Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Comparative hemodynamic study of anesthesia induction with propofol (Diprivan), thiopental, methohexital, etomidate and midazolam in patients with coronary disease].
In patients undergoing cardiac surgery, the induction of anesthesia is not without risk because of specific cardiovascular effects of the anesthetic and the preoperative state of the patient. The hemodynamic effects of etomidate, midazolam, thiopental, and methohexital are well known: etomidate is an anesthetic that induces only minor cardiovascular changes; its influence on the endocrine system, however, has reduced its clinical indication. Barbiturates such as thiopental and methohexital produce negative inotropic effects in combination with an increase in heart rate and myocardial oxygen consumption; midazolam reduces pre- and afterload in patients with poor left ventricular function. Propofol, a new short-acting induction agent with good anesthetic properties, is said to diminish arterial pressure as well as myocardial oxygen consumption. ⋯ In a randomized study we investigated the hemodynamic effects of intravenous induction with propofol (2 mg/kg body wt.), thiopental (5 mg/kg), methohexital (1 mg/kg), etomidate (0.3 mg/kg), and midazolam (0.15 mg/kg) in 50 patients undergoing coronary artery bypass grafting. All patients were premedicated with flunitrazepam (0.03 mg/kg up to 2 mg) and morphine hydrochloride (0.2 mg/kg up to 15 mg) 100 min before the investigation. After 0.003 mg/kg fentanyl the patients received the induction agent in the above-mentioned dosage within 40 s followed by 0.1 mg/kg pancuronium bromide. Hemodynamic measurements were performed 1, 3, and 5 min after the end of the injection as well as 1 and 5 min after intubation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Renal function is not considered to be as important as cardiovascular or respiratory function during the perioperative period. Nevertheless, recent studies demonstrate a significant correlation between preoperative levels of creatinine and postoperative disturbances of kidney function. ⋯ In a recent study Hou et al. [5] could show that 5% of all patients suffer renal insufficiency during their hospital stay. Mortality for acquired renal failure is still 40-70%. The most important factor in the development of disturbances of kidney function is pre-existing kidney disease. The patients investigated in this study were high-risk patients. Cardiovascular complications during the perioperative phase are common, and hemodynamically mediated renal failure is the most frequent form of kidney failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Pain is a primary component of normal childbirth as evidenced by the behavior of parturients in primitive societies. Methods of pain relief such as the use of herbs and plant extracts were described in ancient writings. Modern obstetric analgesia employing ether began in 1847, three months after the first successful surgical anesthetic. ⋯ Simultaneously, psychologic methods were propagated, but were not uniformly successful. Continuous lumbar extradural analgesia has evolved as the optimal method of bsotetric pain relief, both subjectively and objectively, and its combination with childbirth education is considered to be complementary. The increasing utilization of obstetric analgesia and the recognition of marked physiologic and pharmacologic differences between pregnant and nonpregnant patients has led to the development of the subspecialty of obstetric anesthesia as well as to the foundation of obstetric anesthesia societies.
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There are two ways to introduce electronic data processing in anesthesia recording, which should be combined in the future: (1) computer-aided data collection (during anesthesia) and (2) data analysis. Both procedures have their own advantages and disadvantages. The first step in data collection is a system whereby the on-line registered data are automatically plotted and the discrete data are noted by hand (semi-automatic recording). ⋯ As an example we discuss evaluations for administrative purposes. Evaluations for scientific questions are even more affected by the quality of data definitions, and the efforts involved in data management are considerably higher. At the end of this paper we sketch a hybrid information system for computer-aided anesthesia recording that combines data collection and data analysis.