Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 2000
Randomized Controlled Trial Comparative Study Clinical Trial[Is the combination of nitrous oxide and hyperventilation in elective neurosurgical operations useful?].
The use of nitrous oxide (N2O) and hyperventilation (HV) in elective neurosurgery is controversially discussed. The emphasis of the study was to show the effects of N2O and/or moderate hyperventilation (paCO2 31.0 +/- 1.2 mmHg) on parameters of cerebral metabolism: jugularvenous oxygen saturation (SjVO2), cerebral extraction of oxygen (CEO2), arterial jugularvenous difference of oxygen contents (AJDO2), arterial jugularvenous difference of lactate (AJDL) and glucose (AJDGL) and lactate-oxygen index (LOI). The study was approved by the Ethics Committee of the University of Leipzig. ⋯ The parameters AJDL, AJDGL and LOI did not show any significant changes in any of the four groups. The described data represent a reduction of cerebral oxygenation, but deleterious effects caused by cerebral ischaemia could not be observed. Based on our data, hyperventilation and its combination with N2O should not be used routinely in neuroanaesthesia.
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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
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 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.