Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2000
Randomized Controlled Trial Comparative Study Clinical Trial[Clonidine compared to midazolam for intravenous premedication for ambulatory procedures. A controlled double blind study in ASA 1 patients].
Midazolam is frequently used for premedication in day-case surgical patients whereas clonidine is rarely administered for this indication. However, clonidine has several useful effects that make the drug an interesting alternative to conventional premedicants. Thus, in this randomised, double-blind, and controlled study the anxiolytic effect of midazolam was compared to that of clonidine. Furthermore, effects on postoperative complaints and minor complications, and readiness for discharge were investigated. ⋯ The effects of an intravenous premedication with 1.5 micrograms/kg clonidine or 50 micrograms/kg midazolam, respectively in young ASA-1 patients undergoing minor surgical procedures on a day-case basis are restricted to decrease of anxiety and inner tension before surgery. No beneficial effects were found during the postoperative period compared with untreated control patients.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2000
Comparative Study Clinical Trial[Recovery of balanced anesthesia with various inhalation anesthetics in comparison to intravenous anesthetics: a retrospective analysis of 20,060 patients].
The aim of this investigation was to compare routine balanced anaesthesia with different inhalation agents to intravenous anaesthesia (IVA) using an Anaesthesia-Information-Management-System (AIMS) with regard to time of recovery from anaesthesia, the time of discharge from the postanaesthesia care unit (PACU) and postoperative nausea as well as postoperative therapy with analgesics. ⋯ Results achieved in routine correspond only in part to results from studies. In our investigation balanced anaesthesia with isoflurane and sevoflurane correspond with the shortest stay in PACU compared to balanced anaesthesia with halothane and IVAs with propofol-fentanyl or propofol-remifentanil. One reason for this could be the intraoperatively administered opioide piritramide in IVAs. Furthermore we conclude that an AIMS may provide additional information about overall costs-effectiveness. However this information depends largely on local factors, e.g. patient case mix, staffing, policy of discharge from the PACU etc.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2000
Clinical Trial[Experience with G27 Whitacre needle in in-patient and out-patient settings--incidence of post dural puncture headaches and other side effects].
The aim of the study was to evaluate the incidence of side-effects in patients bearing a high risk of post dural puncture headache (PDPH) when a spinal anaesthesia was performed. This included outpatients, patients for sectio caesarea and patients younger than 40 years who were mobilized as soon as the surgeon agreed. ⋯ The use of a thin pencil point needle (Whitacre G27) enables the application of a spinal anaesthesia to young people with a low risk of moderate PDPH. Pregnancy is not a contraindication. Early mobilisation does not increase the risk of PDPH even in young patients nor is this the case in outpatients. In outpatients older than 60 years a G26 Quinke needle, which is easier to handle and cheaper, is suitable for spinal anaesthesia without a risk of PDPH. Better post-operative vigilance may be a further benefit of the method. Young people especially appreciated the option to pursue their own video-endoscopic surgery. In a comparable group where an epidural was performed we found more side-effects.
-
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.
-
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.