Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 2000
Biography Historical Article[Paul Sudeck--his contribution to anesthesia].
Paul Sudeck is not generally recognised as a pioneer in anaesthesia, although he is well known for the atrophy of bone named after him. However, he not only championed the use of ether as a safe anaesthetic agent, described a method of ether analgesia for outpatient surgery and devised an inhaler for its administration, but also reintroduced nitrous oxide into Germany and invented possibly the first circle carbon dioxide absorption system with an optional attachment for continuous positive pressure respiration useful for the performance of thoracotomies.
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Anaesthesiol Reanim · Jan 2000
Randomized Controlled Trial Clinical Trial[Clonidine within the scope of balanced inhalation anesthesia with sevoflurane--effects on pEEG parameters].
The anaesthetic-saving property of clonidine has often been reported. In our own prospective, randomized study, in which the depth of anaesthesia was controlled by using spectral edge frequency (target-SEF90 = 10 Hz) and clinical parameters, we confirmed the anaesthetic-saving property only for fentanyl (-20%). On the other hand, there was no difference in MAC-sevoflurane values between the groups in keeping a steady target-SEF. ⋯ The described EEG effects on the power-spectrum inevitably influence SEF50 and SEF90. In our opinion, SEF50 is not a powerful predictor of depth of anaesthesia, when anaesthesia is performed in the way described. By performing this variation of balanced anaesthesia and co-medication with clonidine, higher values of SEF90 (11-14 Hz) seem to be adequate for surgical manipulation.
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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
Review Comparative Study[Perioperative management with short-acting intravenous anesthetics].
Total intravenous anaesthesia (TIVA) with short-acting drugs is a standard procedure for day case surgery and is increasingly used for neurosurgical, cardiac surgical and paediatric surgical operations. The combination of propofol with alfentanil or remifentanil is frequently applied due to its favourable pharmacological properties. Propofol is characterized by a large volume of distribution at steady state and a relatively long elimination half time (t1/2 beta). ⋯ Adequate pain therapy is mandatory after total intravenous anaesthesia with short-acting drugs. Continuous infusion of remifentanil for postoperative analgesia or supplementation of regional anaesthesia requires careful monitoring of vital functions. The economic aspects of TIVA remain to be determined.
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In the literature there is only little information about the influence of hyperoxia on cerebral metabolic parameters. The aim of our study was to examine the effect of increased inspiratory oxygen concentrations on parameters of brain metabolism in elective neurosurgical patients. Ten patients undergoing an elective craniotomy for brain tumour resection were included in the study. ⋯ Under increasing levels of FiO2, one can see an increase in sjO2, of jugularvenous oxygen tension (pjO2) and in oxygen content (cjO2). The most important result is the significant decrease (10% from baseline) in jugularvenous lactate at FiO2 1.0, while arterial lactate did not change significantly nor did the following parameters: paCO2, pjCO2, LOI, modified LOI, arterial and jugularvenous glucose. Hyperoxia causes a possible shift to aerobic metabolic situation in the brain reflected by decreased jugularvenous lactate.