Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Comparison of postoperative volume therapy in heart surgery patients].
Patients who have undergone cardiac surgery with use of extracorporeal circulation frequently reveal marked hypovolaemia in spite of a highly positive fluid balance. This is thought to be due to transient microvascular damage and extravascular fluid shift. Further volume replacement to achieve haemodynamic stability in the postoperative period may cause fluid overload and congestive heart failure. The present study was designed to investigate whether this fluid overload could be avoided by using a hypertonic-hyperoncotic solution (group I: HHL, 10% hydroxyethylstarch 200/0.5 in 7.2% saline) instead of two different standard colloid solutions (group II: HA, 5% albumin; group III: HES, 6% hydroxyethylstarch in 0.9% saline). ⋯ We found that HHL is a safe and effective solution for acute correction of hypovolaemia after cardiac surgery. The advantages of a smaller initial volume load by HHL cannot be maintained for longer than 2 h.
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
[Propofol-alfentanil reduced cerebrovascular CO2 reactivity in comparison with isoflurane].
The present study compared the effects of propofol/alfentanil versus isoflurane anaesthesia on cerebral vascular reactivity to changes in carbon dioxide (CO2) using transcranial Doppler sonography (TCD). METHODS. Seventeen ASA class I patients undergoing minor elective surgery were studied following IRB approval and informed consent. ⋯ The data show that although CO2 reactivity is maintained during both isoflurane and propofol/alfentanil anaesthesia, the cerebral vascular response to CO2 was lower in propofol/alfentanil compared to isoflurane patients. This is likely due to propofol/alfentanil-induced cerebral vasoconstriction. These data suggest that CO2 reactivity is a function of the pre-existing cerebral vascular tone induced by the anaesthetic.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Continuous monitoring of critical patients with a newly developed pulmonary arterial catheter. A cost analysis].
The introduction of flow-directed pulmonary artery (PA) catheters has helped to improve our knowledge of cardiovascular physiology. There have been several developments of this equipment in recent years, including continuous monitoring of mixed-venous O2 saturation (SvO2) and cardiac output (CO). The high purchase price, however, is an obstacle to its use in the critically ill. ⋯ Costs for laboratory analyses can blunt the advantage of lower costs for the standard PA catheter. Intermittent (standard) monitoring of SvO2 and CO was significantly more time-consuming than the continuous methods. It can be summarised that although purchase costs for the more advanced PA catheters are higher than for standard PA catheters, the use of these continuous monitoring devices in the critically ill can be justified from a financial point of view.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Hemodynamic effects of new phosphodiesterase inhibitors in patients with coronary heart disease. A comparison between enoximone and R80122].
At present, phosphodiesterase III inhibitors are commonly used for the treatment of low cardiac output states. Despite their positive inotropic and lusitropic effects, these drugs are still under discussion because of certain adverse effects like thrombopaenia, elevation of transaminases, abdominal disregulation, and excessive peripheral vasodilatation. As a consequence, more cardioselective phosphodiesterase inhibitors were developed with the aim of reducing these adverse effects. ⋯ Both enoximone and R80122 showed the expected inotropic effects. Nevertheless, both substances have a distinct vasodilative effect, which leads to a decline in MAP. R80122 does not have higher cardioselectivity than enoximone.
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Randomized Controlled Trial Clinical Trial
[Strabismus surgery in children. The effect of paracetamol and bupivacaine].
Postoperative vomiting is induced by different mechanisms such as age, anaesthetic technique and medications, postoperative analgesia, and surgical traction on the extra-ocular muscles. The influence of anticholinergic premedication and the use of benzodiazepines as factors affecting the incidence of vomiting is controversial. In a prospective, randomised, single-blind study we examined two different treatments with regard to postoperative pain, vigilance, and vomiting in young children undergoing strabismus repair. ⋯ CONCLUSIONS. Intraoperative administration of rectal paracetamol or topical 0.5% bupivacaine was most effective in the treatment of postoperative pain for strabismus surgery in younger children. Sublingual flunitrazepam and i.v. atropine given as premedication probably decrease postoperative vomiting.