Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Preventive pain therapy. Preventive tramadol infusion versus bolus application in the early postoperative phase].
Even today, adequate postoperative analgesia is still a great problem. Based on positive results of former studies using a continuous infusion of tramadol for postoperative pain relief, we aimed to improve this regimen. In order to investigate the effectiveness of preventive analgesia, one group of patients was given 100 mg tramadol (Tramal) at the time of extubation, followed by a maintenance infusion. ⋯ The patients in the preventive group asked, on average, 30 min later for treatment for pain. The subsequent pain relief in both groups was comparable, although the amount of tramadol administered at that time was higher in the on demand group than in the preventive group (100 mg versus 50 mg+ amount given by infusion). These facts show the efficacy of the preventive infus
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Randomized Controlled Trial Clinical Trial
[Air conditioning with a high-performance HME (heat and moisture exchanger)--an effective and economical alternative to active humidifiers in ventilated patients. A prospective and randomized clinical study].
Heat and moisture exchangers (HME) are used as artificial noses for intubated patients to prevent damage resulting from dry and cold inspired gases. HME collect a large fraction of the heat and moisture of the expired air, adding them to the subsequent inspired breath. In a prospective clinical study the air conditioning capacity of a heated humidifier was compared with a hygroscopic HME. ⋯ These data show that modern HMEs are able to maintain physiological air-conditioning even in long-term ventilated patients. The small increase in airway resistance associated with HMEs (3.1 +/- 2.5 mbar/l.s) has to be noted in difficult weaning procedures. Both labour and costs per day are significantly less with HMEs (8.60 vs. 21.70 DM).
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Case Reports
[Anesthesiologic aspects of pregnancy and delivery in a patient following a modified Fontan procedure ].
The number of patients with congenital cyanotic heart disease who reach child-bearing age is increasing. This is partly a consequence of the high long-term survival and the haemodynamic benefits resulting from the Fontan procedure, which is used for the definitive palliation of such cyanotic heart disease as tricuspid atresia and single ventricle. However, so far little experience has been recorded with pregnant patients who have undergone right ventricular exclusion procedures. ⋯ Impairment of venous return caused by slight caval compression or high airway pressure may reduce cardiac output more critically than in patients with a normal circulation. CONCLUSION. This case demonstrates that the haemodynamic consequences of pregnancy and of caesarean delivery under general anaesthesia can be tolerated in post-Fontan patients despite the absence of a contractile pulmonary ventricle.
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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.