Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1999
Randomized Controlled Trial Clinical Trial[Total intravenous anesthesia (TIVA) and balanced anesthesia with short-acting anesthetics for ENT surgery in children].
It was the aim of this study to compare total intravenous anaesthesia (TIVA) with balanced anaesthesia using modern short-acting anaesthetics for ENT-surgery in children regarding the influence on haemodynamics, recovery, side-effects and costs. After approval of the Ethics Committee of the Medical Faculty of the University of Rostock, 80 children in the age of 3 to 12 years, rectally premedicated with midazolam (0.3 mg/kg) and atropine (0.01 mg/kg), were randomly assigned to TIVA (group 1, n = 41) and balanced anaesthesia (group 2, n = 39), respectively. TIVA was induced with propofol (2 mg/kg) and remifentanil (1 microgram/kg) and maintained with propofol (6 mg/kg/h) and remifentanil (0.2 microgram/kg/min). ⋯ We conclude that both TIVA and balanced anaesthesia performed with short-acting anaesthetics, are suitable anaesthetic methods for ENT operations in children. Because balanced anaesthesia with sevoflurane led to higher heart rates, this kind of anaesthesia should be used with caution in children with heart diseases. The main advantage of both methods is their short recovery time.
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Anaesthesiol Reanim · Jan 1999
Randomized Controlled Trial Comparative Study Clinical Trial[Preemptive effects caused by co-analgesia with ketamine in gynecological laparotomies?].
The preemptive use of analgetics makes it possible to influence sensitization proceedings caused by a trauma. Various mechanisms are effective in central pain treatment. The NMDA receptor plays an important role. ⋯ In addition, the pain intensity showed no differences regarding an improved postoperative analgesia through the combination of analgetics with different points of contact. The intraoperative combination of ketamine and alfentanil does not lead to a reduction of postoperative pain. No preemptive analgesia is clinically provable.
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Anaesthesiol Reanim · Jan 1999
Randomized Controlled Trial Comparative Study Clinical Trial[Effect of local anesthetics on hemodynamic effects during Mayfield skull clamp fixation in neurosurgery using total intravenous anesthesia].
For neurosurgical procedures, the association between insertion of the Mayfield skull clamp and haemodynamic changes is generally recognized. We investigated the protective effect of two local anaesthetic substances (lidocaine and bupivacaine) under the conditions of total intravenous anaesthesia (TIVA) with propofol and alfentanil. Forty-two patients undergoing an elective craniotomy (tumor resection) were included in the study and randomly divided into three groups. ⋯ The effect of both substances was the same in our study. Our results suggest that a significant reduction of the haemodynamic effects caused by insertion of the Mayfield skull clamp can be achieved by the use of local anaesthesia. Total intravenous anaesthesia alone with propofol and alfentanil cannot protect against these haemodynamic stimuli.
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Anaesthesiol Reanim · Jan 1999
Randomized Controlled Trial Comparative Study Clinical Trial[Effects of priming technique on onset profile of cisatracurium].
Compared to atracurium, cisatracurium releases less laudanosine and histamine, but it has a longer onset time. The primary objective of this study was a blinded, randomized comparison of intubation scores and onset times of a threefold ED 95 of cisatracurium using the priming technique with two priming substances cisatracurium itself and pancuronium. To test the effect of priming with cisatracurium or pancuronium on the onset of cisatracurium, 45 patients were anaesthetised with 0.15-0.25 mg/kg alfentanil, 0.25-0.3 mg/kg edomidate i.v. and O2/N2O, and were randomisely divided into one of three groups. ⋯ The two priming groups showed a significantly faster onset of neuromuscular blockade than the control group (cisatracurium priming group: T1 = 0: 178.4 +/- 16.3 sec., pancuronium priming group 171.2 +/- 15.3 sec. vs. control group: T1 = 0: 205.5 +/- 18.9 sec.). Both primed groups showed no significantly better intubation scores, compared with the control group. Using the priming principle, cisatracurium will give good intubation scores 120 seconds after injection with a clinical duration profile comparable to an equipotent dose of atracurium.
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Anaesthesiol Reanim · Jan 1999
Randomized Controlled Trial Clinical Trial[Preoperative clonidine comedication within the scope of balanced inhalation anesthesia with sevoflurane in oral surgery procedures].
Both clonidine and sevoflurane are interesting drugs for anaesthesia in maxillo-facial surgery. The present study was performed to discover how far it is possible to combine the benefits of sevoflurane (fast modulation of depth of anaesthesia, rapid emergence and recovery) and clonidine (reduction of perioperative stress response, prophylaxis of postoperative shivering, analgetic, antiemetic and anaesthetic-saving effect) without compromising the pharmacokinetic of sevoflurane. Twenty-eight patients were included in the present double-blinded prospective study. ⋯ Preoperative clonidine comedication seems to complicate the management of anaesthesia. On the other hand, it is beneficial during the early postoperative period (e.g. stability in haemodynamics, prophylaxis of shivering) without compromising emergence and recovery. Our results show that therapy with clonidine should be better placed at the end of anaesthesia.