Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Initial results of the reliability and validity of a German-language scale for the quantitative measurement of postoperative pain in young children].
In a previous study it was proved impossible to evaluate the validity of a system modified according to McGrath et al. for measuring postoperative pain in children. Three reasons were postulated for this result. The analgesics used did not modulate the pain in such a manner that the statistical analysis was effective; or the postoperative pain had an acute onset or fluctuated and the regular observations did not allow detection of the pain peaks; or the system used did not measure pain. ⋯ RESULTS. A replication verified the results of the previous study: the factor analysis resulted in a one-factorial solution. Of the 8 items (wakefulness, wake-up reactions, crying, position of the trunk, position of the legs, verbal communications on being asked about pain, special defense against stimuli) only 4 had a sufficiently substantial load on all measurements (crying, facial expression, position of the trunk and position of the legs). (ABSTRACT TRUNCATED AT 400 WORDS)
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Randomized Controlled Trial Clinical Trial
[Famotidine dosage in children. The effect of different doses on the pH and volume of the gastric juice].
Children undergoing general anesthesia are at increased risk of severe aspiration pneumonitis. Cimetidine and ranitidine, specific histamine (H2-receptor) antagonists, when given 1-3 h preoperatively markedly reduce the acidity and volume of gastric content. A newer compound, famotidine, is a more specific antagonist with no inhibitory effect on the drug metabolizing microsomal enzyme systems of the liver (cytochrome P-450), in contrast to cimetidine. ⋯ Preoperative famotidine application produces pH values of gastric contents higher than 2.5 in all dosage groups (84%, 94%, 75%), and these differences were highly significant (P less than 0.001), whereas the gastric volume reduction with these doses was not significant. The incidence of pH less than 2.5 and volume of gastric contents exceeding 0.4 ml/kg did not vary with the different doses of famotidine. As there were no measurable differences in the effect of famotidine, we recommend that children at high risk of pulmonary aspiration receive 0.15 mg/kg famotidine orally at least 1.5 h but not later than 6 h before induction.
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The determination of MAC values (minimum alveolar concentrations) for inhalation anesthetics and, correspondingly, of MIR values (minimum infusion rates) for i.v. anesthetics necessarily requires the use of therapeutically ineffective doses so that reactions to skin incision can be observed. EEG feedback-controlled dosing systems for i.v. anesthetics make it possible to determine dose requirement curves, allowing the definition of effective therapeutic infusion rates (ETI). During total i.v. anesthesia in 11 patients treated with fentanyl the mean effective infusion rate for methohexitone was found to be 4.68 +/- 1.39 mg/min, while for propofol the mean ETI in 11 volunteers was determined at 9.90 +/- 2.46 mg/min. The implications of feedback-controlled dosing systems for the study of clinico-pharmacologic problems in anesthesia are discussed.