Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[Optimal dosage strategies in total intravenous anesthesia using propofol and ketamine].
The combination of propofol and ketamine for total intravenous anesthesia was investigated; the intention was to minimize the side effects of each drug by the concomitant application of the other drug. METHODS. Twenty patients scheduled for lower abdominal interventions were divided into two groups. ⋯ The major known side effects of propofol (reduced hemodynamics during induction) and ketamine (psychic disturbances and cardiovascular stimulation) were absent and respiratory function was adequate after the end of surgery. This technique, therefore, can be used in risk patients and under disaster conditions when i.v. access is the only possible route of drug administration. The use of computer-assisted infusion pumps markedly enhances handling and controllability of total i.v. anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
[A comparison of autologous transfusion procedures in hip surgery].
The risks associated with transfusion can be minimized with autologous blood. The efficiency of preoperative deposit, preoperative hemodilution and intra- and postoperative autotransfusion in reducing homologous transfusions has been demonstrated. There seem to be few studies, however, that compared the different methods of autologous transfusion. ⋯ CONCLUSION. Under the conditions studied, preoperative autologous deposit was the most efficient method of autologous transfusion for hip arthroplasty. It should be employed primarily.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The use of ketamine and midazolam for analgesia and sedation in ventilated patients subject to obligatory treatment with catecholamines].
This study was undertaken to compare two regimens for analgesic sedation in intensive care patients with exogenous catecholamine therapy, giving special regard to catecholamine demand and hemodynamic parameters. A total of 20 ventilated patients in a surgical intensive care unit were investigated in a prospectively randomized design. Exogenous catecholamine therapy with epinephrine and/or norepinephrine was started at systolic pressure (SAP) less than 85 mmHg or mean arterial pressure (MAP) less than 65 mmHg to maintain cardiovascular function. ⋯ In time course, PAP increased by about 5 mmHg in the ketamine group but not in the fentanyl group (P = 0.009). The average central venous pressure (CVP) was 12 mmHg in both groups. At the end of the investigation, CVP decreased in the fentanyl group and increased in the ketamine group (P = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Propofol for induction and maintenance of anesthesia during heart surgery. Results of pharmacological studies in man].
Numerous reports have concluded that propofol is suitable for maintenance of anesthesia by continuous infusion. The aim of this study was to evaluate the use of propofol and fentanyl for coronary bypass surgery in patients with good left ventricular function. The effects of this anesthetic combination on quality of anesthesia, hemodynamic status, and endocrine and metabolic responses were assessed. ⋯ CONCLUSION. In summary, it can be concluded that a propofol infusion technique positively enhances the recovery period after cardiac surgery and provides good control during anesthesia. However, the use of propofolfentanyl for induction of anesthesia in patients with limited coronary perfusion is not recommended because of its hypotensive effect.
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Randomized Controlled Trial Clinical Trial
[The prevention of postoperative vomiting following strabismus surgery in children].
Children recovering from anaesthesia for strabismus surgery are particularly prone to nausea and vomiting as a result of intraoperative vagus irritation. Besides being disturbing to the patient, vomiting can be dangerous during emergence from anesthesia and can result in delayed discharge. Droperidol is a powerful antiemetic drug that has been shown to reduce the incidence and severity of postoperative nausea and vomiting in pediatric strabismus patients, although the best timing for administration is not clear. ⋯ The lower incidence of vomiting in all study groups compared to the literature is thought to be due to three factors: (1) emptying the stomach at the end of the operation by a gastric tube, which is removed before extubation; (2) avoidance of opioids; (3) surgical procedure being done by a very experienced surgeon in 57/61 children (12 vomiting versus 45 not vomiting) in contrast to 3/4 children vomiting postoperatively after surgery by a less experienced surgeon. CONCLUSIONS. We recommend preoperative droperidol 75 micrograms/kg i.v. as the best prophylaxis of postoperative emesis without severe side effects in pediatric strabismus surgery.