Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 2001
Review Comparative Study[Clinical administration of muscle relaxants for intubation].
Muscle relaxants are used for tracheal intubation, surgical procedures and in the intensive care unit. This review describes muscle relaxants available in Germany, with special focus on their use in endotracheal intubation. We compare the advantages and disadvantages of succinylcholine (the only depolarising agent) with those of short- and intermediate-acting non-depolarising agents in an attempt to define the characteristics of the ideal muscle relaxant. ⋯ The advantages and disadvantages of using non-depolarising instead of depolarising agents are discussed using data from our studies and those of other research groups. Possible side-effects due to the chemical structure and the necessary dosage for intubation of different agents are also discussed. Two points are emphasized: firstly, the use of non-depolarising agents for intubation requires the possibility of safe ventilation of the patient via mask, and, secondly, it is important that procedures be performed by an experienced anaesthetist.
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Anaesthesiol Reanim · Jan 2001
Randomized Controlled Trial Clinical Trial[Hyperoxia-induced liberation of big-endothelin into jugular venous blood of electric neurosurgical patients].
The use of hyperoxia in emergency situations is generally accepted, but the routine and uncritical application of higher oxygen concentrations is criticized. The influence of short-term application of hyperoxia on cerebral oxygenation, cerebral lactate and BIG-endothelin (BIG-ET) was studied. After approval by the Ethics Committee of the University of Leipzig, 22 patients (hyperoxia group n = 16, normoxia, control group n = 6) undergoing an elective craniotomy were included in the study. ⋯ The changes in lactate and BIG-ET were also seen after the end of the hyperoxia. In the control group (normoxia, FiO2 0.4), no significant changes in sjO2, oxygen content, lactate and BIG-ET were observed. The increase in jugularvenous BIG-ET and the decrease in the arterio-jugularvenous difference of BIG-ET following hyperoxia indicate a higher cerebral release of BIG-ET.
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Pain therapy is an essential component of clinical care. Using the example of a regional hospital, the various possibilities of providing effective pain therapy are discussed. ⋯ Proven methods of organising acute pain service are also discussed. The most decisive factor is the degree of patient satisfaction, which can be ensured by measures of quality control.
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Anaesthesiol Reanim · Jan 2001
Comparative Study[The asphyxia-cardiac arrest rat model for developing mechanism of effect oriented therapeutic concepts after cardiopulmonary resuscitation].
In order to expand and combine clinical and basic science research opportunities on cardiac arrest, the Asphyxial Cardiac Arrest Rat Model, originally developed at the International Resuscitation Research Center in Pittsburgh, was introduced and adapted at the University of Magdeburg Medical Center. For better utilization of established morphological and biochemical evaluation techniques, the former Sprague-Dawley rat model was adapted for Wistar rats. ⋯ Furthermore, a trend towards a more pronounced secondary blood pressure depression was observed especially during the later half of the first hour after resuscitation. Post-mortem brain evaluations using conventional Nissl and haematoxylin-eosin staining techniques showed--most distinctly in the hippocampal CA1 region--delayed neuronal damage with a peak at 72 hours after resuscitation and with only a few neurons remaining after seven days of survival.
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Anaesthesiol Reanim · Jan 2001
Randomized Controlled Trial Comparative Study Clinical Trial[Rocuronium or vecuronium for intubation for short operations in the preschool age? Effects on time in the operating room and postoperative phase].
This prospective randomized study compares the effects of rocuronium (R) and vecuronium (V) on the early postoperative period in infants. Forty-eight infants between the ages of three and six, scheduled for elective ENT procedures, were studied after prior approval of local ethics committee and informed parental consent. All children were premedicated with chlorprotixene and belladonna. ⋯ Similarly, no differences in SaO2 were noted during the recovery period in the recovery room. Significant differences between the non-depolarizing relaxants were found in the TOF-ratios at extubation (R: 0.73 +/- 0.31 min, V: 0.48 +/- 0.34 min) and arrival in the recovery room (R: 0.88 +/- 0.21 min, V: 0.69 +/- 0.26 min). 0.4 mg/kg Rocuronium and 0.075 mg/kg vecuronium can be used for intubation during short operations on pre-school children. Rocuronium may be the better alternative, due to its faster neuromuscular recovery properties.