Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2003
Randomized Controlled Trial Comparative Study Clinical Trial[Plasma levels of ropivacaine and bupivacaine during postoperative patient controlled thoracic epidural analgesia].
The postoperative continuous epidural application of local anesthetics can cause side effects like motor blockade and systemic intoxication. The study was performed to evaluate the plasma levels of two local anesthetics and their analgesic and side effects in continuous postoperative epidural analgesia. ⋯ The present study shows that thoracic epidural infusion with bupivacaine 0.125% and with a higher concentration of ropivacaine 0.375% during 96 h provides plasma levels of unbound local anesthetic far below the toxic threshold.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2003
Randomized Controlled Trial Clinical Trial[Blocking nociceptive afferents by retrobulbar bupivacaine does not decrease nausea and vomiting after propofol-remifentanil anaesthesia].
To test whether prophylactic neural blockade of noziceptive afferents or antiemetics diminutes postoperative nausea and vomiting (PONV) we studied in a randomised, prospective, and ouble-blind fashion 102 patients receiving implantation of an episcleral radioactive applicator for treatment of ocular malignant melanoma during remifentanil-propofol-anaesthesia. ⋯ Although prophylactic blockade of nozizeptive afferents by retrobulbar anesthesia decreased ocular pain and postoperative complaints, it failed to decrease the incidence of PONV. Thus, PONV after ocular surgery under propofol-remifentanil anaesthesia is not attenuated by preoperative blockade of noziceptive afferents. In patients undergoing total intravenous anaesthesia with propofol-remifentanil, droperidol prevented PONV more effectively than the used serotonin receptor antagonists.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2003
[Metoclopramide and dexamethasone in prevention of postoperative nausea and vomiting after inhalational anaesthesia].
Because of its complex profile of action (binding to dopamine, serotonin and histamine receptors), low rate of adverse effects and low cost as a medicinal preparation, metoclopramide is an interesting substance for the prophylaxis of post-operative nausea and vomiting (PONV). As a single substance its antiemetic effects are slight at the usual dose, so the aim was to test the efficacy of a combination of metoclopramide and dexamethasone for the prevention of PONV on a group of patients with the same operative trauma. ⋯ The metoclopramide/dexamethasone combination proved to be effective and inexpensive, on the basis of these findings it is used prophylactically at our hospital if only one PONV risk factor exists.