Der Anaesthesist
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Various animals models and several different methods are used in cardiopulmonary resuscitation (CPR) research. The animals used most frequently are dogs and pigs, but in each species thorax configurations, which might be an important factor in the mechanism of blood flow during CPR, are at great variance. The influence of anesthetics on cardiopulmonary and cerebral functions during and following resuscitation are largely unknown, and accordingly there is great variance in the techniques employed by individual researchers. ⋯ Thorax compressions are characterized by frequency, direction (sagittal, transversal), technique (mechanical, manual), relationship of time between compression and relaxation (50:50, 40:60), and depth of compression (power used, esophageal pressure, arterial blood pressure). Effects of CPR techniques are demonstrated during CPR by cardiovascular parameters. In addition to recording of blood pressure and blood flow, examination of regional perfusion rates using radioactive microsphere techniques is common. 24-h surveillance and extensive neurological tests are carried out during recovery following CPR.
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Randomized Controlled Trial Clinical Trial
[Propofol infusion for the maintenance of short-term anesthesia].
The administration of propofol by infusion for maintenance of anesthesia has attracted much attention recently. We investigated the necessary infusion rate of propofol to maintain anesthesia for short surgical procedures without loss of the evident advantages of this substance. Forty unpremedicated female patients aged 18-59, scheduled for minor gynecological procedures, were randomly assigned to four groups. ⋯ After induction, arterial blood pressure decreased by systolic/diastolic 20/10-15 mmHg. With the low infusion rate, arterial pressure increased to its control value during operation; it remained at the postinduction value with high infusion rates. Side-effects: 10 patients had salivation that in some instances lead to coughing, 9 reported pain at the injection site during induction, and 9 reported dreams of a pleasant nature.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
[Dose-dependence of the analgesic action of metamizol].
Whereas dipyrone is used in many countries in clinical practice at doses up to 2.5 g, the dose-response relationship of the analgesic effect has not been investigated in humans. In the present study, doses of 0.5, 1.0, 1.5, 2.0, and 2.5 g dipyrone (Novalgin) were applied orally as film-coated tablets to 18 volunteers in a randomized, placebo-controlled, double-blind design. Pain attenuation was quantified following constant and painful electrical stimulation of tooth pulp at different time intervals up to 7 h after drug administration. ⋯ Maximal analgesia was observed 1 h after administration of the tablets, independent of the dose. An increase in analgesic effect related to dose was observed at this time, the increase being less pronounced with doses exceeding 1.5 g. Generally, analgesia persisted longer with increasing dose.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
[Suppression of blood pressure increases during intubation: lidocaine or fentanyl?].
The hypertensive response to anesthetic induction with endotracheal intubation may be harmful in patients with cardiovascular disease, increased intracranial pressure, or anomalies of the cerebral vessels. Recommendations for attenuating the reflex hypertension and tachycardia elicited by upper airway irritation are therefore manifold. Besides minimizing the cardiovascular response, anesthesia induction for patients at risk must also satisfy the following requirements: it must be applicable regardless of patient collaboration, prevent impairment of cerebral blood flow, and avoid arousal of the patient; it should neither be time-consuming nor affect the duration or modality of the ensuing anesthesia. ⋯ The two equally simple induction procedures were compared to anesthesia induction with thiopental alone. In both patient groups no significant effect of lidocaine on the pressure response could be observed. Fentanyl lowered the pressure response slightly though significantly in brain-tumor patients only (p less than 0.05), but showed a significant pressure-lowering action persisting over the whole observation period in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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The central cholinergic syndrome developed in a 5 1/2-year-old child after premedication with midazolam and a short volatile anesthetic. Diagnosis was made more difficult because of a history of nephrotic syndrome, convulsions, relative acetylcholinesterase deficiency and chronic medication with a corticosteroid. Successful management of such cases depends on a through differential diagnosis before the institution of physostigmine therapy. Intensive postoperative monitoring is strongly recommended.