Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Postoperative pain therapy. The efficacy of a serotonin antagonist (GR 38032F;ondansetron) and the prostaglandin synthesis inhibitor lysin acetylsalicylate (Aspisol)].
Serotonin is one of the many neurotransmitters involved in nociception. Serotonin antagonists may therefore reduce postoperative pain. In the present study we examined whether the new 5-HT3 receptor antagonist GR 38032F (ondansetron) reduced postoperative pain after minor surgery and compared its effectiveness with that of lysin acetyl salicylate (Aspisol). ⋯ For 42 out of 100 patients no analgesics were needed within the first 3 h after end of surgery. Ondansetron was no more effective than placebo in reducing postoperative pain. Lysin acetylsalicylate, however, may be an effective alternative to opioids for the treatment of postoperative pain.
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Randomized Controlled Trial Clinical Trial
[30 degree trunk elevation of the patient and quality of lumbar epidural anesthesia. Effects of elevation in operations on the lower extremities].
The spread and intensity of lumbar epidural anaesthesia are unpredictable. Moreover, segments L5 and S1 are frequently missed. In this study the effect of 30 degrees trunk elevation on the spread and intensity of lumbar epidural sensory and motor blockade and on the cardiovascular system were studied. ⋯ Patients in the hammock position had a clinically insignificant drop in systolic and diastolic blood pressure. In contrast to the young and healthy patients in this study, more severe cardiovascular changes might result in geriatric and/or ill patients subjected to a hammock position. For this reason, use of the technique in geriatric and/or ill patients requires special attention.
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Rocuronium bromide (Org 9426) is a new, non-depolarising steroidal muscle relaxant that is currently undergoing extensive clinical trials worldwide. Since it is expected to be introduced into clinical practice in the near future, the purpose of this review is to give a summary of the currently available information on this promising new compound. The search for the so-called ideal muscle relaxant [34] in the last years was focused on a non-depolarising compound that could replace succinylcholine for rapid intubation. ⋯ In initial clinical studies [13, 42] its most impressive features appeared to be rapid onset time and, more importantly, the rapid development of good intubating conditions. Thirty to 90 s after the injection of 0.6 mg/kg (2 x ED90), rocuronium provided intubating conditions that were equal to those observed after succinylcholine [9, 17, 31, 38]. Although the onset time of rocuronium at the adductor pollicis muscle is slower than that of succinylcholine, intubation with this compound can be performed faster than with any other non-depolarising agent.(ABSTRACT TRUNCATED AT 250 WORDS)
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Major conduction anaesthesia is not harmless. Based on new findings about sympathetic blockade, it was analysed whether circulatory side effects after spinal or epidural anaesthesia, in particular cardiocirculatory arrest, correlate with the level of segmental spread and whether prophylactic or therapeutic measures are effective. With spinal or epidural anaesthesia in healthy, unpremedicated patients, blood pressure, heart rate, and cardiac output remain within +/- 20% of normal independent of the height of segmental spread. ⋯ Infusion of crystalloid or colloid solutions may diminish the drop in blood pressure, whereas vasopressors reduce the frequency and extent of cardiocirculatory side effects. As yet, however, there is no safe prophylaxis to prevent cardiocirculatory arrest. Cardiopulmonary resuscitation after circulatory arrest must be combined with early administration of catecholamines.