Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2000
Randomized Controlled Trial Comparative Study Clinical Trial[S-(+)-ketamine versus ketamine racemic mixture: hemodynamic studies].
Evaluation of hemodynamic effects of S-(+)-ketamine versus ketamine-racemic mixture during induction of anesthesia, during steady-state of a fentanyl-midazolam-anesthesia and in the period of aortic cross-clamping during extracorporeal circulation. ⋯ There were no major differences in the hemodynamic profiles of S-(+)-ketamine and the racemic mixture. S(+)-ketamine did not provide hemodynamic advantages. The use of both preparations should be limited to selected clinical situations in patients with reduced coronary reserve.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2000
Randomized Controlled Trial Comparative Study Clinical TrialEconomic aspects of different muscle relaxant regimens.
At a time of cost reduction in medical care efforts to manage the ever-increasing costs of new pharmaceutical drugs become increasingly important. Costs of four different muscle relaxant regimens including the new intermediate-acting neuromuscular blocking drugs (NMBD) cisatracurium and rocuronium will be analyzed. ⋯ It is summarized that the use of cisatracurium was associated with higher costs compared to a standard muscle relaxant regimen using atracurium, whereas patient outcome was the same in all study groups. The routine use of the newer NMBDs can only be justified economically, if considerable improvements to clinical practice can be demonstrated.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2000
Randomized Controlled Trial Clinical Trial[Sympathoadrenergic, hemodynamic and stress response during coinduction with propofol and midazolam].
This study was undertaken to investigate simultaneously the influence of coinduction with propofol and midazolam on sympathoadrenergic and hemodynamic reactions and stress response during the extended induction period of TIVA. ⋯ In elderly patients, co-induction with 0.05 mg/kg BW midazolam halved the induction dose of propofol and led to a further dose reduction with maintained hypnotic potency. However, the halvage of propofol induction dose had no effect on the reduction of the sympathoadrenergic tone with decrease of blood pressure and heart rate. The overall moderation of the stress response was comparable as well. Thus, both induction regimens investigated in this study cannot be recommended in patients with severe hemodynamic disorders like hemorrhagic or cardiac shock. The propofol reduction should be primarily considered under economic aspects.