[Intubation-linked dental injuries. Relevance of individually adaptable tooth protection models]. / Intubationsbedingte Zahnverletzungen. Wertigkeit individuell adaptierbarer Zahnschutzmodelle.

BACKGROUND: Tooth damage during anaesthesia could be reduced by using tooth protectors during endotracheal intubation. The effectiveness of different models was investigated using an upper jaw model. METHOD: A total of 6 individual adaptable dental protectors (Endoragard and Camo, with wax or silicone filling, respectively, Beauty pink dental wax with and without tissue inserts) were examined in three different categories. The upper jaw was covered with each dental shield and then loaded with a force of 150 N via a blade of a laryngoscope. Subsequently, force reduction was measured in axial as well as horizontal directions. Furthermore, the reduction in oral view was determined by measuring the thickness of each dental shield with a micrometer. RESULTS: The combination of Camo and silicone achieved the maximum horizontal force reduction value (39.2 N). Endoragard and silicone achieved the best axial value (21.6 N). Beauty pink wax had the thinnest dental shield (2.8 mm), whereas the combination of Camo and silicone gave the most limited view inside the oral cavity (3.8 mm). CONCLUSION: Preformed dental shields are useful for reducing the force applied to the teeth and potentially reducing the probability of tooth damage during laryngoscopy. However, the shield with the highest force reduction capability is relatively large and expensive which makes general use almost impossible. The model Beauty pink was slightly less force reducing and could be considered as an inexpensive and yet effective tool for clinical assignment.

Alcohol and drug abuse in burn injuries.

Two studies are described in this paper. In the first study 225 acutely, severely burned patients were retrospectively investigated as to admission blood alcohol level and history of chronic alcohol abuse. The influence of further risk factors, circumstances and therapeutic data was studied, in particular the influence of gender, full-thickness burns, smoke inhalation injury, smoking, length of total and ICU stay, and suicide attempt. The 70 patients with positive blood alcohol levels on admission had a significantly higher fatality rate (31.5 per cent) in comparison with the 18.1 per cent fatality rate of patients with a negative blood alcohol level. Both groups had nearly identical mean TBSA and mean age. Chronic alcohol abuse was noted in 59 patients. These patients were found to have a higher fatality rate (31.4 per cent, 22/70) compared with that of patients without a history of chronic alcohol abuse who had an overall fatality rate of 18.1 per cent (28/155). No significant difference was found between non-intoxicated and acutely intoxicated alcoholics (31.4 vs 29.3 per cent). Our conclusion is that intake of alcohol before burn injury represents an independent risk factor. The second study was a prospective study of 16 consecutively admitted burn patients, who were evaluated for both drug and alcohol intake. Five patients had positive drug levels and five had positive alcohol levels. Five patients had a history of chronic drug and/or alcohol abuse. This incidence of alcohol and drug abuse supports the findings of our retrospective study.

The 'heparin lock': cause for iatrogenic coagulopathy.

BACKGROUND AND OBJECTIVE: The reasons for coagulopathy may be multiple and the identification of the underlying cause is often difficult. Recently, we identified two patients showing characteristics of heparin overdose during surgery. We hypothesised that filling a Shaldon dialysis catheter with heparin prior to closure, so-called heparin lock, might have triggered this coagulation disorder. Therefore, the aim of this in vitro study was to show whether this procedure can lead to an iatrogenic administration of heparin. METHODS: A Shaldon catheter (GamCath; Joka Kathetertechnik, Hechingen, Germany) was hung up in a container filled with NaCl solution 0.9% 5 mL and a heparin lock was simulated. Instead of using heparin solution we injected 1 mL of a KCl solution (1 mol L(-1)) into the Shaldon catheter, because the measurement of the potassium concentration is faster and more reliable than that of heparin. Ten measurements were taken after fast (0.5 s) and slow (3 s) injection speeds. RESULTS: Although the catheter volume is specified as 1.07 mL, an amount up to 0.51 mL KCl solution on average was detectable in the solution after locking the catheter with 1 mL KCl solution. CONCLUSIONS: Following a heparin lock a considerable amount of the injected solution is accidentally administered to the patient. Only 49.1% of the injected volume may remain in the Shaldon catheter. This could lead to an increased risk of coagulopathy.

[Pindolol in intraoperatively developing isorhythmic AV dissociation]. / Pindolol bei intraoperativ auftretender isorhythmischer AV-Dissoziation.

The pathogenetic mechanism of isorhythmic AV dissociation (ID)--the often so-called nodal rhythm--developing during anesthesia is unclear. It has been proposed that stimulation of the AV node is caused by elevated sympathetic tone and a simultaneous blockade of the sinus node. In our prospective, randomized study the effect of the beta-blocking agent pindolol in converting ID into normal sinus rhythm has been investigated. Methods. Fourty patients (27 men, 13 women) aged 17 to 81 years, ASA class I and II, who developed ID during an elective surgical procedure were divided into four equal, randomized groups. The biometric data, type of operation, and anesthesia technique were comparable: induction of anesthesia with thiopental, intubation, and continuation with N2O/O2 combined with halothane or enflurane. The patients in group A formed the control group. The other patients received pindolol in a dose of 0.5 (group B), 1.0 (group C), and 2.0 (group D) micrograms/kg over a period of 30 s intravenously. The frequency of restoration of sinus rhythm during a testing period of 15 min in the pindolol-treated patients was compared with the frequency of the spontaneous converting rate in the control group. Results. A spontaneous return to sinus rhythm occurred in 2 of 10 (20%) patients of the control group, whereas with pindolol the restoration of sinus rhythm was effected in 25 of 30 (83.3%) patients during the observation period of 15 min (p less than 0.001). The dose of 2.0 micrograms/kg pindolol (group D) was most effective.(ABSTRACT TRUNCATED AT 250 WORDS)

[Alcohol-induced lactic acidosis in thiamine deficiency]. / Alkoholinduzierte Lactatacidose bei Thiaminmangel.

Thiamine deficiency leads to a moderate hyperlactacidemia. As a result of an acute alcohol exposure the hyperlactacidemia is increased. In addition metabolic and respiratory acidosis with a distinct low pH value occurs. These changes constitute vital risks and may be considered as basic arguments for the explanation of sudden death in chronic alcoholics.

[Metabolic acidosis caused by thiamine-deficiency (author's transl)]. / Metabolische azidose durch thiaminmangel.

The known B1 - deficiency reaches excessive high values with light exercise. This results in decompensation of the base-acid balance with metabolic acidosis. Therefore B1 - deficiency has to be considered in the differential diagnosis of all metabolic acidosis situations.

[Multimat--a new instrument for the facilitation of infusion therapy]. / Multimat--Ein neues Gerät zur Erleichterung der Infusionstherapie.

1. Multimat simplifies the complicated equipment required in controlled infusion therapy, and makes it easier to appreciate it at a glance. 2. Safety requirements are fully met and even enhanced by the fact that the entire system is easier to see and comprehend.

[Secondary lung surgery following contralateral pneumonectomy. Anaesthesiological considerations]. / Sekundäre Lungeneingriffe nach vorausgegangener kontralateraler Pneumonektomie. Anästhesiologische Aspekte.

Although there have been an increasing number of reports on secondary lung surgery following contralateral pneumonectomy in recent years, little information is available about the anaesthesiological management of these patients. We therefore report on a 58-year-old patient who had already undergone a left-sided pneumonectomy and now required a right-sided thoracotomy to remove a recurrent tumour in the right upper lobe. The patient received a total intravenous anaesthesia (propofol, fentanyl) combined with atracurium for muscle relaxation. Following the orotracheal intubation with a Woodbridge tube, the patient was ventilated with the high frequency jet ventilation technique. The jet stream was administered via a catheter placed in the tube. The arterial O(2) saturation during ventilation was always 100%, and arterial CO(2) partial pressure was also normal. No complications occurred during tumour resection from the right upper lobe, and the patient was transferred to the ICU with stable pulmonary and haemodynamic conditions. After 2 h of ventilation, the patient was extubated with a completely expanded lung. The postoperative recovery was uneventful. This case report shows that,presupposing a sufficient pulmonary capacity, secondary lung surgery in previously pneumonectomised patients is feasible without complications given an appropriate anaesthesiological management.

[Short-term effect of arginine hydrochloride on amino acid concentrations in serum of the rat]. / Die kurzfristige Wirkung des Argininhydrochlorids auf die Aminosäurenkonzentrationen im Serum der Ratte.

The short-period effect of a parenteral application of arginine hydrochloride on the amino acid concentrations was investigated on rats. To enable a judgement to be made on the growth hormone stimulated through arginine, 23 amino acids were determined from the serum of non-hypophysectomized and hypophysectomized animals in each case. A group of non-hypophysectomized rats was used to determine the normal values. The second group of non-hypophysectomized animals showed reductions in the concentrations of 15 amino acids after arginine infusion in relation to the normal values. In contrast to this the hypophysectomized animals of the third group showed higher values for 14 of the 23 amino acids after infusion with arginine. A direct comparison of the groups of non-hypophysectomized and hypophysectomized rats after infusion with arginine hydrochloride resulted in higher concentrations of 17 amino acids in the group of the hypophysectomized animals. These results suggest that the growth hormone has an influence on the amino acid level within 30 minutes.

[What is the benefit of subglottic suction?]. / Was bringt die subglottische Absaugung?

Bronchopulmonary infections are the main cause of morbidity and mortality in intensive care wards. Since the usual anatomical and physiological barrier is missing in the intubated patient, oropharyngeal secretion will reach the subglottic space between glottis and upper rim of the low-pressure cuff. Starting from there, continuous microaspiration between cuff and tracheal mucosa leads to bacterial contamination of the upper respiratory tract. In patients with a disturbed immune system from that point on colonization and infection may follow. Therefore one is called upon to search for measures to prevent infection in ventilated patients. Selective decontamination of oropharynx and gastrointestinal tract has been described as an effective method. Others are recommending the application of aminoglycosides in the tracheobroncheal system. Removing retained secreted material is a general surgical principle. Therefore we tested the practicability and effectiveness of a continuous subglottic drainage. At this point we are mainly interested in its clinical aspects and in the method. We investigated the subglottic drainage in 10 intensive care patients who were on long-term mechanical ventilation and had undergone tracheostomy. All patients had an Ultratracheoflex cannula Nr. 9-11 (Rüsch Company, West Germany). It was modified by a suction catheter Ch. 12 (Uno Plast Company, West Germany): We cut two additional small holes in the curved catheter tip and attached the catheter with this part above the cuff at the dorsal convexity to the tracheoflex cannula (see illustration 1). An infusion pump was used for suctioning secretion from the subglottic space by an ordinary infusion set and at a suction flow of 100-125 ml/h.(ABSTRACT TRUNCATED AT 250 WORDS)

[Atropine in intraoperative isorhythmic AV dissociation]. / Atropin bei intraoperativ auftretender isorhythmischer AV-Dissoziation.

40 patients of the ASA groups I and II in whom intra-operatively an isorhythmic AV dissociation occurred under inhalation narcosis with halothane or enflurane, were examined in a randomized study. Within an observation period of 15 minutes the spontaneous rate of return to the sinus rhythm was 20 per cent (group A, n = 20). Intravenous administration of 0.01 mg/kg atropine sulphate produced a significantly higher rate of return of 80% within the same period. On the whole, no influence on arterial blood pressure was noted. Atropine increases the heart rate by 32%, and this is considered to be an important drawback. The possibility of influencing the AV dissociation via atropine points to the pathogenetic importance of the vagus in so far as it acts as a depressant on the sinus node.

[Problems of accidental blood vessel puncture in peridural anesthesia]. / Ein Beitrag zur Problematik der akzidentellen Gefässpunktion in der Periduralanaesthesie.

An angiogram of the lumbar venous plexus was obtained following accidental insertion of a peridural catheter into the plexus. The problem of vascular puncture is discussed and the possible methods of prevention of intravascular injection of local anaesthetic are outlined.

[Glucose-induced hyperlactatemias in thiamine deficiency]. / Glucoseinduzierte Hyperlactatämien bei Thiaminmangel.

Parenteral nutrition with carbohydrates is limited, inter alia, by the occurrence of a dose-dependent hyperlactataemia. Thiamine deficiency, which can be provoked by an eight weeks' diet which is deficient in thiamine, will produce clearly elevated lactate levels in rats, leading eventually to lactate acidosis as a result of glucose load, compared with a control group on a normal diet. It is recommended to initiate a high-dosage level thiamine therapy before parenteral feeding with carbohydrates, if thiamine deficiency appears possible on the grounds of previous history of the case (alcohol abuse) or because of the underlying disease (e.g. oesophageal strictures, carcinoma of the oesophagus).