Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Anesthesia induction in children: propofol in comparison with thiopental following premedication with midazolam].
Propofol provides smooth and rapid induction of anesthesia in adults and guarantees rapid recovery. The use of propofol in adults is frequently associated with pain on injection, but this can be reduced by: (1) injection into the relatively large veins in the forearm or the antecubital fossa: (2) addition of lignocaine to the propofol; or (3) injection of an opioid (alfentanil) before propofol. Compared with experience in adults, there is very little experience with propofol in pediatric anesthesia. ⋯ Apnea for 20 s was observed only in groups B and C (2 and 3 children respectively). During spontaneous respiration with room air there was a significant decrease of the arterial oxygen saturation about 1 min after induction in all groups. In children ventilated with oxygen by mask, the SaO2 remained nearly constant...
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Extraoral tape fixation of the orotracheal tube for general anesthesia is a major problem in maxillofacial surgery. First of all, surgical access to the perioral and nasal region is handicapped by the tape covering and distracting the skin, especially in those cases where no nasotracheal intubation is possible; furthermore, blood, saliva, and disinfectant fluid interfere with reliable adhesion of the tape. A method of intraoral dental fixation of the orotracheal tube by a rubber dam fixation clamp is presented. The rubber dam isolates teeth against the oral cavity, providing a dry operative field to the dentist. The set of clamps, each designed according to the individual anatomy of the different teeth, is usual in the dental trade. After intubation the selected clamp is placed on the tooth by means of the forceps. The tube is laid on the clamp and tied on by a silk thread (2 x 0), which is inserted through the clamp's holes. We recommend fixation to the teeth in the mandible to avoid tension load, which could strain teeth in the maxilla; as far as possible only teeth without any impairment (e.g. loosening) should be selected. ⋯ The method of intraoral dental fixation of the orotracheal tube by a rubber dam clamp offers the following advantages: (1) the surgeon, especially the maxillofacial surgeon, has a good view of the perioral region and free access for surgery; there is (2) no skin distraction or irritation by tape; there is (3) reliable tube fixation even for patients with allergy to adhesive materials; there is (4) no solution of tape fixation by blood, saliva, or disinfectant fluid; and (5) silk sutures cannot be subjected to strain when solving tape fixation.
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Randomized Controlled Trial Clinical Trial
[Hyperosmolar volume replacement in heart surgery].
The ideal solution for use in volume therapy is still a matter of debate. Hypertonic sodium (HS) solutions have been advocated for resuscitation from hemorrhagic shock (small volume resuscitation). As hypertonic fluids may also be of interest in cardiac surgery, the effects of a new HS solution were studied. ⋯ The hypertonic saline HES solution adds a new dimension to volume therapy for cardiac surgery patients. The improvement in hemodynamics was effective and not only transient. Fluid requirements were significantly reduced during as well as after CPB, and pulmonary gas exchange was least compromised in these patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Hemodynamics and myocardial energy balance in coronary surgery patients during high-dose fentanyl-pancuronium anesthesia and modified neurolept-pancuronium anesthesia].
In 8 patients with coronary artery disease (CAD) classed as NYHA II or III, anesthesia was induced with high-dose fentanyl (0.05 mg/kg) and pancuronium (0.1 mg/kg). The patients were ventilated normally with the aid of a mask (O2: air 1:1, tidal volume 10 ml/kg with a rate of 10/min) for 5 min and then intubated. In 8 further patients with CAD NYHA class II or III, anesthesia was induced with 0.02 mg/kg flunitrazepam, N2O/O2 1:1 and isoflurane 0.5 vol%; they were relaxed with pancuronium (0.1 mg/kg) in combination with a bolus of 0.005 mg/kg fentanyl. ⋯ Measurements and an electrocardiogram were taken before anesthesia, after induction of anesthesia and after intubation. The hemodynamic parameters HR, AP, CI, CPP were relatively stable in patients anesthetized with high-dose fentanyl and pancuronium, whereas we found greater decreases in these parameters with the balanced anesthesia technique. Determinants of myocardial oxygen demand were higher in the high-dose fentanyl group; therefore, myocardial blood flow and oxygen consumption did not decrease to the same extent as in the balanced anesthesia group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cardiopulmonary resuscitation (CPR) during pregnancy is a rare event, but due to the increasing number of pregnant women with significant medical disorders it will gain more importance in the near future. Effective CPR with respect to survival of mother and infant can only be accomplished under optimal conditions. We discuss important pathophysiological alterations during pregnancy and, including recommendations in the available literature, we present a standardized protocol for life support for mother and infant. ⋯ Compared to non-pregnant patients, pregnant women must be placed in a left lateral position immediately. If possible, the decision to perform open-chest CPR has to be made within 15 min of unsuccessful closed-chest CPR. In addition, during late pregnancy there should be no delay in performing an emergency cesarean section, even during CPR.