Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Initial results of the reliability and validity of a German-language scale for the quantitative measurement of postoperative pain in young children].
In a previous study it was proved impossible to evaluate the validity of a system modified according to McGrath et al. for measuring postoperative pain in children. Three reasons were postulated for this result. The analgesics used did not modulate the pain in such a manner that the statistical analysis was effective; or the postoperative pain had an acute onset or fluctuated and the regular observations did not allow detection of the pain peaks; or the system used did not measure pain. ⋯ RESULTS. A replication verified the results of the previous study: the factor analysis resulted in a one-factorial solution. Of the 8 items (wakefulness, wake-up reactions, crying, position of the trunk, position of the legs, verbal communications on being asked about pain, special defense against stimuli) only 4 had a sufficiently substantial load on all measurements (crying, facial expression, position of the trunk and position of the legs). (ABSTRACT TRUNCATED AT 400 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Tramadol in postoperative pain therapy. Patient-controlled analgesia versus continuous infusion].
Patient-controlled analgesia (PCA) is a well-proven procedure for individual pain relief in the post-operative period. Despite its superior approach regarding pharmacokinetic and pharmacodynamic considerations, PCA equipment is not available to many in the clinical practice. The goal of this study was to compare the efficacy and safety of PCA with continuous infusion (CI), an easily feasible method, using tramadol (T) as a centrally acting opioid with minor side effects on circulation and ventilation. ⋯ T is well suitable for postoperative pain relief after major gynecological surgery using both PCA and CI. PCA ensures adjustment of the medication to the individual demand, whereas CI provides better analgesia after sleeping periods. We recommend antiemetic prophylaxis before treatment with T.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Etomidate using a new solubilizer. Experimental clinical studies on venous tolerance and bioavailability].
Pain following intravenous injection as well as thrombophlebitis are substantial side effects of etomidate that have been reported from the first clinical study (1972-1973) onwards. Investigations of our own and by Gran et al. have pointed out that injectable etomidate with intralipid as a solvent removes side effects without impairing the good hypnotic action. The idea of using a lipid emulsion as a solvent was presented a few years later, inducing two further studies. ⋯ The same results have been obtained in the study with volunteers. CONCLUSION. Two unpleasant side effects of etomidate, pain on injection and postoperative thrombophlebitis, were abolished by the solvent "lipid emulsion".
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Randomized Controlled Trial Comparative Study Clinical Trial
[Continuous application of morphine is more effective than a bolus administration in the postoperative analgesia and sedation of children].
In ventilated children the cardiorespiratory and metabolic reserve capacities can be extremely limited. Therefore, these children have low thresholds of tolerance for additional stress factors. One of the most obvious aims in the critical postoperative period after heart surgery in children is protection of the cardiorespiratory system against stress reactions. ⋯ Continuous application of morphine was more effective in sparing VO2 than bolus injections in ventilated children after cardiac surgery. We conclude that continuous application of morphine represents stress prevention whereas bolus application of morphine is stress therapy. From the clinical point of view it is more effective to prevent than to treat pain and other stress factors in pediatric patients.
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Randomized Controlled Trial Clinical Trial
[Hyperosmolar volume replacement in heart surgery].
The ideal solution for use in volume therapy is still a matter of debate. Hypertonic sodium (HS) solutions have been advocated for resuscitation from hemorrhagic shock (small volume resuscitation). As hypertonic fluids may also be of interest in cardiac surgery, the effects of a new HS solution were studied. ⋯ The hypertonic saline HES solution adds a new dimension to volume therapy for cardiac surgery patients. The improvement in hemodynamics was effective and not only transient. Fluid requirements were significantly reduced during as well as after CPB, and pulmonary gas exchange was least compromised in these patients.