Der Anaesthesist
-
Randomized Controlled Trial Comparative Study Clinical Trial
[Anesthesia induction using etomidate in a lipid emulsion].
The use of etomidate as an anaesthetic induction agent has been hampered significantly by unwanted side effects such as pain on injection and thrombophlebitis. Investigations by Doenicke et al. have shown that the solubilizer propylene glycol is responsible for these side effects and that they can be avoided by the use of a lipid emulsion formulation. It was the goal of the present study to quantitate the reduction of thrombophlebitis and pain on injection following both formulations under double-blind study conditions. ⋯ On the 1st and 2nd postoperative days, examination of the injected vein revealed a significantly higher incidence of symptoms of thrombophlebitis in the group treated with eto-pg (25% vs 3%). CONCLUSION. From these results it is concluded that in terms of vein compatibility the new galenic formulation of etomidate with lipofundin MCT 20% is superior to the propylene glycol preparation while pharmacodynamic properties seem not to be affected.
-
Randomized Controlled Trial Clinical Trial
[Continuous monitoring of spontaneous postoperative respiration. 3. The effect of amiphenazole on cutaneous oxygen and carbon dioxide partial pressure following gynecologic surgery under halothane anesthesia].
In an attempt to verify non-invasive respiratory monitoring for patients in the early postoperative period, cutaneous O2 and CO2 pressures were monitored in 30 female patients recovering from major gynaecologic surgery under halothane anaesthesia. In a double-blind and randomized fashion, in the recovery room the patients received a single intravenous bolus injection of placebo or 150 mg amiphenazole, a respiratory stimulant. The data were collected and stored in a personal computer, using the TCM3 system with a combination electrode for simultaneous measuring of cutaneous oxygen and carbon dioxide partial pressures (TINA, Radiometer) at 30-s intervals. The overall observation period was 240 min. Means and standard deviations were calculated for individual data and for data pooled at 15- or 60-min intervals. Groups were compared by means of the chi 2 test, Student's t-test, Wilcoxon rank sum test or analysis of variance (level of significance P < or = 0.05). ⋯ The present study confirmed that spontaneous respiration in the early postoperative period can be monitored non-invasively by measuring transcutaneous partial pressures of carbon dioxide and, less precisely due to large individual variations, oxygen. It showed that spontaneous respiration deteriorates after gynaecological surgery under halothane anaesthesia and recovers slowly during the next 4 h. The respiratory stimulant amiphenazole (150 mg i.v.) was of no significant value with respect to the improvement of ventilation.
-
Randomized Controlled Trial Comparative Study Clinical Trial
[A comparison of different endotracheal tubes. Tracheal cuff seal, peak centering and the incidence of postoperative sore throat].
The study objective was to evaluate cuff seal, tube tip position and incidence of postoperative sore throat in three different endotracheal tubes: the reusable Rüsch "red rubber" tube (low-volume, high-pressure cuff) and the disposable Rüsch "Super Safety Clear" and Mallinckrodt "lo-pro" tubes (both high-volume, low-pressure cuffs). ⋯ Despite the economic (usable up to 100 times) and ecological (less PVC waste) advantages of the rubber tube, the disposable tubes with high-volume, low-pressure cuffs tended to be superior regarding cuff seal, tube tip position and incidence of postoperative throat complaints. Nevertheless, the continued use of "red rubber" type reusable tubes may be justified in cases where the tube has to stay in place for only a short time.
-
Randomized Controlled Trial Clinical Trial
[Acupressure in the prevention of postoperative nausea and vomiting].
Despite modern anaesthetic procedures, postoperative nausea and vomiting are still the side-effects most often mentioned: acupressure is reported to be an additional method of preventing these effects in minor gynaecological surgery. We investigated the effectiveness of acupressure in patients undergoing gynaecological operations of longer duration (6-8 h) in a verum acupressure group compared to a placebo group. Before beginning the study we investigated a control group to find out the frequency of emesis. ⋯ As demonstrated in this group of longer gynaecological surgery patients as well as in chemotherapy-induced nausea and vomiting, we were able to demonstrate that acupressure is an effective method of preventing nausea and vomiting without any side-effects. It is a valuable addition to the prevention of postoperative nausea and vomiting. Further studies should be conducted to investigate this possibility further.
-
The coeliac plexus block is an approved method for the relief of upper abdominal pain due to cancer of the upper intra-abdominal viscera or to chronic pancreatitis. While there are many reports concerning the posterior approach to the coeliac plexus block, little attention has been given the anterior approach. There are two ways of implementing the anterior approach to the coeliac plexus: CT-guided and the ultrasound guided approach. ⋯ Also, no contrast medium is necessary. Only a small volume of local anaesthetics or alcohol is required. We prefer the anterior approach of the coeliac plexus block as a fast, safe and cost-effective method, which should receive increasing attention during the next few years.