Der Anaesthesist
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Randomized Controlled Trial Comparative Study
[Nasojejunal enteral feeding tubes in critically ill patients. Successful placement without technical assistance].
Critically ill patients with early enteral feeding seem to profit from post-pyloric administration. Two feeding tubes were studied that, due to their construction, are able to move into the duodenum without the necessity of technical support. The duration until successful positioning, time until total enteral feeding and possible complications were compared. ⋯ In comparison to the Bengmark tube the Tiger tube has a higher success rate in terms of positioning in intensive care patients with impaired abdominal motility.
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Randomized Controlled Trial
[Intra-articular bupivacaine following hip joint arthroscopy. Effect on postoperative pain].
The effect of intra-articular bupivacaine on postoperative pain following arthroscopy has been intensively studied for the knee joint but no data are currently available for the hip joint. The aim of the present prospective, randomized and double-blind study was to evaluate a possible effect of intra-articular bupivacaine on postoperative pain intensity following hip arthroscopy. A total of 26 patients were included: 13 received 20 ml of 0.25% bupivacaine through the trocar at the end of surgery and 13 patients received 20 ml of 0.9% NaCl as placebo. ⋯ In the bupivacaine group, a significantly lower mean VAS was recorded at rest (17.5 vs 27.5, p=0.05) and during movement of the hip joint (23 vs. 46, p=0.001). The additional piritramide consumption tended to be higher in the placebo group. In conclusion, intra-articular bupivacaine following arthroscopic hip surgery reduces pain in the postoperative period mainly during movement and thus may possibly allow earlier mobilization.
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Randomized Controlled Trial
[Intra-articular ketamine after arthroscopic knee surgery. Optimisation of postoperative analgesia].
Surgery of the knee can be very painful and sufficient postoperative pain treatment is often problematic. To optimize postoperative analgesia, application of local analgesics has been suggested. In the present study it was investigated whether intra-articular administration of ketamine reduces the level of pain after arthroscopic knee surgery. ⋯ The i.a. application of ketamine after arthroscopic knee surgery leads to a significant decrease of postoperative analgesic demand and decreases patients' subjective level of pain compared to i.a. application of bupivacaine or placebo. Likewise, the i.v. application of ketamine is similarly effective but the effect is of shorter duration.
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Randomized Controlled Trial
[Levobupivacaine for parturients undergoing elective caesarean delivery. A dose-finding investigation].
The optimum intrathecal dose of hyperbaric levobupivacaine for spinal anaesthesia during elective caesarean section has not yet been investigated. ⋯ Levobupivacaine 7.5 mg did not provide satisfactory intraoperative analgesia in all parturients. There were no statistically significant differences between 10 and 12.5 mg levobupivacaine with respect to analgesic, sensory and motor block characteristics. Therefore, based on these data, 10 mg levobupivacaine is recommended for parturients undergoing elective caesarean section with spinal anaesthesia.
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Randomized Controlled Trial
[Non-invasive extended hemodynamic monitoring. Reduction of circulatory risk situations].
Cardiac output and the cardiac index (CI) are not routinely monitored during major abdominal surgery for economic as well as medical reasons. This practice, however, might be changed by the application of newer non-invasive technologies like the partial CO(2) rebreathing method based on the inverse Fick's principle. In this prospective randomized study we investigated the impact of a non-invasive monitoring of CI on the incidence of hemodynamic instability and interventions by the attending anesthesiologist during major abdominal surgery. ⋯ The incidence of hemodynamic instability was significantly reduced during major abdominal surgery when anesthesiologists were aware of the measurement results of extended hemodynamic monitoring.