Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Changes in somatosensory evoked potentials after sevoflurane and isoflurane. A randomized phase III study].
Monitoring of somatosensory evoked potentials (SEP) is used to identify critical phases of cerebral ischaemia by means of characteristic changes in the signal patterns. A correct interpretation of the results is possible, however, only if the influence of drugs that act on the central nervous system is known. We were able to show that volatile anaesthetics have an impact on latencies and stimulus amplitudes. ⋯ Under the influence of N2O, there were marked reductions in amplitude of the cortical stimulus response. Thus, it can be recommended that supplementation with N2O should be avoided in the presence of low initial amplitudes. Based on our results, the use of isoflurane and sevoflurane concentrations up to 1.0 MAC seems to be compatible with intraoperative monitoring of SEP.
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Review Comparative Study
[Effects of sevoflurane on the area of the liver and spleen].
Recently, there has been increased interest in the preservation of hepatic function during anaesthesia and surgery. In common with other halogenated volatile anaesthetics, sevoflurane causes dose-related cardiovascular depression, which suggests that the blood flow of various organ systems is affected. ⋯ The effort should be encouraged to study this new volatile anaesthetic in human subjects; if a parallel to isoflurane can be drawn, the impact of both substances on the hepatic circulation should be quite small. In Germany, the introduction of sevoflurane into clinical practice should be a reason to proceed with clinical investigations of this type.
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Polymorphonuclear leukocytes (PM-NL) constitute the first line of defence in the protection of the host from invading microorganisms. PMNL also contribute to the removal of cellular debris from necrotic tissues during reparative processes. For these purposes PMNL are armed with highly efficient bactericidal mechanisms which, under certain pathophysiological conditions, can be turned against the host himself. ⋯ The manifestation of ARDS in leukopenic patients, however, indicates the development of this clinical syndrome independently of the presence of PMNL. The ability to differentiate between PMNL-dependent and PMNL-independent pathways in the pathogenesis of this syndrome is not only of theoretical interest but also of therapeutic significance. Since the patient's systemic inflammatory response may vary according to the stage and type of the underlying disease, an exact qualitative and quantitative analysis of PMNL functions may provide the rationale for new anti-inflammatory drug regimens aimed at modifying the host's response without increasing the risk of infection.
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The inhalational anaesthetic fluor-methyl-trifluor-1-(trifluoromethyl)-ethylether sevoflurane has been known for more than 20 years and is structurally related to the currently available volatile anaesthetics. This anaesthetic is characterized by a low blood/gas partition coefficient of 0.69 and high fat solubility, leading to a sharp rise in alveolar concentration and quick anaesthesia induction. As opposed to desflurane, sevoflurane does not boil at ambient temperature, thus making a special vaporizer unnecessary. ⋯ As opposed to methoxyflurane, which may be nephrotoxic due to its microsomal metabolism in kidney tissue, sevoflurane does not seem to cause clinical inhibition of renal function even at plasma fluoride levels above 50 mumol/l, a concentration thought to be associated with renal tubular impairment. A possible reason for this observation is lower metabolism of sevoflurane within renal tissues. Due to its quick onset and fast elimination, sevoflurane is an interesting new volatile anaesthetic offering various clinical advantages.