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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The routine use of nitrous oxide as a component of the carrier gas has been unanimously called into question in recent surveys, in fact, its use is now recommended in indicated cases only. Whereas a lot of contraindications are listed in the surveys, precise definitions of justified indications are not given. In clinical routine practice, there are absolutely no problems in carrying out inhalational anaesthesia without nitrous oxide. ⋯ Furthermore, these calculations disregard the cost of the technical maintenance fo the central gas piping system and of the regular measurement of workplace contamination with nitrous oxide by a certified institute, which in Germany, ad least, is obligatory. The additional costs of nitrous oxide-free inhalational anaesthesia seem to be balanced by the savings. Given the numerous justified arguments against the routine use of nitrous oxide, the lack of precisely-defined indications and the clinical experience showing that doing without nitrous oxide is uncomplicated, self-financing and ecologically beneficial, the use of nitrous oxide should be given up completely.
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Anaesthesiol Reanim · Jan 2000
Randomized Controlled Trial Comparative Study Clinical Trial[Anesthesia with remifentanil combined with desflurane or sevoflurane in lumbar intervertebral disk operations].
Recovery characteristics, haemodynamic profile, analgesic requirement and costs were evaluated and compared in patients undergoing elective lumbar discectomy with remifentanil-based anaesthesia using either desflurane or sevoflurane as the volatile anaesthetic agent. Sixty-two patients (ASA I/II status) were randomly assigned to receive either desflurane and remifentanil or sevoflurane and remifentanil (in oxygen/air) for anaesthesia. After induction with 0.5 microgram/kg/min remifentanil, 4 to 5 mg/kg thiopentone and 0.5 mg/kg atracurium, the patients received 0.25 microgram/kg/min remifentanil and 0.5 +/- 0.05 MAC of one of the volatile anaesthetic agents for further maintenance of anaesthesia. ⋯ Incidence and severity of side-effects such as nausea, vomiting or shivering did not differ between the groups and were acceptable under clinical conditions. Costs for desflurane were significantly higher than those for sevoflurane, but total costs were not different between the groups. Concerning recovery profile, desflurane/remifentanil seems to have small advantages over sevoflurane/remifentanil in patients undergoing lumbar vertebral disc resection.
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Anaesthesiol Reanim · Jan 2000
Randomized Controlled Trial Comparative Study Clinical Trial[Effects of sevoflurane versus propofol on oculocardiac reflex--a comparative study in 180 children].
Oculocardial reflex (OCR) occurs particularly through manipulation of the medial rectus muscle and results in a bradycardic arrhythmia. In children the incidence is between 60 and 80%. After using sevoflurane in clinical practice, the absence or non-occurrence of this reflex was observed. ⋯ Under sevoflurane the occurrence of the reflex was significantly (p < 0.05) reduced to 14% of all patients as compared to 75% in patients who received a propofol infusion. Sufficient reflex reduction according to the depth of narcosis under sevoflurane in combination with the sympathomimetic effects of this drug could therefore be discussed as a reason for its positive effects. In our opinion, the use of sevoflurane should be considered as an option for general anaesthesia in strabismus surgery.
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Anaesthesiol Reanim · Jan 2000
Comparative Study[Continuous recording of cardiac output volume with the OptiQ system--experiences with clinical application].
This report discusses initial experiences with the clinical application of continuous cardiac output measurement (OptiQ SvO2/CCO-System). The system was used in 9 intensive care patients suffering either global cardiac insufficiency or systemic inflammatory response syndrome. Continuous cardiac output measurement was recorded during a period of stable blood pressure conditions and compared with the results of the conventional thermodilution method (bolus technique) in these patients. ⋯ After a period of two days, the costs of the conventional bolus technique significantly exceeded those of continuous measurement. The expenses for the conventional thermodilution technique are largely determined by the frequency of application and, hence, by the personnel and laboratory costs. In our experience, easy component handling and stable measuring properties make this new method of continuous cardiac output monitoring a valuable method in the diagnose and care of patients who are critically ill.