Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Propofol, isoflurane and neuroleptanesthesia. Ophthalmic surgery in geriatric patients].
Ophthalmic surgeons require anaesthesia to ensure that the patient is completely relaxed for microsurgical operations and that the intraocular pressure is reduced. These conditions must be maintained throughout the operation. In addition to these requirements, the anaesthetist mostly deals with elderly patients with multiple diseases. ⋯ Therefore, it seems on the whole that there are benefits from propofol-fentanyl anaesthesia because of the fact that in comparison with the rather techniques, elderly patients become alert again faster. However, sufficient postoperative pain therapy is necessary to free the patients of pain to the same degree as with neuroleptanaesthesia. In most cases peripherally acting analgesic substances with no interference with vigilance are sufficient.
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Randomized Controlled Trial Clinical Trial
[Topographic-quantitative EEG-analysis of the paradoxical arousal reaction. EEG changes during urologic surgery using isoflurane/ N2O anesthesia].
Increases in slow-wave (delta) activity in the EEG may reflect increased depth of anaesthesia provided that hypoxia, haemodynamic instability and drug overdose have been excluded. In contrast, similar intraoperative EEG responses have been described as paradoxical arousal reactions. The aim of this study was to assess the effects of surgical stimulation on spatial EEG changes during anaesthesia with 0.6% isoflurane/66% nitrous oxide. ⋯ Since these events occur predominantly at frontal areas they may not be detected with single-channel parietal recordings. Our data suggest that topographical EEG monitoring may useful for assessing painful events during surgery. Using EEG monoparameters like spectral edge frequency or median the occurrence of paradoxical arousal reactions may be falsely interpreted as an increased depth of anaesthesia.
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Comparative Study
[The effect of age on the spread of spinal anesthesia using isobaric 2% mepivacaine].
In the elderly, anaesthesia and surgery are associated with higher perioperative mortality and morbidity as compared to younger patients. There is some evidence that spinal anaesthesia may improve the postoperative state of elderly patients. A prospective study was performed to elucidate the effects of age on the characteristics of spinal anaesthesia with isobaric 2% mepivacaine. ⋯ It is concluded that there was a tendency for greater spread of spinal analgesia with isobaric 2% mepivacaine in the elderly. The clinical significance of this finding is limited. In elderly patients hypotension is more common than in younger patients, but might not be related solely to age or extent of the neural blockade.
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Humidified soda lime is commonly used to eliminate carbon dioxide from the circulatory system. Little is known about adverse reactions to accidentally dried soda lime. Therefore, a case of unexpected absorption of halothane by dry soda lime is reported. ⋯ The absorption of halothane is accompanied by an increase in the temperature of the soda lime. Therefore, in every situation lacking a sufficient anaesthetic level during inhalation anaesthesia, absorption of the vaporized anaesthetic must be excluded. Only dried soda lime can absorb halothane.