Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1998
Randomized Controlled Trial Multicenter Study Clinical Trial[Development of an observational scale for assessment of postoperative pain in infants].
In a prospective trial in 139 infants ASA classification I-II 13 observational items were scaled during the first postoperative hour (13 assessments). The items were drawn from the literature and chosen for economic purpose. Factor analyses (Principal component, Kaiser Criterion, Scree-test) were used for the elimination of useless items and for the identification of suitable ones. ⋯ There was a significant interaction between repeated measurements and the supply of Piritramide and Ketamine, but not of Midazolam. Concurrent and constructive validation were positive for both systems, using administration of Piritramide as a criterion. For clinical purpose the CHIPPS should be preferred, because it has been proven to be valid in children up to 4 years of age and because controlled data on its sensitivity, specify, reliability and validity could already be presented.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1998
Case Reports[Combined sciatic nerve-3 in 1 block in high risk patient].
We report on a case of combined sciatic nerve block and 3-in-1 block for amputation of lower limb in an ASA IV-V patient 6 days after intraoperative cardiopulmonary resuscitation following induction of general anaesthesia. ⋯ The combined sciatic and 3-in-1 block is a rarely used technique, but for haemodynamically unstable patients it is a safe method for surgery of the lower limb.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Histamine plasma concentration and cardiovascular effects of non-depolarizing muscle relaxants: comparison of atracurium, vecuronium, pancuronium and pipecuronium in coronary surgical patients at risk].
Cardiovascular effects of four commonly used non-depolarising muscle relaxants and their ability to increase histamine plasma concentrations were studied in patients scheduled for coronary artery bypass grafting. ⋯ All investigated neuromuscular blocking agents exhibited marked cardiovascular stability which permits their use, being based exclusively on pharmacodynamic and pharmakokinetic considerations even in patients with coronary heart disease. If an increase in heart rate appears beneficial Pancuronium may be advantageous.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1998
Review[Aspects in monitoring and treatment of gastrointestinal underperfusion in sepsis. Diagnosis and therapy of gastrointestinal underperfusion in sepsis].
Tissue hypoxia, especially in the splanchnic area, is still considered to be an important cofactor in the pathogenesis of multiple organ failure. Thus, in the treatment of septic shock the specific effects of ino-tropic drugs on the splanchnic perfusion are of particular interest. To give strict recommendations for monitoring and for therapeutic strategies in the treatment of gastrointestinal failure in patients with sepsis is difficult not only due to the lack of data on clinical outcome and organ dysfunction, but also due to some limitations in the methods applied to assess splanchnic perfusion and oxygenation. ⋯ Epinephrine and dopamine should be avoided because they seem to restribute blood flow away from the splanchnic region. There are no convincing data yet to support the routine use of low dose dopamine or dopexamine in patients with sepsis. These recommendations are limited by the lack of outcome studies and optimal methods for the assessment of splanchnic perfusion/oxygenation.