Role of phospholipase A in multiorgan failure with special reference to ARDS and acute renal failure (ARF).

In 150 patients admitted to an ICU phospholipase A serum activity was measured daily. The correlation between the increase of phospholipase A serum activity and the severity of adult respiratory distress syndrome (ARDS) and the incidence of acute renal failure (ARF), two important target systems in multiple organ failure (MOF) syndrome was studied as well as the efficacy of a treatment with phospholipase A inhibitors (methylprednisolone and dexamethasone). The results of this study show that there exists a statistically significant correlation between the increase of phospholipase A activity and the incidence of multiple organ failure. Inhibitory treatment ameliorates the organ function for a short time without any change of long-term outcome. The results could not clarify whether the rise of the mother enzyme of the arachidonic acid metabolism is only an epiphenomenon of multiple organ failure or the causative agent itself.

Serum activities of phospholipase A in acute posttraumatic pulmonary insufficiency.

The time courses of serum phospholipase A (PLA) and arterioalveolar oxygen differences (AaDO2) were compared in a group of 30 patients with severe multiple injuries. Evaluation of 391 measuring points revealed that high PLA (above 50 U/l) was associated with increased AaDO2 (above 150 mm Hg). Twelve patients who died having the symptoms of acute respiratory distress syndrome (ARDS) exhibited high serum PLA levels with individual peak values between 65 and 363 U/l (normal range 0-10 U/l). Analysis of individual time courses showed some striking parallelism between PLA and AaDO2. In five cases, however, AaDO2 increases preceded those of PLA by 1 to 4 days, while in one patient, impairment of the pulmonary function and subsequent recovery followed the corresponding PLA values with a 5-day delay. Our study supports present theories assuming some association between lung failure and the release of PLA into the circulation. Regarding the obvious time dissociation between both events, the nature of this relationship seems, however, to be complex so that pathophysiological conclusions should be drawn with caution.

[Anesthesia in craniofacial interventions in childhood]. / Anästhesie bei kraniofazialen Eingriffen im Kindesalter.

Nine children with severe craniofacial malformations underwent eleven major reconstructive craniofacial osteotomies; in two children, cranio-orbito-facial reconstructions were performed. Anaesthesia lasted from seven to eleven hours. The anaesthetic technique consisted of inhalation anaesthetics and supplementation with narcotics. Intraoperative problems were seen mainly regarding the protection of airways, the body temperature, and the extensive blood loss. At the end of anaesthesia all children were awake, three were extubated in the operating room. In children with mid-face advancement the nasotracheal tube was left in place for at least 48 hours.

[The problem of the difficult intubation]. / Zur Problematik der schwierigen Intubation.

Endotracheal intubation has become widespread routine in modern anaesthesiology and intensive care. Nevertheless, there are still patients in whom endotracheal intubation fails or is hampered by anatomical malformations. In these cases "conventional" attempts at intubation are not only time-consuming but also involve considerable risk for the patient, including total failure. Moreover these techniques (e.g., blind nasal) require a highly skilled performer as well as a good deal of luck. Under such circumstances, fiberoptic endotracheal intubation is the method of choice. This technique is easy to perform even by untrained persons, achieves a high rate of success and nearly totally lacks special hazards. The practical points of the procedure are outlined and possible problems discussed, which, however, are rare.