Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Desflurane versus isoflurane in geriatric patients. A comparison of psychomotor and postoperative well-being following abdominal surgical procedures].
The new volatile anaesthetic agent desflurane has a significantly lower blood-gas partition coefficient (0.42) than isoflurane (1.4), suggesting excellent intraoperative control of anaesthesia and rapid emergence and recovery from anaesthesia. However, only limited experience is available in geriatric patients undergoing major abdominal surgery. ⋯ Using a balanced anaesthesia technique, we found desflurane as suitable as isoflurane for geriatric patients. Additionally, due to the fast emergence from anaesthesia, an improved cooperativity was found. In the DES group overall better postoperative psychomotor performance resulted in a shortening of discharge times from the recovery room. Hence, desflurane anaesthesia may be advantageous in geriatric patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1998
Comparative Study Clinical Trial[Measurement of the humidity of inspired air in ventilated patients with various humidifer systems].
Humidification of inspired gas in artificially ventilated patients positively influences mucociliary function and secretolysis. We performed this study to examine the properties of heat and moisture exchangers in comparison with hot water humidifiers and dry artificial ventilation. ⋯ Hygrobac s and hygrovent s may be an alternative to hot water humidifiers. Further clinical studies of HMEs and hot water humidifiers will be necessary to evaluate the influence of inspired gas humidity on the outcome of artificially ventilated patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1998
Review[Arterial hypertension: its impact on perioperative morbidity and mortality].
Chronic hypertension is associated with structural as well as functional changes of the vasculature, in particular of the coronary, cerebral and renal circulation. It is important to realise that [1] functional changes are often the result of structural changes, [2] the longer lasting the hypertension, the slower and less complete the regression of structural changes, and [3] acute "normalisation" of arterial pressure in long-standing hypertension may initially induce functionally subnormal smooth muscle and/or cardiac activity because the structure of the cardiovascular system is adapted to function at elevated pressures. Despite a multitude of studies, the impact of hypertension on peri-operative morbidity and mortality remains controversial. ⋯ Although, in general, a gradual reduction of blood pressure over a period of weeks to months is the optimal therapeutic approach, we will be hard-pressed delaying surgery for the sole purpose of "better blood pressure control". With full appreciation and detailed knowledge of the pathophysiology of hypertension, combined with sophisticated haemodynamic monitoring and interventions in the peri-operative period, acutely anaesthetising an inadequately treated hypertensive patient will probably not adversely affect his outcome. Delaying surgery for additional work-up may possibly improve outcome in patients with target organ disease, evidence of secondary hypertension, in the most severe forms of hypertension or sudden-onset hypertension.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1998
Clinical Trial[Early and long-term results of percutaneous dilatation tracheostomy (PDT Ciaglia) in 195 intensive care patients].
Tracheostomy is frequently required in the treatment of critically ill patients to prevent the complications associated with prolonged translaryngeal intubation. Tracheostomy may facilitate airway suctioning and improve patient comfort in the process of weaning. The purpose of the study was to assess our experience with PDT and to evaluate the complications in comparison with open surgical tracheostomy which is associated with complication rates ranging up to 50%. ⋯ PDT is a safe and practicable alternative technique which can be performed in the intensive-care unit with a lower risk of complications than open surgical tracheostomy. Endoscopic guidance prevents serious complications and apparently increases the safety of this procedure.