enabling combination with new therapeutic possibilities in the management of patients with severe ARDS ." ], "offsets": [ [ 0, 1681 ] ] } ]

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[ { "id": "DerAnaesthesist.80470229.eng.abstr-passage-0", "type": "abstract", "text": [ "Since its introduction in clinical use more than ten years ago , propofol is well appreciated for sedation and supplemental hypnosis in anaesthesia . However the substance is approved only for anaesthesia in children elder than three years . As can be substantiated by many data reported in literature , there are no pharmacokinetic or pharmacodynamic reasons whatsoever to withhold propofol from the younger children ; this applies both to the use as a narcotic supplement and as a short term hypnotic for diagnostic and therapeutic interventions ." ], "offsets": [ [ 0, 549 ] ] } ]

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[ { "id": "DerAnaesthesist.80470238.eng.abstr-passage-0", "type": "abstract", "text": [ "We report the case of a 3-year-old boy , who received long-term parent-controlled analgesia after traumatic amputation of one leg . He underwent surgery 17 times for a period of 25 days . Parent-controlled analgesia was started four days after admission because analgesia with non-opioid analgetics ( acetaminophen ) proved to be insuffient . The pump was set to a bolus-dose of 23 µg kg-1 piritramide ( dipidolor ) and a lockout interval of 10 minutes . Permitted maximum cumulative dose in four hours was 5 mg piritramide . There was no continuous infusion of opioid . PCA and possible adverse effects were explained to the mother . A monitoring regimen was used to assess efficacy ( pain intensity estimated by the mother ) , adverse effects ( sedation score , occurrence of nausea and vomiting ) and piritramide consumption . For fear of side effects opioid administration was insufficient in the beginning . After three days the mother used the PCA effectively and no additional analgesic medication was required . Nausea or other side effects were not observed . After seven days opioid consumption nearly doubled . Apart from tolerance , this might have resulted from the mother's caution in the first days . After 17 days the PCA was discontinued . Oral analgetics ( tramadol ) controlled the pain adequately . Management of postoperative pain in childrens is difficult and too often insufficient . PCA is a safe and effective method of providing postoperative pain relief . Feasability was shown in adolescents and , more recently , in children aged five years and over . Only few reports are available describing long term use of PCA in children younger than five years . Our case suggests that PCA may also be used effectively and safely in children younger than five years , if experienced staff , a monitoring regimen and cooperative and well instructed parents are available ." ], "offsets": [ [ 0, 1890 ] ] } ]

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