Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[Total intravenous anesthesia with methohexital-alfentanil or propofol-alfentanil in hypogastric laparotomy. Clinical aspects and the effects of stress reaction].
Total intravenous anaesthesia (TIVA) using a combination of a hypnotic and an analgesic agent is gaining increasing popularity as an alternative to balanced anaesthesia with volatile anaesthetics for abdominal surgery. Among the required characteristics of the drugs used in this technique are a good correlation between dose, plasma concentrations, and effect as well as rapid elimination from the circulation, allowing close control of anaesthetic depth. Two hypnotic drugs with similar pharmacokinetic and pharmacodynamic profiles are propofol and methohexitone, both of which can be employed as a component of a TIVA technique. ⋯ Plasma concentrations of glucose, lactate, and fatty acids were lower in the TIVA groups than in the Iso group intraoperatively, but increased to comparable postoperative levels. CONCLUSIONS. Both TIVA regimens are acceptable alternatives to balanced anaesthesia with Iso N2O. (ABSTRACT TRUNCATED)
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Comparative Study Clinical Trial
[Intraoperative transesophageal versus preoperative transthoracic contrast echocardiography. A method for detection of patent foramen ovale in neurosurgical patients].
Preoperative detection of a patent foramen ovale (PFO) may be achieved employing either transthoracic echocardiography (TTE) with the Valsalva manoeuvre in the awake patient or trans-oesophageal echocardiography (TEE) in the anaesthesised patient. Our study was undertaken to validate these methods with regard to their efficacy in identifying patients at risk for paradoxical air embolism (PAE). METHODS. ⋯ The reason for the lower incidence of PFO detected by TEE during airway pressure 20 cm H2O may have been an insufficient increase of pressure in the right atrium with a negative right-to-left atrial pressure gradient. A standardised ventilation manoeuvre with supra-atmospheric airway pressure of 20 cm H2O is not sufficient. Bulging of the intra-atrial septum from right to left during airway pressure is a possible indication of the efficacy of the manoeuvre, regardless of the influence of the breathing pattern.
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Case Reports Clinical Trial
[A guidewire as a reintubation aid. Translaryngeal fiberoptic insertion of a guidewire into the trachea to assist fiberoptic reintubation in patients difficult to intubate].
Securing the airway following surgery can be a problem in certain patients. Preparation, therefore, should include a plan for safe reintubation, if necessary. ⋯ In addition, one of the patients suffered from an acute abdomen and ileus. We used a guidewire placed into the trachea via a fiberscope to facilitate fiberoptic reintubation.