Der Anaesthesist
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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.
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In many anaesthesia ventilators in common use, the tidal volume delivered is different from the tidal volume preset on the respirator. Tidal volume delivered by mechanical ventilation during anaesthesia may be influenced by fresh gas flow (FGF), the respiratory rate (RR) or the inspiratory: expiratory ratio (I:E). This may cause inadequate hypo- or hyperventilation in small children, especially in newborns and neonates. ⋯ Computed compressible volume from the circuit and the ventilator is added to the tidal volume preset on the ventilator; therefore, the volume delivered by the bellow consists of the volume set on the ventilator plus the compressible volume. With these characteristics the anaesthesia ventilator CICERO meets important requirements for a ventilator in paediatric anaesthesia. However, for final assessment further clinical studies are required.
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After remission of the dermatological symptoms of herpes zoster infection, post-zoster neuralgia (PZN) can persist or recur for months and years. Most frequently, satisfactory therapy of PZN is not possible. During recent years the persistence of viruses on the surface of neuronal cells has been discussed as the possible reason for chronic pain. ⋯ Treating pain in persistent PZN is extremely difficult and mostly results in a small diminution of the pain level. Persistence of viruses on the neuronal cell surface and resulting reduction of "luxury functions" of those cells may explain algogenesis by PZN and resistance to therapeutic efforts. We used VZI for the first time for therapy of PZN and observed a striking analgesic effect in all patients for the entire surveillance time.
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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!"