Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1996
Case Reports[Intraosseous puncture as vascular access in pediatric emergency and intensive care medicine].
In paediatric resuscitation scenarios, emergency physicians have sufficient skills in endotracheal intubation. They are successful in about 80% of the cases as US studies indicate. However, vascular access is much more of a critical problem and emergency physicians succeed in only 50%. ⋯ Eleven patients survived who would not have done so without quick intravenous access. As complications we recorded a minor fracture, one compartment syndrome, which did not require surgical intervention, and a postmortally discovered minor fat embolism, which was of no clinical significance. Courses teaching this method should be offered in Germany to spread knowledge of this life-saving technique.
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Anaesthesiol Reanim · Jan 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Effect of rocuronium in sufentanil/isoflurane and sufentanil/propofol anesthesia].
It is a well-known fact that the duration of the effect of non-depolarizing neuromuscular blocking agents is influenced by other anaesthetics. Etomidate, propofol and nitrous oxide have no influence on the duration of effect of rocuronium, but a prolongation of the rocuronium effect under the influence of isoflurane has been described. In this study, we investigated the onset time, duration of effect and recovery index of rocuronium in isoflurane/N2O/sufentanil anaesthesia compared with these parameters in propofol/N2O/sufentanil anaesthesia. ⋯ Significant changes in arterial blood pressure or heart rate were not observed. The intubation conditions after 60 seconds were excellent in 34 patients (85%) and good in 6 patients (15%). It can be concluded that in comparison with anesthesia maintained by propofol/sufentanil and nitrous oxide/oxygen, the relatively low but necessary supplementation with isoflurane instead of propofol does not lead to a clinically relevant amplification of the relaxing effect of rocuronium.
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Anaesthesiol Reanim · Jan 1996
Review[Spinal para-medullary conduction anesthesia in therapy with anticoagulant drugs].
Epidural and spinal blocks can lead to iatrogenic bleeding in the spinal canal. Incidence of this severe complication is considered low, but the risk of irreversible neurological defects for the patient requires increased attention by the anaesthetist. The perioperative risk is higher in patients under anticoagulant therapy. The different pharmacodynamics and pharmacokinetics of practically relevant anticoagulants are discussed and recommendations for the performance of centroneuraxis blocks in patients under anticoagulant therapy are given.
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Mivacurium is a potent, short-acting, nondepolarizing relaxant of the benzylisoquinoline series. In adults endotracheal intubation can be performed after a 2 x ED95 dose of 0.15-0.2 mg/kg within 2-2.5 minutes. In infants onset time and clinical duration of mivacurium are significantly shorter than in adults. ⋯ The properties of mivacurium described above are related to patients with normal pseudocholinesterase activity. Particularly patients with atypical pseudocholinesterase show a marked increase in clinical duration. Side-effects due to significant histamine release with flush, tachycardia and hypotension are seldom observed if mivacurium is injected slowly over a period of more than 30 seconds and bolus injections of more than 2 x ED95 or 3 x ED95 are avoided.
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Anaesthesiol Reanim · Jan 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Combination of intravenous patient-controlled analgesia with epidural anesthesia for postoperative pain therapy].
The aim of this study was to prove the hypothesis that a combination of epidural anaesthesia with intravenous patient-controlled analgesia (PCA) could improve perioperative pain management. Patients of the urological department undergoing lower abdominal surgery were randomized for two different pain managements. Patients of group 1 (n = 37) were narcotized, intubated and ventilated for the operation; arriving at the recovery room, they were given a PCA-pump, the drug used was piritramide and the parameters were bolus 2.5 mg, blocking time 20 minutes and no basal infusion rate. ⋯ The benefits of better pain management contrast with the risks resulting from combining the two techniques. In our patients we found an improvement of pain management in the early postoperative period. The combination of epidural anaesthesia with intravenous patient-controlled analgesia can be regarded as a further possibility for treating postoperative pain in the sense of "balanced pain management".