Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Cardiovascular effects after bolus administration of cisatracurium. A comparison with vecuronium].
Cisatracurium-one of the ten stereoisomers of atracurium-is an intermediate long-acting non-depolarizing neuromuscular blocking agent. Cardiovascular reactions have been described after administration of cisatracurium or vecuronium in surgical patients. ⋯ After the administration of cisatracurium in two different doses (3xED95 and 5xED95) or vecuronium (3xED90) only minor cardiovascular changes were observed. Both drugs proved to be safe for use during induction of anaesthesia in patients ASA I-II. With regard to its cardiovascular effects, cisatracurium shares with vecuronium the requirements of an ideal muscle relaxant.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effect of convection warming during abdominal surgery on the early postoperative heat balance].
Hypothermia (core temperature < 36 degrees C) is common after longer-lasting surgical procedures. Heat loss mainly occurs during anaesthesia and surgery and leads to increased risk, especially in the early recovery period of elderly patients. In the present study we investigated the effects of intraoperative forced-air warming, administered via an upper-body blanket ("Warm Touch", Mallinckrodt, USA), with the specific aims of: (1) drawing up heat balances; and (2) analysing postoperative thermoregulation, oxygen consumption (VO2) and cardiovascular reactions of mechanically ventilated patients. The general aim of our study was to compare intraoperative forced-air-warming and conventional patient-insulation with cotton blankets. ⋯ Both groups were comparable for gender, body weight, height, age, duration of their operations and amount of intraoperative fluids, narcotics and muscle relaxants. Room temperatures in the control group were significantly higher than in the forced air group (24 vs 22 degrees C). Initial setting of the forced-air blower was "high" (42-46 degrees high air flow). When the oesophageal-temperature reached 36.5 degrees C, the blower temperature was reduced to 36-40 degrees C. Reduction was necessary approximately 60 min from start in the operation. At the end of surgery/administration to the ICU core-temperatures of both groups differed significantly (35.2/ 35.4 degrees C vs 36.3/36.2 degrees C). Mean-skin temperatures were higher, too, but no statistical analysis was carried out for the intraoperative period, because warm air influenced skin thermometers located on the upper body. At admission to the ICU patients in the control group had a heat loss of 4.4 kJ/kg; those in the convective warming group had a heat-gain of 0.8 kJ/kg. Further measurements of postoperative core temperatures did not differ significantly, but the skin-temperatures of patients who received forced-air warming in the theatre remained higher (P < 0.05) until 120 min from the end of surgery. Shivering was more frequent and lasted longer in the control group (8 patients, 20 min vs 4 patients, 9 min; P < 0.05). Patients in the control group needed more drugs to stop increased cardiovascular reactions (hypertension, tachycardia) or shivering.(ABSTRACT TRUNCATED)
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effect of the laryngeal mask airway on the postoperative incidence of vomiting and sore throat in children].
100 ASA I and II children, aged 4 to 14 years, and scheduled for strabismus surgery, were randomly assigned to one of the following groups: group 1 (n = 50): endotracheal tube, group 2 (n = 50): laryngeal mask airway. Apart from airway management, the anaesthesiological procedures were identical in both groups: induction with 2-3 mg/kg propofol, 0.02 mg/kg alfentanil, 0.05 mg/kg vecuronium, and 0.01 mg/kg atropine. After endotracheal intubation or insertion of the laryngeal mask, anaesthesia was continued with 6-15 mg/kg.h propofol and 10-30 micrograms/kg.h alfentanil. All patients were ventilated with N2O/O2 (2:1). No antiemetics were given, gastric contents were not aspirated. Postoperative nausea and vomiting (PONV) were recorded by 24 h, the incidence of sore throats was recorded 8, 12, and 24 h post-operatively. ⋯ In children undergoing strabismus surgery, the laryngeal mask airway was superior to the endotracheal tube in terms of PONV and was associated with fewer local complications such as sore throat.
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Randomized Controlled Trial Clinical Trial
[Variation in inspiratory gas flow in pressure support ventilation. The effect on respiratory mechanics and respiratory work].
During pressure support ventilation (PSV), the timing of the breathing cycle is mainly controlled by the patient. Therefore, the delivered flow pattern during PSV might be better synchronised with the patient's demands than during volume-assisted ventilation. In several modern ventilators, inspiration is terminated when the inspiratory flow decreases to 25% of the initial peak value. However, this timing algorithm might cause premature inspiration termination if the initial peak flow is high. This could result not only in an increased risk of dyssynchronization between the patient and the ventilator, but also in reduced ventilatory support. On the other hand, a decreased peak flow might inappropriately increase the patient's inspiratory effort. The aim of our study was to evaluate the influence of the variation of the initial peak-flow rate during PSV on respiratory pattern and mechanical work of breathing. ⋯ COPD patients had significantly higher pressure support than control patients. With decreasing inspiratory flow, Wpi increased significantly in COPD patients.(ABSTRACT TRUNCATED)
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Randomized Controlled Trial Clinical Trial
[The effects of age on onset and recovery from atracurium, rocuronium and vecuronium blockade].
Elderly patients may show an age-related decline in physiologic functions, which may be responsible for the prolonged duration of some neuromuscular blocking agents. Previous studies have yielded conflicting results as to the effects of these drugs in the elderly. ⋯ This study suggests that onset time for atracurium, rocuronium and vecuronium is not age-dependent. Recovery was prolonged in the elderly for all three relaxants. This effect appears to be secondary to changes in body composition and function accompanying the aging process. Neither atracurium nor vecuronium depends significantly on the kidney for elimination, but the negative correlation between Ccr and rocuronium suggests an appreciable role for the kidney in the elimination of this relaxant. The long recovery times observed in this study could also be related to enflurane anaesthesia. We suggest that failure of EMG responses to return to baseline values during recovery from neuromuscular block may be related to age, especially for atracurium and rocuronium.