Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Propofol for induction and maintenance of anesthesia during heart surgery. Results of pharmacological studies in man].
Numerous reports have concluded that propofol is suitable for maintenance of anesthesia by continuous infusion. The aim of this study was to evaluate the use of propofol and fentanyl for coronary bypass surgery in patients with good left ventricular function. The effects of this anesthetic combination on quality of anesthesia, hemodynamic status, and endocrine and metabolic responses were assessed. ⋯ CONCLUSION. In summary, it can be concluded that a propofol infusion technique positively enhances the recovery period after cardiac surgery and provides good control during anesthesia. However, the use of propofolfentanyl for induction of anesthesia in patients with limited coronary perfusion is not recommended because of its hypotensive effect.
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Review Comparative Study
[The meaningfulness of central venous blood samples. Central venous versus mixed venous O2 status].
Both mixed-venous and "central-venous" oxygen status (O2 partial pressure [pO2], O2 saturation [sO2], O2 concentration [cO2], hemoglobin concentration [cHb]) are often considered to adequately represent total-body oxygen supply. Since modern technology has made continuously in vivo measurement possible, mixed-venous O2 saturation (svO2) and partial O2 saturation (psO2) have become extensively used for that purpose. Both venous sites of measurement are used as diagnostic adjuncts regarding hemodynamic status. ⋯ The best parameters for interpreting the cardiovascular situation seem to be arteriovenous O2 difference (avDO2) and C. O. In particular, the avDO2 can be accepted as an integrating parameter for AO2 and QO2, and may therefore serve as a diagnostic indication of cardiovascular imbalance.
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This prospective study investigated the effects of standard pharmacotherapy in out-of-hospital ventricular fibrillation (VF) after i.v. or endobronchial (e.b.) administration of epinephrine and lidocaine. METHODS. Only patients presenting with out-of-hospital VF were included in this study, whereby VF of noncardiac origin was excluded. ⋯ Recommended doses are 2.5 mg for epinephrine and 400-500 mg for lidocaine. Resuscitation from VF requires immediate epinephrine therapy if initial defibrillation is not successful. Lidocaine has no effect on resuscitation from VF and therefore should be used specifically for antiarrhythmic therapy after restoration of spontaneous circulation.
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Sufentanil, a synthetic opioid that is 5-10 times as potent as fentanyl, has been suggested for use during neurosurgical procedures because it maintains cardiovascular stability and produces hypnosis without the use of additional anesthetic agents. Doses as low as 2.5 micrograms.kg-1 are reported to create deep levels of anesthesia as demonstrated by EEG changes to high-amplitude delta-waves. However, there are no reports concerning the effects of sufentanil on blood flow and metabolism in the human brain. ⋯ The increase in metabolic activity with sufentanil during hypocapnia might be caused by an alkalosis-induced stimulation of glycolysis. It might also be related to a reduction in the depth of anesthesia, although neither the EEG nor the hemodynamic parameters indicated this. This study shows that the coupling between CBF and metabolism is well maintained and that the cerebrovascular response to CO2 is unimpaired during high-dose sufentanil anesthesia.