Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 1993
Randomized Controlled Trial Comparative Study Clinical Trial[Comparative effectiveness and tolerance study of a new galenic etomidate formula].
One of the major disadvantages of etomidate is the high frequency of pain on injection. A new galenic formulation based on a lipid emulsion for etomidate (Etomidat-Lipuro) was compared with the commercial standard (etomidate in propylene glycol, Hypnomidate) in a prospective, randomised, double-blind clinical evaluation in 232 patients undergoing elective surgery in general anaesthesia. The patients were premedicated with flunitrazepam 2 hours before the investigation. Two intravenous cannulas were inserted in veins of forearm or back of the hand. One cannula was only used for the application of etomidate and removed immediately after injection. General anaesthesia was induced with 0.3 mg/kg etomidate at an injection rate of 20 mg/30 s. If the patient did not complain of pain or other sensations during injection spontaneously, he was questioned for 15 s after beginning of injection. The arm used for application of etomidate was kept free of any manipulation during the operation and the following five postoperative days. ⋯ There were marked differences between the two etomidate preparations concerning venous irritation. About 20% of the patients receiving the hypnotic in propylene glycol complained spontaneously of pain on injection, whereas none with the lipid emulsion. No difference was found in the incidence of myoclonic movements. The time interval between the beginning of injection and loss of eyelid closure reflex was about 50 s and not different for the two galenic formulations. Blood pressure during and after induction of anaesthesia did not differ. The heart rate in the group of patients with etomidate in lipid emulsion was slightly increased before and immediately after intubation compared to the propylene glycol group. 4% of the patients in the propylene glycol group suffered from postoperative venous complications as reddening, swelling, induration or pain. These complications could not be seen in the lipid emulsion group.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 1993
Review[Infections caused by intravascular catheters. Etiopathogenesis--diagnosis--therapy--prevention].
Despite improvements in infection control measures, catheter-related infections represent a challenging problem in modern medicine. The difficulties in correctly diagnosing catheter-related infections and the necessity to remove the device in case of suspected infection require preventive measures in the first place. Most authors stress the importance of strict aseptic catheter management. ⋯ Newer studies show that impregnation of catheters with the antiseptic substances silver-sulphadiazine and chlorhexidine is effective in reducing bacterial colonisation of the catheters. A pilot study on intensive-care patients demonstrated a significant reduction in catheter-related infections and bacteraemia by impregnated catheters. This novel approach may reduce the incidence of catheter-related infections below the level which could be achieved by employing all current preventive measures.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 1993
[Connector for double-lumen tubes in thoracic surgery interventions].
The junction between double-lumen endotracheal tube (DLT) and anaesthetic circuit is of crucial importance to modern anaesthesiological management in thoracic surgery. We present a connector which allows for all the essential procedures, such as clinical control of DLT position, use of fiberoptic bronchoscope (FOB) to control or correct DLT position, application of differential lung ventilation patterns or simple suction manoeuvres by easy handling, minimal interference, and avoidance of disconnection or clamping.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 1993
Comparative Study[High purity ryanodine for in vitro diagnosis of malignant hyperthermia].
The identification of disposition for malignant hyperthermia (MH) is performed by the halothane-caffeine contracture test in skeletal muscle. However, testing currently renders about 14% of the patients MH equivocal (MHE). To reduce this number the "ryanodine contracture test" has been proposed in addition to the established procedure. As all ryanodine preparations used until now are combinations of ryanodine and dehydroryanodine, we investigate in this study the effects of the now available high-purity ryanodine (HPR) in concentrations of 2,5 and 10 mumol/l. ⋯ The ryanodine contracture test should be added to the current diagnostics of malignant hyperthermia.