Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[The effect of halothane, alfentanil and propofol on blood flow velocity, blood vessel cross section and blood volume flow in the middle cerebral artery].
Transcranial Doppler sonography (TCD) has gained in relevance for noninvasive monitoring of the cerebral circulation during the perioperative period. As long as the diameters of the investigated vessels remain unknown, however, flow velocities alone are not really informative. Exact vessel diameter determination in humans under the influence of different anesthetic drugs has not yet been performed due to ethical and methodological restrictions. ⋯ LAR remained unaltered after alfentanil administration. The site of action of some anesthetic agents on cerebral vessels does not seem to be restricted to cerebral arterioles: at least for halothane, a vasodilating effect on large cerebral arteries could be demonstrated. This should be kept in mind when transcranial Doppler is applied during the perioperative period.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Nifedipine versus nitroglycerin in aortocoronary bypass surgery. The effect on hemodynamics, kidney function and homologous blood requirement].
Even during adequate general anesthesia, hypertension is a common phenomenon in patients undergoing aortocoronary bypass grafting (CABG). In such cases application of vasodilators is recommended in order to decrease myocardial oxygen consumption. This study was performed to compare two commonly used substances, i.e., nitrates and nifedipine, with regard to their influence on hemodynamics, renal blood flow, kidney function, and the requirement for homologous blood transfusions. ⋯ Nevertheless, 4 patients in the nifedipine group but no patient in group 1 did not need homologous blood transfusion. CONCLUSION. In comparison to nitrates, nifedipine showed some advantages in the treatment of hypertension during CABG: (1) it provided better myocardial performance; (2) it had a more reliable but not too long-lasting effect on elevated total peripherial resistance, leading to better hemodynamic stability; and (3) by not affecting the capacitance vessels it may necessitate fewer homologous blood transfusions.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Droperidol versus metoclopramide. Prevention of emesis following strabismus surgery in children].
Vomiting after strabismus surgery is a major problem that remains as yet unsolved, especially in children. Droperidol and metoclopramide, both known as powerful antiemetic drugs, were compared in this study. METHODS. ⋯ Droperidol (0.075 mg/kg) and metoclopramide (0.15 mg/kg) both reduce postoperative vomiting after strabismus surgery. Droperidol seems to be more effective in reducing severe vomiting. Postoperative sedation after droperidol was not a major problem in our experience.
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Of 434 cases of epidural, subdural, and intracranial haematomas published in the last 2-3 decades, 61 had developed following spinal, epidural or caudal anaesthetic procedures; 29 haematomas were around the spinal cord and 32, within the cranium. The most frequent secondary cause of this complication was pre-, intra-, or postoperative administration of drugs influencing blood coagulation. Simultaneous traumatic and haemorrhagic punctures may favour the development of a haematoma. ⋯ Postoperative results of laminectomies for lumbothoracic haematomas has been found to on the time interval between the first symptoms and the start of surgery. If surgery is performed within 8 h after the onset of paraplegia the prognosis is relatively good. Compared with the frequency of spinal, epidural, and caudal anaesthetic procedures throughout the world, haematomas of the lumbothoracic or cranial region are extremely rare complications.