Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
[Propofol-alfentanil reduced cerebrovascular CO2 reactivity in comparison with isoflurane].
The present study compared the effects of propofol/alfentanil versus isoflurane anaesthesia on cerebral vascular reactivity to changes in carbon dioxide (CO2) using transcranial Doppler sonography (TCD). METHODS. Seventeen ASA class I patients undergoing minor elective surgery were studied following IRB approval and informed consent. ⋯ The data show that although CO2 reactivity is maintained during both isoflurane and propofol/alfentanil anaesthesia, the cerebral vascular response to CO2 was lower in propofol/alfentanil compared to isoflurane patients. This is likely due to propofol/alfentanil-induced cerebral vasoconstriction. These data suggest that CO2 reactivity is a function of the pre-existing cerebral vascular tone induced by the anaesthetic.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Continuous monitoring of critical patients with a newly developed pulmonary arterial catheter. A cost analysis].
The introduction of flow-directed pulmonary artery (PA) catheters has helped to improve our knowledge of cardiovascular physiology. There have been several developments of this equipment in recent years, including continuous monitoring of mixed-venous O2 saturation (SvO2) and cardiac output (CO). The high purchase price, however, is an obstacle to its use in the critically ill. ⋯ Costs for laboratory analyses can blunt the advantage of lower costs for the standard PA catheter. Intermittent (standard) monitoring of SvO2 and CO was significantly more time-consuming than the continuous methods. It can be summarised that although purchase costs for the more advanced PA catheters are higher than for standard PA catheters, the use of these continuous monitoring devices in the critically ill can be justified from a financial point of view.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Hemodynamic effects of new phosphodiesterase inhibitors in patients with coronary heart disease. A comparison between enoximone and R80122].
At present, phosphodiesterase III inhibitors are commonly used for the treatment of low cardiac output states. Despite their positive inotropic and lusitropic effects, these drugs are still under discussion because of certain adverse effects like thrombopaenia, elevation of transaminases, abdominal disregulation, and excessive peripheral vasodilatation. As a consequence, more cardioselective phosphodiesterase inhibitors were developed with the aim of reducing these adverse effects. ⋯ Both enoximone and R80122 showed the expected inotropic effects. Nevertheless, both substances have a distinct vasodilative effect, which leads to a decline in MAP. R80122 does not have higher cardioselectivity than enoximone.
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The quality, result, and prognosis of neurosurgery relies heavily on the anaesthetic technique. Many different classes of drugs have been used during neurosurgical anaesthesia. This article reviews the use of intravenous (IV) propofol as an alternative to volatile anaesthetic techniques. ⋯ On the other hand, all IV agents except ketamine are associated with decreases in CMRO2 and are cerebral vasoconstrictors. For this reason, it is rational to use them for the induction and maintenance of anaesthesia for neurosurgery as part of a total IV anaesthetic technique. The third part of the article focuses on propofol as the newest representative of IV anaesthetics.(ABSTRACT TRUNCATED AT 250 WORDS)
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Pregnancy causes substantial changes in the cardiovascular system: cardiac output (40%-50%) and blood volume (40%) increase whereas systemic peripheral resistance and arterial pressure decrease. The rise in progesterone and estrogen levels accompanying pregnancy stimulates the renin-angiotensin-aldosterone system. Increased prostaglandin production follows renin activation; simultaneously, the arterial vessels show diminished angiotensin sensitivity. ⋯ An upregulation of angiotensin receptors enhances vascular reactivity, with the consequence of high peripheral resistance. For antihypertensive therapy hydralazine, alpha-methyldopa, and magnesium sulfate are the drugs of choice. A generalised recommendation of anaesthesia for the pre-eclamptic gravida cannot be made because both general and epidural anaesthesia have risks of severe side effects.