Anaesthesiologie und Reanimation
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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.
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Anaesthesiol Reanim · Jan 1999
Case Reports[High-frequency jet ventilation for placing tracheal stents--a case report].
Stenoses of the larynx and trachea may cause acute life-threatening situations. Surgical procedures in patients presenting this type of problem are a real challenge for the surgeon and the anaesthesiologist. Depending on the extent and the nature of the stenosis, the insertion of a stent may be the best therapeutic option. ⋯ In addition, at the end of the operation the newly implanted stent should not be altered by manipulations necessary for artificial respiration. We describe a new method which uses tracheal jet ventilation for implanting a stent with only short interruptions of artificial ventilation. During recovery from anaesthesia, there is no risk of dislocating the newly placed stent.
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The long predominance of the semi-open anaesthetic system in paediatric anaesthesia has been ended by the introduction of circle systems by Altemeyer. Narcoses in newborn infants, however, are usually performed with a circle system and a fresh gas flow (FGF) that greatly exceeds the ventilation volume per minute required. This prevents a desirable degree of gas climatisation. ⋯ When FGF was reduced there was a significant increase of temperature parameters after 25 min (gas) and 35 min (body). Body temperature came back to normal values or stayed normal. Artificial ventilation of neonates in anaesthesia lasting more than 50 minutes should routinely be performed with minimal FGF in order to ensure normothermia.