Der Anaesthesist
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Case Reports
[Cesarean section with continuous spinal anesthesia in a cardiopulmonary high-risk patient].
As a consequence of the progress in (perinatal) medicine the number of pregnant women with severe cardiopulmonal risk, who need caesarean delivery, is rising. The anaesthetic care of these patients requires optimal preparation and--as a prerequisite--constant intraoperative vital functions (heart rate, blood pressure, oxygen saturation). Typical risks like airway-problems, hypoxia, hyper- and hypotension and tachycardia must be strictly avoided. We report a case of successful caesarean delivery in a patient with severe coronary heart disease, using spinal catheter technique. ⋯ This case demonstrates, that the use of a continuous spinal catheter technique for caesarean section anaesthesia is an alternative method, which should be considered especially in high risk patients, when meticulous care for constant vital functions is requested urgently.
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Randomized Controlled Trial Multicenter Study Clinical Trial
[Ondansetron. Prophylaxis and therapy of nausea and vomiting following major gynecologic procedures. Results of a national multicenter study].
This investigation was conducted as a national multicenter study to evaluate effectiveness and safety of prophylactic and therapeutic ondansetron for postoperative nausea and vomiting (PONV) in major gynaecological surgery. ⋯ Our investigation proves the efficiency of ondansetron 8 mg prior to induction of anaesthesia in preventing PONV. Furthermore, our results demonstrate the safety of the drug for prophylaxis and therapy.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
[Predictability and precision of "target-controlled infusion" (TCI) of propofol with the "Disoprifusor TCI" system].
In Germany a TCI-system for propofol (Disoprifusor-TCI) has been commercially available since spring 1997. We investigated the prediction error and precision of this TCI system as part of a multicentre study. Bias, precision, blood concentrations and dosage of propofol were compared with patients receiving propofol via a manually controlled infusion device. ⋯ With a precision of 27.5% the investigated TCI system (Diprifusor-TCI) showed an acceptable inaccuracy, as for TCI-systems a median prediction error of +/- 30% has to be expected due to the inherent variability of pharmacokinetic parameters. Further studies will be necessary to find out whether the investigated TCI system for propofol may offer substantial advantages.
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Randomized Controlled Trial Clinical Trial
[The effect of gamma-hydroxybutyrate (GHB) on proinflammatory cytokine gene expression in coronary surgical procedures].
To determine the influence of gamma-hydroxy-butyrate (GHB) on spontaneous and lipopolysaccharide (LPS)-stimulated release of tumour necrosis factor-alpha (TNF), interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6) and interleukin-10 (IL-10) in whole blood from patients undergoing coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC). In addition, the pharmacological modulation on lipopolysaccharide (LPS)-stimulated cytokine release by GHB (GHB-Na and GHB-ethanolamide) was characterized in a separate in vitro-assay. ⋯ The results suggest a biphasic response of stimulated PBMC cytokine gene expression during CABG with an initial tolerance to LPS-stimulation shortly after termination of ECC. However, whether or not PBMC express functional GHB receptors remains unclear in light of contradictory effects of the different ligands. In spite of the ex vivo and in vitro results, application of GHB-Na in doses which are primarily based on its use as an anesthetic agent do not seem to modulate the release of the cytokines studied.
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In this article current indications and limitations of neuromuscular monitoring are reviewed. Attention is mainly focused on detection of residual curarisation. ⋯ Surprisingly in this context, despite the benefit of neuromuscular monitoring, its utilisation in clinical practice is rather an exception than the routine. A lack of standardisation of neuromuscular monitoring is probably the major problem on the way to a widespread utilisation of the monitoring.