Der Anaesthesist
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Analgesia and sedation with the associated reduction of undesired vegetative reactions are important components in the therapeutic regimen of intensive care patients. None of the sedative drugs available can fulfil every one of the criteria expected of an "ideal" sedative. Four commonly used drug combinations have been established as standards: 1. opioid and neuroleptic, 2. opioid and benzodiazepine, 3. ketamine and benzodiazepine, and 4. opioid and propofol. ⋯ In some patients (e.g. those with a history of alcohol abuse) a massive increase of the drug dose is not indicated when the effect is not adequate. Instead, an entirely different substance should be employed and the administration of less frequently used drugs should be considered. Despite detailed knowledge of the altered pharmacokinetics in critically ill patients, the drugs should be dosed as dictated by the situation, true to the anaesthesiologists' adage: "Dosage according to effect!"
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The technique of combined spinal epidural anaesthesia (CSE) combines the versatility of spinal with the variability of epidural anaesthesia. Spinal application of the local anaesthetic achieves a fast response, reliable sensorial and motor block at a low dose with little toxicity. The epidural catheter allows for the duration of surgical anaesthesia to be extended and provides analgesia for the postoperative period. ⋯ CONCLUSION. Owing to the possibility of medico-legal consequences, which sometimes occur a long time after anaesthesia has been given, we think it is unwise to reuse such needles. We hope that disposable and cheap 29 gauge needles will soon become available.
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The laryngeal mask airway (LMA) provides a patent airway when placed 'blindly' into the hypopharynx. At the laryngeal side it is supposed to form a seal surrounding the laryngeal inlet with the epiglottis lying outside the mask aperture. This study is designed to assess the prelaryngeal position of the mask by the fibreoptic technique. ⋯ For patients who are at risk of regurgitation of gastric contents, use of the LMA is absolutely contraindicated. Relative contraindications are local pathology of the pharynx and situations with low pulmonary compliance and/or high airway resistance (massive obesity, asthma, etc.), especially during controlled ventilation. Further studies are necessary to establish definite indications for the application of the LMA.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Pediatric surgery. A comparison of spinal anesthesia and general anesthesia].
Forty patients aged 2 to 5 years who were admitted for paediatric operations were randomly assigned to have either spinal or general anaesthesia. Spinal anaesthesia was achieved with isobaric bupivacaine 0.5% at a dose of 0.5 mg/kg. General anaesthesia was induced with thiopentone 2-5 mg/kg and continued with low-dose fentanyl (1-2 micrograms/kg, oxygen/nitrous oxide/isoflurane (30/70/0.1-0.5%), vecuronium normoventilating the patients. ⋯ Vomiting (2), sore throat (4) and micturition difficulties (2) were the adverse events associated with general anaesthesia. Three patients were restless after spinal anaesthesia. It can be concluded that spinal anaesthesia is a suitable anaesthetic technique for paediatric surgery.
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Randomized Controlled Trial Clinical Trial
[Hemodynamics of coronary surgery patients following magnesium aspartate infusion].
Hypertension is a common phenomenon in patients undergoing aortocoronary bypass grafting. This hypertension increases myocardial oxygen consumption and can be prevented by application of vasodilators. A possible cause is activation of the renin angiotensin system. ⋯ Due to its vasodilating effect, magnesium lowers the output impedance of the left ventricle and improves cardiac pumping function. It opposes detrimental cardiovascular responses to sternotomy and following aortic cannulation. Also of importance is the advantageous effect of magnesium on cardiac arrest elicited by cardioplegia and for reactivation of the ischaemic myocardium.