Der Anaesthesist
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Selecting a route for drug administration during CPR requires consideration of the speed with which access can be obtained, the technical difficulties involved in performing the procedure, the associated risk of complications, delays in drug delivery to the central circulation, and the duration of effective drug levels following injection. The peripheral venous route is the safest method, and drug delivery can be enhanced by a fluid bolus after injection of the medication. The circulation time is shortest after central venous injection, but there is some risk of complications. ⋯ The endotracheal tube provides an accessible route for administration of most drugs, but peak concentrations are lower than those obtained by other routes. While the results are almost the same as an intravenous injection, the intraosseous route is currently underrepresented in clinical practice. This method must not only be considered in pediatric patients, but in adult patients as well.
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Randomized Controlled Trial Clinical Trial
[Conduction block in man is stimulation frequency dependent].
The action of local anaesthetics on isolated nerves is enhanced by high stimulation frequencies. The aim of our study was to investigate whether high-frequency stimulation enhances regional anaesthesia in man. METHODS. ⋯ The spread of sensory block at the end of the experiments was also enhanced by stimulation with high frequencies, whereas the onset of vasomotor block (rise in skin temperature) remained unaltered. CONCLUSION. Non-oxious electrical stimulation with high frequencies significantly accelerates the onset of anaesthesia and extends the spread of sensory block.
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Clinical Trial
[Insertion of a fiber optic catheter into the hepatic veins of patients with multiple organ dsfunction syndrome (MODS)].
As it is the driving force in the development of a multiorgan dysfunction syndrome (MODS), the gastro-intestinal region is at the centre of current discussion. Recently, hepatovenous oximetry has been used increasingly to monitor the relationship between oxygen supply and consumption in the splanchnic system. In the present paper we report an exclusively oximetrically controlled catheterisation procedure that can be carried out at the bedside without the use of imaging procedures. ⋯ For this reason the opening of the hepatic veins could not be recognized by a decrease in saturation using the oximetric procedure. Placement of a catheter was not possible. Future studies on larger groups of patients will be required to show to what extent monitoring of ShvO2 can lead to an efficient therapy specific for this part of the cardiovascular system in patients with sepsis and MODS.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Intubation conditions following administration of atracurium and vecuronium. Bolus method versus priming technique].
Prompted by the ongoing discussion of the pros and cons of using succinylcholine, this study was conducted to compare the responses to bolus injections of atracurium or vecuronium with those after sequential injection of these drugs (priming principle). We evaluated the earliest possible intubation times, intubating conditions, and the onset times (i.e. times from the end of injection to the maximum blockade) under conditions approaching real use as closely as possible. METHODS. ⋯ The administration of the relaxants in divided doses significantly shortened the intubating time after atracurium (100 vs 124 s) and improved the intubating conditions of vecuronium (good vs tolerable), but had no effect on the time course of the neuromuscular blockade (onset times in the bolus groups 224 +/- 84 s for atracurium and 209 +/- 64 s for vecuronium; in the priming groups 249 +/- 112 s for atracurium and 205 +/- 52 s for vecuronium). CONCLUSIONS. The priming technique presented here is clinically superior to the bolus method and therefore should be preferred in all elective cases and in those patients in whom succinylcholine is contraindicated.
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The treatment of cancer pain with opioids is well accepted. However, the use of opioids for the treatment of non-cancer pain is still a matter of controversy. The main matters of concern are physical dependence and opioid abuse. ⋯ The reliable intake of prescribed medication must be assured if necessary by laboratory screening. The treatment of non-cancer pain with opioids may be an alternative for those patients, who didn't gain sufficient reduction of pain by other therapies. Standards for this therapy are an absolute necessity and are to be followed closely.