Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Histamine plasma concentration and cardiovascular effects of non-depolarizing muscle relaxants: comparison of atracurium, vecuronium, pancuronium and pipecuronium in coronary surgical patients at risk].
Cardiovascular effects of four commonly used non-depolarising muscle relaxants and their ability to increase histamine plasma concentrations were studied in patients scheduled for coronary artery bypass grafting. ⋯ All investigated neuromuscular blocking agents exhibited marked cardiovascular stability which permits their use, being based exclusively on pharmacodynamic and pharmakokinetic considerations even in patients with coronary heart disease. If an increase in heart rate appears beneficial Pancuronium may be advantageous.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1998
Randomized Controlled Trial Multicenter Study Clinical Trial[Development of an observational scale for assessment of postoperative pain in infants].
In a prospective trial in 139 infants ASA classification I-II 13 observational items were scaled during the first postoperative hour (13 assessments). The items were drawn from the literature and chosen for economic purpose. Factor analyses (Principal component, Kaiser Criterion, Scree-test) were used for the elimination of useless items and for the identification of suitable ones. ⋯ There was a significant interaction between repeated measurements and the supply of Piritramide and Ketamine, but not of Midazolam. Concurrent and constructive validation were positive for both systems, using administration of Piritramide as a criterion. For clinical purpose the CHIPPS should be preferred, because it has been proven to be valid in children up to 4 years of age and because controlled data on its sensitivity, specify, reliability and validity could already be presented.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · May 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Desflurane versus isoflurane in geriatric patients. A comparison of psychomotor and postoperative well-being following abdominal surgical procedures].
The new volatile anaesthetic agent desflurane has a significantly lower blood-gas partition coefficient (0.42) than isoflurane (1.4), suggesting excellent intraoperative control of anaesthesia and rapid emergence and recovery from anaesthesia. However, only limited experience is available in geriatric patients undergoing major abdominal surgery. ⋯ Using a balanced anaesthesia technique, we found desflurane as suitable as isoflurane for geriatric patients. Additionally, due to the fast emergence from anaesthesia, an improved cooperativity was found. In the DES group overall better postoperative psychomotor performance resulted in a shortening of discharge times from the recovery room. Hence, desflurane anaesthesia may be advantageous in geriatric patients.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 1998
Randomized Controlled Trial Clinical Trial[Electrophysiologic arousal reactions during sufentanil-/isoflurane anesthesia].
There is controversy about relevant EEG signal changes indicating adequate or inadequate anaesthesia. Differences of drug-induced and nociceptive mediated signal changes have not been studied in detail. The present study investigates whether signal changes during decreases of depth of anaesthesia due to surgical stimulation depend on different isoflurane concentrations during sufentanil anaesthesia. ⋯ EEG recordings are useful in assessing pharmacodynamic drug effects. In contrast, intraoperative EEG recordings have a low correlation to clinical signs of changes in the anaesthetic state. Previous studies demonstrate paradoxical EEG-arousal reactions during isoflurane anaesthesia. The present data suggest that classical or even paradoxical EEG arousal due to nociceptive stimulation may depend on the isoflurane concentration. It seems reasonable that the ascending reticular formation is functionally blocked by isoflurane in a dose-dependent manner.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 1998
Randomized Controlled Trial Clinical Trial[Pulse oximetry and capnography in intensive care transportation: combined use reduces transportation risks].
Due to the growing number of diagnostic and therapeutical procedures intensive-care patients must be transported intra- and interhospitally more often. These transports are among the most critical events during intensive-care therapy, with a high incidence of potentially life-threatening mishaps [23]. The aim of this study was to evaluate the possible benefit of the combined application of pulse oximetry and capnometry for patient safety during transport. ⋯ The combination of pulse oximetry and capnometry offers the possibility to detect potentially life-threatening problems in ventilated patients during transport. This allows for early therapeutical consequences and may help to reduce the risk of transports.