Der Anaesthesist
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Review Meta Analysis
[Levobupivacaine for regional anesthesia. A systematic review].
Levobupivacaine [S(-)bupivacaine], the levorotatory S-enantiomer of racemic bupivacaine, is commercially available in the U. S. and in most European countries. We performed a systematic review (MEDLINE database) and identified 88 articles on the clinical application of levobupivacaine in more than 3,000 patients. ⋯ In these regional techniques, levobupivacaine was used for all common indications in a wide range of clinical settings. Epidural levobupivacaine was combined with fentanyl, morphine, sufentanil, epinephrine, and clonidine, spinal levobupivacaine was combined with sufentanil, fentanyl, and epinephrine. In most studies, levobupivacaine was compared to bupivacaine and/or ropivacaine.
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Meta Analysis
[Ultrasound and local anaesthesia. Part III: ultrasound and neuroaxial local anaesthesia].
The use of ultrasound as a diagnostic tool for the visualisation of the epidural space has effects on the quality and the performance of epidural anesthesia. This work presents an overview of the recent experiences with ultrasound for epidural anesthesia and on the possibilities for ultrasound imaging techniques. The results of visualisation of the epidural space and its limiting structures obtained by various working groups are presented. ⋯ The ultrasound-guided puncture allowed an ideal needle trajectory and a more precise application of the catheter. A significant improvement of analgesia quality ( p<0.035) and patient satisfaction ( p<0.006) could be achieved. The metaanalysis of the different studies regarding puncture quality by ultrasound-guided peridural anaesthesia showed a clear advantage for the use of imaging techniques.
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Transient neurologic symptoms (TNS) after spinal anesthesia (SPA) is defined as back pain with radiation or dysesthesia in the buttocks, thighs, hips and calves, occurring within 24 h after recovery from otherwise uneventful SPA. The symptoms last for about 1-3 days but neurophysiologic evaluation does not show pathologic findings. The type and the preparation of the local anesthetic drug (baricity, concentration, additives or preservatives) are most often discussed as the underlying cause of TNS. ⋯ Prilocaine and bupivacaine for SPA are associated with less TNS than lidocaine and mepivacaine. For the other local anesthetics there were not enough comparative trials to give conclusive recommendations.
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Meta Analysis
[Dexamethasone for prophylaxis of postoperative nausea and vomiting. A meta-analysis of randomized controlled studies].
Randomised controlled trials investigating the efficacy of dexamethasone alone or in combination with other antiemetics to prevent postoperative nausea and vomiting (PONV) were included in a meta-analysis to estimate the relative efficacy of these treatments. ⋯ Dexamethasone has antiemetics effects that are superior to placebo treatment and are comparable with conventional antiemetic agents (e.g. 5-HT3-antagonist, dopamine antagonists). The drug is especially useful in combination with other antiemetics and increases the efficacy of the antiemetic partner drug.
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Meta Analysis
[The laryngeal mask in pediatric adenotonsillectomy. A meta-analysis of medical studies].
Anaesthesia both for adenotomy (AT) and for tonsillectomy (TE) frequently presents a challenge. On one hand, children scheduled for adenotomy often have upper airway infections and are thus at risk of laryngo- and bronchospasm; on the other hand the ENT surgeon and the anaesthetist have to share the "workspace" in the patient's mouth. ⋯ Following several years' use of the mask for this purpose in AT and TE in young children, we report our experience and summarise the literature on this topic. The laryngeal mask represents a safe alternative to intubation, provided there is close cooperation with the ENT surgeon.