Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Less pain on injection by a new formulation of propofol? A comparison with propofol LCT].
Pain on injection is a major disadvantage of propofol, experienced by the vast majority of patients. Since the traditional formulation has almost normal osmolality and pH, it is hypothesised that the concentration of free propofol in the aqueous phase of the emulsion is responsible for the pain and that reducing the amount of free propofol would also reduce the frequency and intensity of pain on injection. This study was designed to investigate whether pain on injection can be reduced in frequency and intensity by a new formulation of propofol. ⋯ Propofol-MCT/LCT produced significantly less pain on injection when compared to standard propofol in ASA I and II patients undergoing elective surgery. Pain was also significantly less severe, with both effects presumably being due to the lower concentration of free propofol in the MCT/LCT-preparation. With regard to injection pain propofol-MCT/LCT offers significant a advantage over standard propofol.
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Multiple organ failure (MOV) still represents the leading medical and economical problem in the care of the critically ill surgical patient. Although the incidence of MOF has tended to decrease over the last several years reflecting improved surgical and supportive therapy in the ICU, prognosis still remains serious when MOF develops. ⋯ Besides complexity and redundancy of the mediator systems involved, their beneficial local reparative as opposed to detrimental systemic effects may have contributed to the disappointing results of anti-mediator strategies in the treatment of MOF and sepsis. Although treatment of the underlying disease remains the cornerstone of the care of the critically ill patient to prevent MOF, recent results indicating a decreased mortality in severely septic patients receiving activated protein C as a supportive treatment suggest that modulation of the mediator cascades of sepsis and MOF remains a generally promising therapeutic strategy.
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A private reptile breeder who handled exotic snakes was bitten by a Cobra near his ear. An ambulance was immediately called and the patient was transferred under unstable hemodynamic conditions to the nearest major hospital. During transport the patient had to undergo cardiopulmonary resuscitation. ⋯ After 4 days of deep coma the patient regained consciousness and spontaneous respiration and was extubated. Around the location of the bite wound angioedema and local necrosis developed. Surgical treatment of the wound was not necessary and 8 days after the incident the patient was fully recovered and was discharged from the hospital.
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Regional analgesia provides effective pain relief during delivery. Postpartal neurological deficits may be due to pressure of the fetal head on nerve structures at the pelvic rim or may be a complication of epidural analgesia. ⋯ This case report describes the differential diagnosis of neurological deficit after spontaneous delivery under epidural analgesia and a discussion of the recent literature. Finally recommendations for the treatment of neurological deficits after delivery under epidural analgesia are presented.