Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1995
Comparative Study[Interactions between renal and general hemodynamics in fentanyl, droperidol, ketamine, thiopental and in peridural anesthesia--animal studies].
The main focus of this paper is to show regulative interactions between cardiac index (CI) and renal blood flow (RBF) with various intravenous anaesthetics under steady state conditions. Several experimental series were carried out on dogs with the following anaesthetic doses (as given per hour and per kilogram body weight-h-1 x kg-1): fentanyl 50 micrograms, ketamine 4 and 10 mg, and thiopentone 10 and 20 mg. The basic anaesthesia used was halothane (0.7 vol.%) in N2O/O2 (ratio about 3:1), because renal function, renal autoregulation and responsiveness to renally effective drugs remain nearly unaltered by this anaesthetic procedure. ⋯ The effect of each anaesthetic drug on RBF has principally to be taken as regulative adaptation to altered circulatory conditions. Increasing plasma renin levels are mainly a compensatory reaction following a decline in arterial blood pressure due to anaesthesia induced sympathicolysis. With regard to renal function, the additional use of epidural anaesthesia (functional "denervation" of the kidney) can be recommended especially for highly invasive surgical procedures to antagonize reduction of RBF, which is often induced sympathetically by pain or by commonly used anaesthetic drugs.
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Anaesthesiol Reanim · Jan 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Early detection of opiate-induced respiratory depression in the postoperative phase].
We examined in 30 patients the efficacy of regular assessments of respiratory rate (every 15 minutes) and blood gas analysis (at 30, 60, 120, 180 minutes) and continuous monitoring via pulsoximeter and capnometer in recognizing early ventilatory problems. For postoperative analgesia the patients received randomly and double-blind patient-controlled intravenous or epidural analgesia with sufentanil. Within 15 minutes after the initial intravenous bolus injection of 15 micrograms sufentanil respiratory depression occurred in 4 patients. ⋯ Oxygen saturation time patterns of pulsoximetry and blood gas analysis correlated significantly (p < 0.001), although the mean values of the methods differed (NS). In contrast, carbon-dioxide pressure time patterns of capnometry and blood gas analysis correlated less significantly (p < 0.01) although the mean values of the methods correlated significantly (p < 0.01). Concomittant monitoring via pulsoximeter and capnometer is therefore superior to regulary assessments of respiratory rate and blood gas analysis and potentially useful for the clinical routine.
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Anaesthesiol Reanim · Jan 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Improved climatization of anesthetic gases by modifying the Sulla 808 V anesthesia equipment].
Maintenance of a physiological airway climate is one of the goals of anaesthesia ventilation. This may be achieved by integration of heat and moisture exchangers (HME's) or--more economically--by reducing fresh gas flow rate down to the minimal-flow-range. Conventional bag-in-bottle ventilators with hanging bellows do not allow operation with minimal-flow-rates; flow reduction results sooner or later in a positive-negative-pressure ventilation pattern; especially so in patients suffering from COPD. ⋯ Twenty-four consenting patients were randomly assigned to be ventilated with either high (6.0 L/min, n = 12) or minimal (0.6 L/min, n = 12) fresh gas flow rate. The time course of inspiratory temperature and humidity was measured over a period of 120 minutes; water content was calculated from relative humidity and temperature. In the minimal-flow-group, already after 60 minutes a temperature of 28.6 +/- 0.9 degrees C and a water content of 17.6 +/- 1.9 mg H2O/L were achieved (mean +/- SD).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anaesthesiol Reanim · Jan 1995
Review Comparative Study[Treatment of postoperative pain with peridural administration of opioids].
The advantages and disadvantages associated with epidural opioids require careful selection of the opioid and its dose regimen. There is no ideal opioid available for epidural use. Comparative pharmacokinetic data help selection of the appropriate epidural opioid. ⋯ Nalbuphine and butorphanol should not be selected for epidural use until the benefit/risk ratio is defined. The safety of patients is paramount. If patients are harmed by inappropriate opioids or dose regimens, this will unjustly discredit a valuable treatment of postoperative pain.
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Anaesthesiol Reanim · Jan 1995
Biography Historical Article[The "narcotization statistics" of Ernst Julius Gurlt of 1895--an early contribution to quality control in anesthesia].
The fifth compilation of anaesthetization statistics "Zur Narkotisirungsstatistik", presented by the surgeon Ernst Julius Gurlt in 1895 summarizes the answers to a questionnaire of the German Surgical Society given by 78 mainly large German surgical hospital departments. It comprises 55,395 anaesthetic procedures, most of them (34,412) performed under chloroform, although this substance was still associated with many more fatal complications than ether. ⋯ Details concerning premedication, the role of the anaesthetist, postoperative care, documentation and especially complications and how to prevent and deal with them are taken from 38 reprinted reports. Gurlt's activities initiated more than 100 years ago are to be seen as pioneer work in the field of anaesthesiological quality assessment.