Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Intravenous anesthesia with propofol versus thiopental-/enflurane anesthesia. A consumption and cost analysis].
It may be possible to reduce costs in anaesthesia when there is a choice of drugs and methods. Two of the most widespread techniques are inhalation anaesthesia with enflurane following induction with thiopentone, and intravenous anaesthesia (IVA) with propofol. The aims of our study were to compare the costs, effectiveness and side effects of the anaesthetics involved in these two techniques, and to measure significant clinical parameters. ⋯ Minute ventilation, oxygen consumption, heart rate and CO2 production indicated a less pronounced stress response and sympathetic activity during and after propofol. Quicker recovery of cognitive and psychomotor abilities, less postoperative pain and less impairment of respiratory function after IVA may lead to an earlier release from the postoperative recovery unit. This might be a cost-reducing factor that should be taken into account when these two anaesthetic regimens are concerned.
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The authors report a tracheal rupture in a 34-year-old patient who was primarily intubated following generalised seizures and loss of consciousness (Rüsch endotracheal tube). Some hours later, she developed high ventilatory airway pressures and subcutaneous and mediastinal emphysema were noted. Reintubation with a high-volume, low-pressure endotracheal tube was planned when it was noted that the ballon of the Rüsch tube was grossly overinflated. ⋯ To maintain low airway pressures post-operatively, she remained sedated for 2 days and received a muscle relaxant to permit pressure-controlled ventilation. In this case, it can be concluded that excessive inflation of the endotracheal tube cuff resulted in the tracheal rupture. Other possible causes and results of tracheal rupture are discussed.
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By measuring pulse rate (PR), blood pressure (BP), electrical integral skin resistance (SR), and skin surface temperature in different areas, the activity of the sympathetic nerves in spinal anaesthetics of different levels was evaluated. It was found that the sympathetic subsystems for vasomotor and sudomotor activity have their own innervation and that the functionally different effectors also manifest different deficiency reactions in low- and medium-level spinal anaesthesia. Functional sympathetic innervation, however, is unimportant after high sensory spread of spinal anaesthesia. ⋯ Subsequently, hand temperature increases, and finally bradycardia and hypotension occur. The functional reaction of sympathetic activity is indicated by correlation of the vasomotor and sudomotor activities in high and low spinal anaesthesia. Failure of sudomotor activity can be observed on average at least 3 min prior to an increase in acral temperature and 9 min at the hands in cases of high spinal anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)