Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2003
Randomized Controlled Trial Clinical Trial[Blocking nociceptive afferents by retrobulbar bupivacaine does not decrease nausea and vomiting after propofol-remifentanil anaesthesia].
To test whether prophylactic neural blockade of noziceptive afferents or antiemetics diminutes postoperative nausea and vomiting (PONV) we studied in a randomised, prospective, and ouble-blind fashion 102 patients receiving implantation of an episcleral radioactive applicator for treatment of ocular malignant melanoma during remifentanil-propofol-anaesthesia. ⋯ Although prophylactic blockade of nozizeptive afferents by retrobulbar anesthesia decreased ocular pain and postoperative complaints, it failed to decrease the incidence of PONV. Thus, PONV after ocular surgery under propofol-remifentanil anaesthesia is not attenuated by preoperative blockade of noziceptive afferents. In patients undergoing total intravenous anaesthesia with propofol-remifentanil, droperidol prevented PONV more effectively than the used serotonin receptor antagonists.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2003
Randomized Controlled Trial Comparative Study Clinical Trial[The time-course of action of rapacuronium and mivacurium after early reversal following equally lasting relaxation].
This study was designed to compare the time course of action and the safety profile of Rapacuronium and Mivacurium in day case dental surgery. After Ethics Committee approval 61 healthy adult patients, scheduled for dental day case surgery, were randomised in an assessor-blinded manner to receive either 1.5 mg/kg Rapacuronium with and without 0.05 neostigmine 5 min later (19 patients each) or a total of 0.25 mg/kg Mivacurium (n = 16). Anaesthesia was induced using Propofol 2 - 5.1 mg/kg and Remifentanil 24 - 73 mcg/kg/h and maintained with Desflurane in N2O/O2 (2/1). ⋯ Also clinical duration was significantly shorter following Rapacuronium without reversal (12 +/- 4 min) as well as with reversal (9 +/- 1 min) compared with Mivacurium (21 +/- 5 min)). Patients treated with Rapacuronium and reversal recovered faster (14 +/- 8 min)) compared to the other two groups (Mivacurium: 20 +/- 6 min, Rapacuronium without reversal: 31 +/- 9 min). The fraction of clinical duration of the total duration was highest following Mivacurium (51 %) when compared with Rapacuronium/Neostigmine (43 %) and Rapacuronium (28 %).
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2002
Randomized Controlled Trial Clinical Trial[Influence of positioning on the quality of unilateral spinal anesthesia].
Unilateral spinal anaesthesia ("hemi-spinal") is theoretically associated with the advantages of fewer cardiovascular effects and longer duration of action while offering high density motor block of the extremity affected. ⋯ Unilateral spinal anaesthesia ("hemi-spinal") is an attractive concept, supposed to be associated with the above mentioned advantages and the additional benefit of a partially maintained sensation of one limb. The results demonstrated in this study seriously question this theoretical concept. The most likely reason for the lack of inter-lateral differences in sensory block is the high concentration of hyperbaric local anaesthetic in the cerebrospinal fluid on the dependent side, which, on turning the patient to the supine position, will transit to the previously non-dependent side subsequently leading to a significant block.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2002
Randomized Controlled Trial Comparative Study Clinical Trial[Prophylaxis of Postoperative Nausea and Vomiting FollowingGynaecological Laparoscopy].
Compared to other procedures, gynaecological laparoscopies are followed rather frequently by postoperative nausea and vomiting (PONV). Therefore, we investigated the prophylactic antiemetic efficacy of metoclopramide and droperidol under general anaesthesia with isoflurane (part 1). Given the rather unsatisfying results of this monoprophylaxis we examined the effects of a quintuple prophylaxis in this setting (part 2). ⋯ Whereas droperidol provides a reliable antiemetic effect, the prophylactic effect of metoclopramide is rather uncertain. Therefore, further studies regarding a dose response-relationship for metoclopramide are deemed necessary. Since a monoprophylaxis with droperidol or metoclopramide failed to attain a satisfying PONV-prophylaxis in patients at high risk for PONV, the quintuple antiemetic combination might be an effective and safe solution.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2001
Randomized Controlled Trial Clinical Trial[Sevoflurane augments the degree and speeds the onset of rocuronium evoked neuromuscular blockade in children].
In adults, sevoflurane augments the intensity of rocuronium evoked neuromuscular blockade. However, in children effective doses and onset of action of rocuronium have not been reported during sevoflurane anaesthesia. To test in children the hypothesis that sevoflurane speeds the onset and potentiates the degree of rocuronium induced neuromuscular blockade we studied 50 children aged 2 - 7 years following approval by the local ethics committee. ⋯ In young children during steady state anaesthesia onset of action of rocuronium is halved and the degree of neuromuscular blockade is markedly augmented during sevoflurane/N(2)O anaesthesia compared to propofol.