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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Der Anaesthesist 43 (1994), S. 309-315 
    ISSN: 1432-055X
    Keywords: Schlüsselwörter: Empfehlungen – Herzkreislaufstillstand – Notfall – Reanimation – Richtlinien ; Key words: Cardiac arrest – Emergency – Guidelines – Recommendations – Resuscitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract. A strong consensus was reached for several changes in the guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC) in the 1992 conference on CPR and ECC held by the Emergency Cardiac Care Committee of the American Heart Association. These new recommendations, together with differing recommendations of the European Resuscitation Council, are described. An unresponsive person with spontaneous respirations should be placed in the recovery position if no cervical trauma is suspected. Compared with endotracheal intubation, other airway-protecting devices such as combination esophageal-tracheal tubes are of minor acceptance. During ventilation, the time for filling the lungs is increased to 1.5 – 2 s to decrease the likelihood of gastric insufflation. Delivery of IV drugs can be enhanced by an IV flush of sodium chloride. In endotracheal drug administration, higher doses and drug dilution are recommended in infants and children up to 6 years of age, the value of intraosseous drug administration is emphasized. For pulseless adult victims, the intitial dosage of epinephrine of 1 mg I.V. remains unchanged. For repeat doses, high-dose epinephrine up to 0.1 mg/kg is classified as of uncertain but possible efficacy. For lidocaine, the recommended I.V. dosage is 1.5 mg/kg. Sodium bicarbonate and calcium are not routinely recommended for resuscitation. For atropine, the maximum dose is 0.04 mg/kg. If hypomagnesaemia is present in recurrent and refractory ventricular fibrillation, it should be corrected by administration of 1 to 2 mg magnesium sulfate I.V. Thrombolytic agents are classified as useful and effective in acute myocardial infarction and should be administered as early as possible. Glucose-containing fluids are discouraged for resuscitative efforts.
    Notes: Zusammenfassung. Die 1992 von der American Heart Association geänderten Empfehlungen zur kardiopulmonalen Reanimation werden vorgestellt und den ebenfalls 1992 veröffentlichten Empfehlungen des European Resuscitation Council gegenübergestellt. Die stabile Seitenlage wird ausschließlich für Patienten ohne Zervikaltrauma empfohlen. Ösophagusobturator und Kombitubus sind gegenüber Endotrachealtubus nur bedingt geeignet. Unter Beatmung wird die Inspirationszeit auf 1,5 bis 2 s verlängert. Bei intravenöser Medikamentengabe wird ein nachfolgender NaCl-Bolus, bei endotrachealer Medikamentengabe eine Dosiserhöhung empfohlen. Für Kinder ist die intraossäre Medikamentengabe geeignet. Die Initialdosis von 1 mg Adrenalin i.v. wird für Erwachsene beibehalten. Wiederholungsgaben können bis zu 0,1 mg/kg dosiert werden. Für Lidocain beträgt die i.v.-Dosis 1,5 mg/kg. Natriumbikarbonat und Kalzium sind bei Reanimation keine Routinemedikamente, die Atropin-Höchstdosis beträgt 0,04 mg/kg. Bei refraktärem Kammerflimmern soll eine Hypomagnesiämie durch Magnesiumsulfatgabe ausgeglichen werden. Eine Thrombolyse ist bei akutem Myokardinfarkt indiziert und soll frühestmöglich erfolgen. Glukosehaltige Lösungen sollen nicht verwendet werden.
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  • 2
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Pharmakodynamik: Atracurium ; Rocuronium ; Vecuronium ; Relaxation: Anschlagszeit ; Erholung ; Altersfaktoren ; Key words Pharmacodynamics: atracurium ; rocuronium ; vecuronium ; Neuromuscular block: onset ; recovery ; Age factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Elderly patients may show an age-related decline in physiologic functions, which may be responsible for the prolonged duration of some neuromuscular blocking agents. Previous studies have yielded conflicting results as to the effects of these drugs in the elderly. Methods. After obtaining informed consent and approval of the Ethics Committee, we compared onset and recovery times of single IV doses of atracurium, rocuronium, and vecuronium given to 108 patients divided into three groups according to age (18–50, 51–64, ≥65 years). Following oxazepam premedication and fentanyl and thiopentone induction, patients were randomly allocated to receive atracurium, rocuronium or vecuronium (0.5, 0.6, or 0.1 mg/kg, respectively) in ≤0.8 vol.% enflurane (end-tidal)-nitrous oxide anaesthesia. Muscular relaxation was assessed by electromyographic (EMG) recording of the adductor pollicis muscle after supramaximal single-twitch stimulation of the ulnar nerve every 10 s. Onset time and recovery to 25%, 75% and 90% of twitch control values (DUR25, 75, 90) were recorded. Creatinine clearance predicted from serum creatinine (Ccr) was correlated with recovery from neuromuscular block. Results. Onset time was not different among groups or relaxants. The results showed a prolonged duration of action for atracurium (DUR75, DUR90), rocuronium (DUR25, DUR75), and vecuronium (DUR25) in the elderly. A number of patients did not reach DUR75 or DUR90. There was a significant relationship between age and failure to return to control values during recovery from neuromuscular block, especially after atracurium and rocuronium. Ccr showed a negative correlation with age for all relaxants, but a negative significant correlation between Ccr and recovery was found only for rocuronium. Conclusions. This study suggests that onset time for atracurium, rocuronium and vecuronium is not age-dependent. Recovery was prolonged in the elderly for all three relaxants. This effect appears to be secondary to changes in body composition and function accompanying the aging process. Neither atracurium nor vecuronium depends significantly on the kidney for elimination, but the negative correlation between Ccr and rocuronium suggests an appreciable role for the kidney in the elimination of this relaxant. The long recovery times observed in this study could also be related to enflurane anaesthesia. We suggest that failure of EMG responses to return to baseline values during recovery from neuromuscular block may be related to age, especially for atracurium and rocuronium.
    Notes: Zusammenfassung Bei alten Patienten kann die Wirkung von Muskelrelaxanzien verändert sein. Wir untersuchten diesen Zusammenhang an 108 Patienten dreier Altersgruppen, die randomisiert klinisch übliche Intubationsdosen von Atracurium, Rocuronium und Vecuronium erhielten. Anschlagszeit und Erholung von der neuromuskulären Blockade wurden mit dem evozierten EMG des M. adductor pollicis nach Stimulation des N. ulnaris (Einzelreizung, 0,1 Hz) ermittelt. Die Anschlagszeiten sind in allen drei Altersgruppen vergleichbar, die Erholungszeiten bei den alten Patienten nach allen drei Relaxanzien verlängert. Die verlängerte Erholungszeit für Rocuronium korreliert mit erhöhten Werten der berechneten Kreatinin-Clearance, was für eine im Vergleich mit Atracurium und Vecuronium vermehrte renale Elimination spricht. Die nicht vollständige Erholung von der neuromuskulären Blockade bei einigen Patienten, auch nach längerer Zeit, korreliert mit dem Alter. Eine Erklärung hierfür kann nicht gegeben werden.
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  • 3
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Hyperglykämie ; Hypoglykämie ; regionale Organdurchblutung ; Microspheres ; kardiopulmonale Reanimation (CPR) ; Key words Hyperglycaemia ; Hypoglycaemia ; Regional organ blood flow ; Microspheres ; Cardiopulmonary resuscitation (CPR)
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Blood glucose alterations prior to cerebral ischaemia are associated with poor neurologic outcome, possibly due to extensive lactic acidosis or energy failure. Cerebral effects of hyper- or hypoglycaemia during cardiopulmonary resuscitation (CPR) are less well known. In addition, little information is available concerning cardiac effects of blood glucose alterations. The aim of this study was to evaluate the effects of pre-cardiac-arrest hypo- or hyperglycaemia compared to normoglycaemia upon haemodynamics, cerebral blood flow (CBF) and metabolism (CMRO2), and regional cardiac blood flow during CPR subsequent to 3 min of cardiac and respiratory arrest and after restoration of spontaneous circulation. Methods. After approval by the State Animal Investigation Committee, 29 mechanically ventilated, anaesthetised pigs were instrumented for haemodynamic monitoring and blood flow determination by the radiolabeled microsphere technique. The animals were randomly assigned to one of three groups: in group I (n=9) blood glucose was not manipulated; in group II (n=10) blood glucose was increased by slow infusion of 40% glucose to 319±13 mg/dl; in group III (n=10) blood glucose was lowered by careful titration with insulin to 34±2 mg/dl. After 3 min of untreated ventricular fibrillation and respiratory arrest, CPR (chest compressor/ventilator (Thumper®) and epinephrine infusion) was commenced and continued for 8 min. Thereafter, defibrillation was attempted, and if successful, the animals were observed for another 240 min. Cerebral perfusion pressure (CPP), CBF, CMRO2, coronary perfusion pressure (CorPP), and regional cardiac blood flow were determined at control, after 3 min of CPR, and at 10, 30, and 240 min post-CPR. Results. In group I, 4/9 animals (44%) could be successfully resuscitated; in group II 4/10 (40%); and in group III 0/10 (0%). Prior to cardiac arrest, mean arterial pressure, CPP, and CorPP in group III were significantly lower compared to groups I and II. In group I, CPP during CPR was 26±6 mmHg; CBF 31±9 ml/min/100 g CMRO2 3.8±1.2 ml/min/100 g; CorPP 18±5 mmHg; and left ventricular (LV) flow 35±15 ml/min/100 g. In group II: CPP=21±5; CBF 21±7; CMRO2 1.8±0.8; CorPP 16±6; and LV flow 22±9; and in group III: CPP 15±3; CBF 11±8; CMRO2 1.5±1.1; CorPP 4±2; and LV flow 19±10. During the 240-min post-resuscitation period, there were no differences in CBF, CMRO2, or LV flow between groups I and II. Conclusion. Hypoglycaemia prior to cardiac arrest appears to be predictive for a poor cardiac outcome, whereas hyperglycaemia does not impair resuscitability compared to normoglycaemia. In addition, hyperglycaemia did not affect LV flow, CBF, or CMRO2. However, it has to be kept in mind that haemodynamics and organ blood flow do not permit conclusions with respect to functional neurologic recovery or histopathologic damage to the brain, which is very likely to be associated with hyperglycaemia.
    Notes: Zusammenfassung Gegenstand der vorliegenden Untersuchung im Schweinemodell ist der Einfluß einer prä-ischämischen Normo-, Hyper- oder Hypoglykämie auf Hämodynamik, regionale Organdurchblutung und Reanimierbarkeit nach 3minüti-gem unbehandelten Herz-Kreislauf-Stillstand und anschließender kardiopulmonalen Reanimation (CPR). Hypoglykämie (Blutzuckerkonzentration von 34±2 mg/dl) war bereits vor der Reanimation mit einer deutlichen Beeinträchtigung hämodynamischer Parameter assoziiert. Keines der hypoglykämischen Tiere konnte erfolgreich reanimiert werden, im Gegensatz zu den hyper- (Blutzucker 319±13 mg/dl) bzw. normoglykämischen Tieren, die keinen Unterschied hinsichtlich der Erfolgsrate der Reanimation aufwiesen. Weder vor noch während oder nach Reanimation unterschieden sich hyper- und normoglykämische Tiere in bezug auf Hämodynamik oder regionale kardiale oder zerebrale Durchblutung. Somit bleibt festzuhalten, daß Hypoglykämie bei CPR mit einer schlechten kardialen Prognose assoziiert ist, während Hyperglykämie die kardiale Reanimation offenbar nicht beeinträchtigt.
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