Anaesthesiologie und Reanimation
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Over the last years, ambulatory anaesthesia has gained more significance within the realm of anaesthesiology in Germany. The German health care system aspires to improve the link between ambulatory and clinical health care. Also, the increasing percentage of older people has changed the demographics of society considerably. ⋯ It also reviews important structural and procedural requirements and recommendations for the implementation of ambulatory anaesthesia. Topics included are technical requirements, equipment, selection of patients, informed consent, fasting regulations, choice of anaesthetics and postoperative care. In order to accomplish a favourable outcome quality in ambulatory anaesthesia, professional judgement and implementation of the respective guidelines appear to be important rules of conduct.
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Pain therapy is an essential component of clinical care. Using the example of a regional hospital, the various possibilities of providing effective pain therapy are discussed. ⋯ Proven methods of organising acute pain service are also discussed. The most decisive factor is the degree of patient satisfaction, which can be ensured by measures of quality control.
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Based on a questionnaire of the General Hospital of Hamburg-Altona, we asked 738 patients about postoperative complaints such as nausea, vomiting, pain in the operating field and feeling of coldness in order to record the quality of the results of operation and anaesthesia in 1997 and 1998. The incidence of nausea and vomiting amounted to only 29% on average. One of our earlier studies of postoperative vomiting from 1995-1997 and the results gained from a control group of non-treated patients in our ondansetron study from 1995, which was conducted using information drawn from the routinely-used anaesthesia protocol and was therefore limited to data from the immediate pre- and postoperative period up to discharge of the patients from the recovery ward, showed much higher frequencies of nausea and vomiting (44 and even 66% on average, respectively). ⋯ This shows that a satisfactory solution to this problem has not yet been found--partly due, unfortunately, to financial restrictions. Nevertheless, for 15% of the patients postoperative nausea and vomiting were of only minor importance for general satisfaction with the treatment given them. This was probably due to good premedication of amnestic after-effects of narcosis.
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Anaesthesiol Reanim · Jan 2001
Randomized Controlled Trial Comparative Study Clinical Trial[Rocuronium or vecuronium for intubation for short operations in the preschool age? Effects on time in the operating room and postoperative phase].
This prospective randomized study compares the effects of rocuronium (R) and vecuronium (V) on the early postoperative period in infants. Forty-eight infants between the ages of three and six, scheduled for elective ENT procedures, were studied after prior approval of local ethics committee and informed parental consent. All children were premedicated with chlorprotixene and belladonna. ⋯ Similarly, no differences in SaO2 were noted during the recovery period in the recovery room. Significant differences between the non-depolarizing relaxants were found in the TOF-ratios at extubation (R: 0.73 +/- 0.31 min, V: 0.48 +/- 0.34 min) and arrival in the recovery room (R: 0.88 +/- 0.21 min, V: 0.69 +/- 0.26 min). 0.4 mg/kg Rocuronium and 0.075 mg/kg vecuronium can be used for intubation during short operations on pre-school children. Rocuronium may be the better alternative, due to its faster neuromuscular recovery properties.
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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.