European journal of anaesthesiology
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Eight currently used factory-new anaesthesia circle systems (Dräger Cicero, Dräger Sulla, Dräger AV1, Gambro Engström Elsa, Megamed 700A, Ohmeda Modulus II Plus, Siemens Ventilator 710 and Siemens Servo Ventilator 900 D with circle system) and a Megamed 077 which had been clinically used for 11 years were tested for gas leaks according to the Draft European Standard Anaesthetic Workstations and Their Modules. All measurements were performed using the Cicero ventilator developed by Dräger with its integrated test program for the detection of system leakage. ⋯ In the 'manual' position and with the soda-lime canister and the volumeter (or flow-sensor) included, the following leak rates were determined: Dräger Cicero, 5.0 ml min-1; Dräger Sulla, 22.8 ml min-1; Dräger AV1, 7.7 ml min-1; Gambro Engström Elsa, 33.4 ml min-1; Megamed 700A, 11.5 ml min-1; Ohmeda Modulus II Plus, less than 0.1 ml min-1; Siemens Ventilator 710, 0.3 ml min-1; Siemens Servo Ventilator 900D with circle system 985, 9.6 ml min-1; Megamed 077, 47.5 ml min-1. All anaesthesia breathing circle systems tested performed below the leakage limit of 100 ml min-1 proposed by the draft standard.
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Randomized Controlled Trial Comparative Study Clinical Trial
A haemodynamic comparison of epidural versus intrathecal sufentanil to supplement general anaesthesia for abdominal aortic surgery.
The present study was designed to evaluate the influence of epidural sufentanil (ES) and intrathecal sufentanil (IS) on the peri-operative haemodynamic responses during abdominal aortic surgery. Twenty-four ASA Grade II patients without clinical symptoms of coronary artery disease received, randomly, epidural (n = 12) or intrathecal (n = 12) sufentanil combined with light general anaesthesia for elective bifemoral grafting for aorto-iliac occlusive disease. The IS group contained significantly more hypertensive patients than the ES group. ⋯ Revascularization produced significant differences in HR, SVR and CI in both groups in comparison with the pre-declamping period. Notable was the maintenance of systemic blood pressure following revascularization due to preservation of sympathetic activity. It was concluded that both epidural and intrathecal sufentanil produce comparable and stable haemodynamics in this category of patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
General anaesthesia versus epidural anaesthesia for primary caesarean section--a comparative study.
Forty-seven healthy parturients undergoing elective Caesarean section were randomly allocated to either general anaesthesia (n = 24) or epidural anaesthesia (n = 23) under standardized anaesthetic and surgical conditions. Seven women of the epidural group required additional systemic analgesia or sedation following delivery of the neonate. Nine of 24 newborns obtained 1-min Apgar scores below 7 after general anaesthesia compared to only 3/23 after epidural anaesthesia. ⋯ Our investigation did not show either the incision-delivery interval or the start of operation-delivery interval to play a role in neonatal outcome. Epidural anaesthesia is superior to general anaesthesia in Caesarean section under normal conditions with regard to neonatal outcome. Whether this is also true for critical conditions cannot be concluded from this study.
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The pharmacodynamics and -kinetics of pipecuronium were studied in 12 patients, six of whom received 100 micrograms kg-1 for laryngectomy (Group L), and six who underwent choledochotomy after insertion of the T-drain and were given 50 micrograms kg-1 (Group C). Onset time and clinical duration were 2.3 and 109 min and 2.8 and 39 min in Groups L and C, respectively. All patients could be sufficiently reversed with neostigmine. ⋯ Within 24 h, 38.6% and 37% were excreted unchanged in the urine and 4.4% and 1% as 3-desacetyl pipecuronium in Groups L and C, respectively. Within 24 h only 2% was excreted into the bile in Group C. Distribution volume and terminal half-life in Group C were positively correlated with pre-operative serum aminotransferase levels (P less than 0.005).
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Randomized Controlled Trial Clinical Trial
Thoracolumbar epidural anaesthesia and isoflurane to prevent hypertension and tachycardia in patients undergoing abdominal aortic surgery.
Cardiovascular and hormonal responses to reconstructive abdominal aortic surgery were studied in 20 patients anaesthetized either with moderate-dose fentanyl (20 micrograms kg-1) combined with isoflurane, nitrous oxide and oxygen (n = 10), or with thoracolumbar epidural bupivacaine combined with isoflurane, nitrous oxide and oxygen (n = 10). After the start of operation, hypotension occurred in four patients in the epidural group. In both groups, the aortic cross-clamping caused slight increases both in mean arterial pressure and in calculated systemic vascular resistance, and a significant decrease in cardiac index. ⋯ At the same time, plasma vasopressin and adrenaline increased significantly in both groups, whereas plasma noradrenaline did so only in the fentanyl group. The results suggest that thoracolumbar epidural bupivacaine combined with low-dose isoflurane in nitrous-oxide-oxygen prevents intra-operative hypertension and tachycardia, but it may cause hypotension. Post-operative hypertension and tachycardia as well as the increase in plasma noradrenaline are prevented by epidural administration of bupivacaine-fentanyl.