Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1997
Review Comparative Study[Local anesthetics--maximum recommended doses].
"Maximum doses" determined up to now do not take account of such important pharmacokinetic and toxicological data as: 1) the dependence of blood levels measured on the technique of regional anaesthesia, 2) and the raised toxicity of a local anaesthetic solution containing adrenaline following inadvertent intravascular (intravenous) injection. A maximum dose recommendation differs according to the technique of local anaesthesia for A: subcutaneous injection, B: injection in regions of high absorption, C: single injection (perineural, e.g. plexus), D: protracted injection (catheter, combined techniques), E: injection into vasoactive regions (near to the spinal cord, spinal, epidural, sympathetic). This sequential categorization also underscores the need to select appropriate techniques as well as concomitant monitoring according to the technique of administration and to the expected and possible plasma level curve. ⋯ They must be varied individually depending on the body weight and condition of the patient. Recommended maximum doses are of orientative significance, they do not constitute a maximum dose. There is no quantitative limit for ropivaccine because the recommended techniques do not allow higher volumes of this long acting local anaesthetic.
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Anaesthesiol Reanim · Jan 1997
Review[Ventilation modes and strategies in intensive care medicine].
Advances in ventilator technology and recent findings in pathophysiological mechanisms have resulted in a remarkable decrease in classical volume controlled and pressure controlled ventilation modes as treatment for severe acute respiratory insufficiency. New modes of ventilatory support enabling and encouraging patients' spontaneous breathing, such as Biphasic Positive Airway Pressure (BIPAP) and Airway Pressure Release Ventilation (APRV), make it possible to adapt ventilatory support better and more easily to suit patients' needs than conventional modes of controlled ventilation. Preservation and support of patients' spontaneous breathing improves pulmonary gas exchange and reduces stress imposed by mechanical ventilation. ⋯ Through this, the need for sedation and analgesia is considerably reduced and this may minimize systemic side-effects and complications from analgo-sedation and mechanical ventilation. The drugs should be administered in an adequate, individually adapted manner. Routinely-ordered and fixed combinations of drugs administered continuously are not adequate adequate as they further carry the risk of overdosing a different single drug with the corresponding side-effects (depression of respiratory drive, gut motility, etc.).
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Anaesthesiol Reanim · Jan 1997
Randomized Controlled Trial Comparative Study Clinical Trial[Pain therapy after thoracotomies--systemic patient-controlled analgesia (PCA) with opioid versus intercostal block and interpleural analgesia].
Both regional analgesia and systemic opioid therapy (e.g. PCA) are commonly used for pain relief following thoracic surgery. Many anaesthesiologists are reluctant to use thoracic epidural analgesia on general surgical wards. ⋯ Intercostal blocks and interpleural analgesia significantly reduce opioid demand following thoracotomy and are effective means of postoperative pain management. Nevertheless, in contrast to epidural analgesia, both methods have to be supplemented by, or combined with, systemic analgesics in most patients. On the other hand, compared to epidural analgesia, ICB and IPA are less invasive and easier to manage on general surgical wards.
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Anaesthesiol Reanim · Jan 1997
Randomized Controlled Trial Comparative Study Clinical Trial[Effect of gamma-hydroxybutyric acid and pentoxifylline on kidney function parameters in coronary surgery interventions].
After cardiac surgery, transient renal dysfunction often occurs. The main reasons for impairment of renal function are intraoperative hypotension, ischemia/reperfusion injury and inflammatory response to cardiopulmonary bypass (CPB). Pentoxifylline is known to have anti-inflammatory properties. ⋯ The results of the present pilot study suggest the detection of tubular proteins and enzymes a useful addition to present routine clinical standards for recognizing early intraoperative changes in renal function. In the patients studied, there were no clinical signs of renal dysfunction. Neither GHB nor pentoxifylline--in the doses applied--was able to show a therapeutic benefit despite the theoretical advantages.
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Anaesthesiol Reanim · Jan 1997
Review Comparative Study[Critical evaluation of the new inhalational anesthetics desflurane and sevoflurane].
New anaesthetic agents are being continuously developed to find the ideal agent. The most commonly used inhaled anaesthetic in adults is isoflurane and in children halothane. The need for, and the value of the new agents desflurane and sevoflurane depend on a comparison of the properties of a theoretically ideal agent with those of isoflurane, halothane and the new agents. ⋯ Desflurane has a major advantage over sevoflurane: it is not biotransformed nor does it interact with carbon dioxide absorbents. However, desflurane is associated with troublesome cardiovascular stimulation involving tachycardia and both pulmonary and systemic hypertension. Sevoflurane appears to be advantageous for three reasons: firstly, because of its pleasant odour and consequent suitability for induction by inhalation, particularly in paediatric anaesthesia; secondly, it can be used with currently employed vaporizers, and thirdly, surgical demands can be met by lower doses, because its potency is higher.