Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Midazolam (Dormicum) as oral premedication for local anesthesia].
Good physician-patient rapport and an anxiolytic, sedative, and amnesic premedication are necessary for comfortable, stress-free surgery under local anesthesia. Sufficient experience exists with the intramuscular and intravenous administration of the new benzodiazepine midazolam (Dormicum), while knowledge relating to its oral administration is still scant. Therefore, in a randomized double-blind study midazolam was investigated for oral premedication prior to local anesthesia: two dosages of midazolam were studied and compared with diazepam and placebo. ⋯ Anxiety increased little following the placebo; it decreased significantly following 10 mg diazepam and more markedly following 7.5 and 15 mg midazolam. Sedation increased little following the placebo; it increased more and similarly 50 min after the benzodiazepines; after 90 min the sedative effect was most marked for 15 mg midazolam. However, sedation was of shorter duration after midazolam than after diazepam.(ABSTRACT TRUNCATED AT 250 WORDS)
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The treatment of cerebral edema has changed during recent years. On the one hand, knowledge of the pathophysiology of brain swelling has expanded; on the other, the analysis of biodata such as intracranial pressure, cerebral blood flow, and blood volume has become routine. The methods of measuring intracranial pressure (nowadays without risk due to the use of microtipepidural probes, e.g. ⋯ Barbiturates are used as sedatives or in a loading dose until burst suppression is seen in the EEG. The risk of hemodynamic side effects such as reduced cardiac output and cerebral perfusion pressure is decreased by measuring pulmonary arterial pressure and the use of catecholamines. The acidotic impairment of cerebral autoregulation can be regulated using THAM (thrometamine) and the response of the vascular system to hypocapnia can be improved.(ABSTRACT TRUNCATED AT 250 WORDS)
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The method of extracorporeal CO2-elimination (ECCO2-R) as described by L. Gattinoni [2] and Kolobow [5] is reported in ten patients with severe ARDS in whom conventional respirator therapy had failed. The method itself as well as important pulmonary function parameters, e.g. changes in gas exchange (Fig. 3), extravascular lung fluid (Fig. 6), and chest radiographs are explained. ⋯ In the responders, oxygenation improved and the intrapulmonary shunt Qs/Qt (Fig. 4) decreased, followed by extravascular lung water and mean pulmonary arterial pressure (Fig. 5). Towards the end of the therapy we could find normalization of the compliance (Fig. 7) and chest X-rays, which may be interpreted as a cure. The results confirm our theory that ECCO2-R in combination with high PEEP and low-frequency ventilation seems to be an important method for future therapy of acute pulmonary failure.