Search

Es wird der Fall einer spontanen Kreislaufstabilisierung nach erfolgloser intraoperativer Reanimation bei einem Patienten mit Herzschrittmacher beschrieben. Die Ursache fur das Auftreten solch eines sog.Lazarus-Phanomens ist unklar.In dem beschriebenen Fall scheint eine Kombination mehrerer Mechanismen zur Restitution des Kreislaufs beigetragen zu haben. Diskutiert wird ein Sistieren des venosen Ruckflusses wahrend der Beatmung mit positivem Atemwegsdruck und gleichzeitiger Hypovolamie.Die nach Beendigung der Reanimationsmasnahmen erfolgte Tubusdiskonnektion mit konsekutiver intrathorakaler Druckerniedrigung kann dann eine passive Fullung des Herzens bedingt haben, die zur spontanen Restitution der kardialen Funktion fuhrte. Die fortlaufende elektrische Stimulation durch den Schrittmacher kann entscheidend zur Wiederkehr der elektrischen Eigenaktivitat beigetragen haben.Um ein mogliches Lazarus-Phanomen zu erkennen, wird das Fortsetzen des Monitorings nach Beendigung der Reanimationsmasnahmen fur mindestens 10 min empfohlen.Des Weiteren konnten ein kurzer Apnoeversuch durch Diskonnektion vom Beatmungsgerat sowie der Versuch einer externen Myokardstimulation bei prolongiertem Misserfolg der Reanimationsbemuhungen sinnvoll sein.

We present a case of spontaneous recovery after failed intraoperative cardiopulmonary resuscitation in a patient with a cardiac pacemaker. Of the various mechanisms discussed in the literature, that which seems most relevant in our case of a Lazarus phenomenon, is that of impeded venous return in the course of positive pressure ventilation and hypovolemia.With the disconnection of ventilation, passive cardiac filling combined with electrical stimulation due to the cardiac pacemaker may have caused spontaneous myocardial electrical activity. Corresponding to previous authors,we recommend continued monitoring for 10 min after cessation of cardiopulmonary resuscitation. In addition, we propose a further attempt by disconnecting ventilation and external myocardial stimulation in the case of unresponsiveness to resuscitation efforts.

A convenient modification of the classical closed circuit helium dilution technique was developped to determine functional residual capacity, especially in intubated and artificial ventilated patients. The determination of the still inflatable lung volume and its variability in the course of pulmonary insufficiency or after a change in the adjustment of the respirator (PEEP a.o.), was reproducible better than +/- 10%. This method can be performed in a short time, without risk for the patient and with instruments locally independent of the ICU, surgery or recovery room.

The effect of altering end-expiratory inflation pressure from 0 to 20 cm H2O in relation to the pulmonary capillary wedge-pressure (PCWP) and the left atrial pressure (LAP) were studied in dogs, whose blood volume was varied by infusion of dextran or by haemorrhage. In the hyper- and normovolaemic state there was a good correlation between PCWP and LAP up to an end-expiratory pressure of 15 cm H2O. In the hypovolaemic dogs this close agreement existed only up to levels of PEEP 10 cm H2O. Above this end-expiratory pressure pulmonary capillary wedge-pressure increased more than left atrial pressure.

We measured in 8 experimental studies the oxygen and carbon dioxide partial pressure in systemic arterial, mixed venous and wedge-blood. The results were: 1. In healthy mongrel dogs with controlled intermittent and continuous positive pressure ventilation (FIO2 0,21 and 1,0) paO2 greater than pwO2 greater than pvO2 and pwCO2 less than paCO2 less than pvCO2. 2. During experimentally produced left-sided atelectasis of the lung and positioning of the catheter in the pulmonary artery a) in the ventilated lung we found pwO2 greater than paO2 greater than pvO2 and pwCO2 less than paCO2 less than pvCO2 b) in the atelectatic lung we found paO2 greater than pwO2 greater than pvO2 and paCO2 less than pwCO2 less than pvCO2. According to these findings the sample of highly saturated mixed venous blood from a catheter in the pulmonary artery should be a hint that pulmonary capillary blood is mixed with central venous blood.

Some of the main arguments are presented which led us to develop our present anaesthetic record. This record system and a part of its voluminous code is described. The new version provides for the documentation of arbitrarily complicated status, which are due to the preoperative condition of the patient. Furthermore, the course of aneaesthesia and its effects upon the patient can be numerically recorded in a detailed fashion. The punching is affected by a small rate of error only.