Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[A comparison of a tramadol/metamizole infusion with the combination tramadol infusion plus ibuprofen suppositories for postoperative pain management following hysterectomy].
Postoperative pain management is still a grossly neglected field. In most cases, antipyretic analgesics alone are insufficient during the early postoperative period. Powerful narcotics are often avoided or underdosed because they are associated with the risk of respiratory depression. ⋯ CONCLUSIONS. Satisfactory pain reduction occurred rather late despite high doses of both the tramadol/metamizole and the tramadol/ibuprofen. Both analgesic combination must be regarded as insufficient after inhalational anaesthesia because of the very slow onset of action and the high failure rate.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Propofol versus midazolam. Long-term sedation in the intensive care unit].
Sedative-analgesic treatment of patients on long-term artificial ventilation aims at protection from stress related to their disease or therapy. By stabilising both the patient's vital functions and psychological state this treatment may contribute to therapeutic success. The choice of drugs depends primarily on the nature and course of the underlying disease. ⋯ In both groups this increase was associated with a reduction in peripheral resistance and an increase in rectal temperature. To achieve the desired sedation depth, midazolam was administered at a mean dosage of 0.11 mg/kg.h and propofol at 1.9 mg/kg.h. Catecholamine levels decreased in both groups within the first 8 h: after 8 h of sedation the plasma levels of noradrenaline and adrenaline were 525 and 65 pg/ml, respectively, in the midazolam group and 327 and 51 pg/ml in the propofol group. (ABSTRACT TRUNCATED AT 400 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Cognitive and psychomotor performance following isoflurane, midazolam/alfentanil and propofol anesthesia. A comparative study].
Mental and psychomotor abilities are impaired to varying degrees after general anaesthesia. This has important implications for the time over which patients are monitored in the recovery room and for the discharge of outpatients after day surgery. The present study was undertaken to compare recovery and mental and psychomotor skills in the first 60 min following general anaesthesia with isoflurane, midazolam/alfentanil and propofol. ⋯ The results indicate that in operations of approximately 90 min duration the return of motor and mental abilities is faster following propofol anaesthesia. At 30 min after extubation following propofol anaesthesia patients had test results that allow their transfer from the recovery room, while it took 60 min for patients in the two other groups to reach the same levels of motor and mental function. This is important for the duration of monitoring in the recovery room and, especially, for day case anaesthesia.
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Randomized Controlled Trial Clinical Trial
[The use of propofol during diskectomy in neurosurgery].
The intravenous anaesthetic agent propofol has become more and more popular not only for induction but also for the maintenance of anaesthesia in all fields of surgery. For this purpose, different infusion rates and also combinations of propofol with opioids, nitrous oxide and volatile anaesthetic agents have been described. The present study was designed to find the best dosage regimen for short operations and rapid changes. ⋯ An additional administration of fentanyl can prevent hypertensive reactions or tachycardia with intubation, but on the other hand fentanyl can also increase the cardial depression of propofol with a dangerous decrease in blood pressure and heart rate. Therefore in combination with opioids lower doses of propofol should be used for induction and maintenance of anaesthesia. If opioids are administered, signs of a residual postoperative respiratory depression have to be taken seriously.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Micturition disorders following spinal anesthesia of different durations of action (lidocaine 2% versus bupivacaine 0.5%)].
Disturbances of micturition following spinal anaesthesia are considered to be rare and harmless side effects of this technique. For this reason, we set up a prospective study to investigate their incidence, characteristics and intensity. Our special interest was directed at the influence of the duration of action of local anaesthetics. ⋯ Their higher frequency following the longer acting bupivacaine may be evidence of longer lasting blockade of the efferent sacral parasympathetic fibers innervating the detrusor vesicae muscle, leading to inhibition of bladder voiding. The consequences of these disturbances, if not correctly managed, may be distension of the urinary bladder with ensuing infection and loss of tone of the detrusor muscle. Various measures are recommended: choice of the longer acting local anaesthetic only if necessary, careful control of bladder filling, restrictive infusion of fluids, early mobilization, carbachol, catheterization in good time, prophylactic placement of an indwelling catheter in patients with previous disturbances.