Anaesthesiologie und Reanimation
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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.
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Anaesthesiol Reanim · Jan 1997
Review[Pharmacokinetics from the viewpoint of the clinical anesthetist].
Pharmacokinetics describes the time-depend course of plasma concentration of a drug. Pharmacodynamics describes the pharmacological effect of the substance. Both together form the pharmacological model used in clinical practice. ⋯ The main clinical use of pharmacokinetics is to sustain dosing schemes based on scientific data. It also may be helpful in creating new administration schemes especially for continuous infusion of intravenous hypnotics or analgetics. New developments such as Target-Controlled Infusion (TCI) are based on pharmacokinetic data and computations and may be an improvement for the clinically working anaesthetist.
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Anaesthesiol Reanim · Jan 1997
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of dosage relations of prilocaine and bupivacaine for axillary plexus anesthesia].
The effects of 40 ml of prilocaine 1% compared to 30 ml prilocaine 1% added to 10 ml bupivacaine 0.5% and 20 ml prilocaine 1% added to 20 ml bupivacaine 0.5% after injection into the brachial plexus sheath were evaluated. In a prospective study, 90 patients who underwent surgery on the upper limb were randomly allocated to one of these three groups. In each group 15 patients were treated using nerve stimulation with an immobile needle and 15 using a plexus catheter. ⋯ Six hours after injection the patients who had received 40 ml of prilocaine 1% had significantly more pain (2.25) than patients who had received 30 ml of prilocaine 1% plus 10 ml of bupivacaine 0.5% (0.96); patients who had received 20 ml of prilocaine 1% plus 20 ml of bupivacaine 0.5% had nearly no pain (0.19). We can conclude that mixing of prilocaine 1% with bupivacaine 0.5% is a useful way to achieve adequate duration of anaesthesia and to reduce postoperative pain without extending onset times for axillary plexus block. Postoperative application of analgetics can often be avoided completely.
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Anaesthesiol Reanim · Jan 1997
Comparative Study[Mivacurium--a new muscle relaxant compared with atracurium and vecuronium].
This study investigates the effects of mivacurium (3 times ED95) on neuromuscular block, intubation conditions and general safety in comparison with equipotent doses of atracurium and vecuronium. Following Ethical Care Committee approval and informed consent, 90 ASA I+II patients aged 18 to 65 were studied undergoing elective ENT surgery. Anaesthesia was induced with 1.5 mg/kg propofol and 0.2 mg/kg alfentanil and maintained through continuous infusion of propofol (8 to 10 mg . kg-1 . h-1) and nitrous oxide in oxygen. ⋯ Facial flushing and mild bronchospasms as signs of histamine release resulted more often in the mivacurium (20%) and atracurium groups (23%) than in the vecuronium group (3%). In contrast to atracurium and vecuronium, recovery from mivacurium-induced neuromuscular blockade is rapid. However, the onset time after 3 times ED95 was significantly longer for mivacurium than for atracurium or vecuronium.
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Anaesthesiol Reanim · Jan 1997
Review[Artificial humidification of inspired gas--status of knowledge and technique].
Artificial humidification of inspired air serves to maintain or restore physiological heat and moisture conditions in the bronchial system in intubated or tracheotomized patients. The need to condition the respiratory gases in these patients is undisputed. The present paper reviews the pathophysiology and methods of the artificial active and passive humidifying of inspired gases. ⋯ Present-day medical knowledge indicates that passive artificial humidifying of respiratory gases (heat and moisture exchanger, HME) is adequate to meet most requirements for warming and moistening the inspiratory air in patients whose upper airways are devoid of natural conditioning of respiratory gases in consequence of intubation and tracheotomy. This applies to artificial ventilation in prehospital situations, artificial ventilation in anaesthesia and long-term artificial ventilation on the intensive care unit. With appropriate restrictions, the respiratory air of patients who breathe spontaneously via an artificial air vent (e.g. tracheal cannula) can also be conditioned by HME.