Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Intravenous sedation of spontaneously breathing infants and small children before magnetic resonance tomography. A comparison of propofol and methohexital].
The purpose of the present study was to compare two sedation regimens with either propofol (P) or methohexital (M) for elective magnetic resonance imaging (MRI) in children with respect to safety, side effects, recovery, and discharge time. ⋯ Intravenous sedation with M or P using the reported technique is a safe regimen for children undergoing elective MRI. The fast recovery and discharge times seem to offer advantages over general anaesthesia with endotracheal intubation. The faster recovery and discharge of only a few minutes after P compared with M is without clinical relevance.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Comparison of sufentanil-propofol-anesthesia with fentanyl-propofol in major abdominal surgery].
Major abdominal surgery often leads to a marked sympathoadrenal stress response with high concentrations of plasma catecholomines, hypertension, and tachycardia. We compared the effects of sufentanil-propofol with fentanyl-propofol anaesthesia in a controlled, randomised, double-blind study of 18 ASA I-II patients aged 23-64 years undergoing major abdominal surgery. Study parameters were haemodynamics (heart rate [HR], arterial [ABP], central venous, and pulmonary arterial pressures, cardiac index [CI]), arterial catecholamine concentrations, and the median frequency of the electroencephalogram (EEG) power spectrum. ⋯ With both regimens, the sympathoadrenal stress response to major abdominal surgery was nearly completely suppressed, resulting in stable haemodynamics during the operations. Sufentanil and fentanyl were equally well suited as analgesic components of total i.v. anaesthesia with propofol.
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[The effect of anesthetic method on enflurane air pollution in non-air conditioned operating rooms].
Pollution of work areas by volatile anaesthetics and nitrous oxide occurs during general anaesthesia. Short anaesthesia procedures are often carried out in operating theatres that are not equipped with air-conditioning systems. Methods of lowering exposure during short procedures, where mask anaesthesia is the usual procedure, are double masks and the laryngeal mask. The aim of our investigation was to determine the possibility of lowering the pollution of the environment to below national and international thresholds in a non-air-conditioned work area and to find out which method of anaesthesia is the most effective in environmental protection, i.e. which has the lowest leakage rate. ⋯ In unventilated work areas, it was not possible to lower the exposure of the personnel by changing the method of anaesthesia. The application of procedures like double or laryngeal masks does not avoid the need for installation of air-conditioning systems in all work areas were anaesthesia is performed.
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Case Reports
[Neurologic complications following total endoprothesis implantation of the hip under peridural catheter anesthesia].
This case report describes paralysis of the plantar flexors and extensors after a total hip replacement in a 33-year-old woman performed under epidural anaesthesia (PDA). Six years previously, the patient had undergone a bone marrow transplantation for chronic myeloid leukaemia. She had developed a deep vein thrombosis, a pulmonary embolus, and a severe graft-versus-host reaction of the skin, leading to markedly reduced mouth opening. ⋯ It remains uncertain whether the PDA in a patient receiving low-molecular-weight heparin resulting in a the suspected epidural haematoma was the cause of the neurological sequelae and in agreement with the consultant neurologist, we believe that a direct traumatic lesion of the L5/S1 segment or damage to the sciatic nerve are also likely causes of the symptoms. Undoubtedly, the lack of adequate postoperative neurological monitoring and the intraoperative administration of dextran despite the known epidural vascular lesion deserve criticism. This case report demonstrates the often complex development of neurological complications after nerve blocks, where a definite cause can frequently not be determined.