Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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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.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2000
Randomized Controlled Trial Comparative Study Clinical Trial[Desflurane--general anesthesia for cesarean section compared with isoflurane and epidural anesthesia].
Desflurane 2.5% was compared to Isoflurane 0.5% in a randomized study in terms of maternal and newborn effect on both groups with epidural anesthesia. Fifty patients under general anesthesia were randomly designated to receive either desflurane 2.5% or isoflurane 0.5% maintained in a 50-50% nitrous oxide and oxygen mixture. Twenty-five patients were assigned to receive epidural anesthesia using 15 ml ropivacaine 7.5 mg/ml with fentanyl 100 micrograms. ⋯ Similarly, the level of postoperative comfort was the same in both groups. Comparing the general and epidural anesthetic groups, no differences could be detected in neonatal outcomes. Conclusion is that there is one significant difference between desflurane 2.5% and isoflurane 0.5% anesthesia for cesarean section and it is the rapid recovery characteristic with desflurane which makes it an attractive alternative to TIVA (total intravenous anesthesia) and to other inhalational anesthetics available to obstetric anesthesiologists.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2000
Review[Clinical significance and effects of foreign body embolism during the use of central venous catheters].
An embolism caused by catheters or puncture devices is generally a rare complication during the use of central venous catheters. Possible reasons are either mistakes on the part of the user (e.g. shearing off or tearing of catheters or Seldinger wires) or other accidental causes (e.g. faulty products, material fatigue). As patients are at risk of suffering serious injuries following an embolism, foreign bodies should be removed from the patient's cardio circulatory system as quickly and as completely as possible. Two-dimensional echo-cardiography has proved to be very helpful for diagnostics, while interventional radiology is most effective for the removal of intravascular foreign bodies.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2000
Clinical TrialThe influence of airway pressure changes on intracranial pressure (ICP) and the blood flow velocity in the middle cerebral artery (VMCA).
Due to the exponential shape of the intracranial volume-pressure relation, simple measurement of epidural, parenchymal or intraventricular intracranial pressure (ICP) in traumatic brain injury (TBI) often fails to early recognize patients with a fulminant development of intracranial hypertension even during recently available methods of tissue PO2 and microdialysis measurements. One approach to this problem could be repetitive intracranial volume provocations to evaluate a trend of the intracranial elastance. Several previously published methods use invasive volume challenge through access to the cerebrospinal fluid (CSF). This pilot study describes changes in intracranial pressure due to variations of airway pressure with BIPAP ventilation maneuvers. ⋯ Elevation of the venous outflow resistance and a transient increase in cardiac output have to be considered as mechanisms for transduction of transthoracic pressure changes to intracranial pressure variations. We conclude, that trends of changes in elastance can be derived from intermittent airway pressure variations. This can be useful in easy and on line dynamic monitoring of ICP in traumatic brain injury.