Der Anaesthesist
-
Randomized Controlled Trial Comparative Study Clinical Trial
[Quality of induction and adrenocortical function. A clinical comparison of Etomidate-Lipuro and Hypnomidate].
The purpose of this study was to compare etomidate in a lipid emulsion (Etomidat-Lipuro; Braun, Melsungen) and in propylene glycol (Hypnomidate, Janssen Pharmaceutica) in 90 patients in terms of anaesthetic induction characteristics with special reference to injection side effects, haemodynamic changes, and quality of induction. Adrenocortical hormones were determined in 30 patients who received either Etomidat-Lipuro, Hypnomidate, or propofol (Diprivan, ICI Pharma) for induction of anaesthesia. ⋯ Local side effects are minimal after the administration of Etomidat-Lipuro and Hypnomidate. Alfentanil reduces the injection pain of etomidate induction agents. Cortisol and aldosterone are depressed by etomidate, but the clinical relevance is minimal after a single bolus injection.
-
Effective pulmonary capillary pressure (Pc) is a major factor determining transvascular fluid filtration in the lung. It may easily be estimated from the pressure decay after rapid pulmonary artery occlusion. If Pc is known, the longitudinal distribution of pulmonary vascular resistance (PVR) can be evaluated. ⋯ The longitudinal distribution of PVR is influenced by the severity of lung injury. PAOP, therefore, may not represent changes in Pc in patients with acute respiratory failure. The routine use of Pc measurement, however, can not be recommended until it has proven more useful than determination of PAOP when managing critically ill patients.
-
Since the 1940s several preclinical investigations have demonstrated the anaesthetic activity of a series of structurally related pregnanes without notable endocrine action. One of the most active of these is pregnanolone (3-alpha-hydroxy-5-beta-pregnane-20-one), which is a naturally occurring metabolite of progesterone. Pregnanolone is not soluble in water, which has prevented its use for clinical research. ⋯ Three patients in this group also did not stop counting (dose: 0.29 mg/kg body weight). Blood pressure remained stable in all patients but 1 throughout the observation period. In 1 patient there was an alarming rise in blood pressure from 160/90 mmHg before to 200/100 mmHg 3 min after the injection.(ABSTRACT TRUNCATED AT 400 WORDS)
-
Difficult intubations can occur in cases of anatomical or physiological abnormalities of the face and neck. They are frequently predictable when specific signs are evident preoperatively. There are still occasional unexpected difficulties during conventional laryngoscopy when common blades like the Macintosh and Foregger types are used. ⋯ Because of its dual availability, it offers both direct and non-direct visualisation of the larynx. Handling of this mirror-blade can be practised extensively, which allows integration of this equipment in the "failed intubation drill". This should be an integral part of the teaching and training of anaesthesia personnel.