[Fetal monitoring for anesthesiologists]. / Fetales Monitoring für Anaesthesisten.

Several monitoring methods for the fetus are presented, the knowledge of which is appropriate for anesthesiologists active in the field of obstetrics. A distinction is made between external, indirect methods for monitoring when the amniotic sac is intact and internal, direct methods employed when the sac has ruptured. Particular emphasis is placed on cardiotocography (CTG), which is an obligatory method of routine monitoring during the late period of cervical dilatation and expulsion. It registers the reaction of fetal heart rate to parturition and labor, and represents a good indirect measure of both uteroplacental blood flow and fetal cardiac reserve. Criteria of evaluation for cardiotocograms are presented on the basis of guidelines elaborated by the Standard Committee on Cardiotocography (Chairman: Prof. Dr. H. Rüttgers). These enable the status of the fetus to be evaluated with differentiation. An inevitable sign of fetal well-being is a normal baseline with a rate between 120 and 160 beats/min, normal microfluctuation, and oscillations between 5 and 25/min with absent variable or late decelerations. Warning signs are restricted microfluctuation, elevated baseline, variable decelerations, and clinical passage of meconium. Suspicious signs are a baseline between 100-119 and 161-170 beats/min, respectively, decreased oscillation amplitude, and protracted decelerations over as much as 2 min.(ABSTRACT TRUNCATED AT 250 WORDS)

[Use of fentanyl for anesthesia induction in cesarean section. Pharmacokinetics and pharmacodynamics in mother and child]. / Fentanyl-Gabe zur Narkoseeinleitung bei Sectio caesarea. Pharmokokinetik und Pharmakodynamik bei Mutter und Kind.

A group of 36 patients in the last trimester of pregnancy and scheduled for cesarean section were examined during the induction of standardized general anesthesia (methohexitone 1.5 mg/kg, succinylcholine 1.5 mg/kg). No other inhalation anesthetics than N2O/O2 (50%:50%) were administered. In addition, 18 of the women received 0.005 mg/kg fentanyl prior to intubation. The remaining 18 patients served as a control group. In the study group maternal fentanyl plasma levels were determined 1 min after injection and again at the time of omphalotomy (radioimmunoassay). Immediately after clamping of the umbilical cord the fetal fentanyl plasma levels and the pH, pCO2 and pO2 values in both umbilical vein and artery were measured. The feto-maternal ratio and the fetal uptake were calculated. RESULTS. Maternal fentanyl plasma levels decreased significantly, from 7.84 (3.55-17.24) ng/ml 1 min after injection to 5.92 (2.01-14.15) ng/ml during omphalotomy. The corresponding fentanyl plasma levels in the umbilical vein were 2.08 (0.88-3.42) ng/ml. The feto-maternal ratio was 0.44 (0.08-1.00). The induction-delivery time ranged from 2 to 8 min. There was a significant correlation between umbilical-venous fentanyl concentration and the induction-delivery time: the longer the induction-delivery time the lower the fentanyl concentration in the umbilical vein. The 1-min Apgar score was 8 (5-9), the 5-min Apgar score 9 (8-10) and the 10-min Apgar score 10 (9-10) in neonates born to the fentanyl group. Only the 1-min Apgar score was significantly lower than in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Combined radiosurgical treatment of advanced carcinoma of the larynx (T3-4 NO-3). A retrospective comparison between sandwich technique and post-operative irradiation (author's transl)]. / Die kombinierte radiochirurgische Behandlung des fortgeschrittenen Kehlkopfkarzinoms (T3-4 NO-3). Ein retrospektiver Vergleich zwischen Sandwich-Technik und postoperativer Bestrahlung.

From 379 cases of laryngeal and pharyngeal carcinomas we picked out the T3-4 NO-3 tumors and proved whether the sandwich technique or the postoperative irradiation will give the better 5 year survival rates. For supraglottic carcinomas the 5 year survival rate is 59.9% after sandwich therapy and 53.0% after post-operative irradiation. In advanced glottic and hypopharyngeal cancers the prognosis does not depend on one of the both therapeutic schedules: the 5 year survival rate is 55.5% resp. 51.3% and 10.0% resp. 8.3%. Summarizing the carcinomas of all regions of the larynx, that is without the hypopharyngeal neoplasms, we got 54.6% after sandwich and 53.2% after post-operative irradiation. The statistical calculations demonstrate that the sandwich technique will improve the prognosis of supraglottic carcinomas distinctly. Radiotherapy alone in the treatment of advanced cancers of the larynx and hypopharynx is insufficient. The survival chance however depends essentially on the preoperative established lymph nodes. In our material the 5 year survival rate has been deteriorated by more than 25% in the case of N1-3.