Der Anaesthesist
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Clinical Trial
[Preclinical blood gas analysis. Technical description--initial experiences--indications].
A new portable device for blood gas analyses (BGA) has been examined for prehospital application. ⋯ One advantage of BGA over the non-invasive methods pulse oximetry and capnography is that it does not interfere with factors like peripheral vasoconstriction or inequality of the pulmonary ventilation/ perfusion ratio. Moreover, it is the only method for controlled buffering of acid-base disturbances. This means more security in diagnostics and therapeutical interventions for the patient in danger of dying. The device has proved to be a useful addition to the monitoring methods for prehospital application.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Cost aspects in anesthesia. Propofol versus isoflurane anesthesia].
Cost control is no longer an option, but a necessity. Propofol anaesthesia is expensive, however, the true differences in comparison to volatile anaesthetics (isoflurane) are not known. ⋯ A climate of cost-consciousness and cost-containment prevails at the present time. The costs of propofol and 'standard' isoflurane anaesthesia were without differences; however, isoflurane used in a low-flow system had the lowest cost in this study. Doubts are justified, however, as to whether the choice of anaesthetic agents may considerably lower the costs of an anaesthesia department.
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Recently, two new halogenated volatile anaesthetics, sevoflurane and desflurane, have been approved for clinical use in Germany. Their low solubility in blood is the most important common property, and this represents the most obvious difference from the inhalational anaesthetics currently used. Extensive clinical and experimental evaluations have confirmed the superior pharmacokinetic properties predicted. ⋯ Nevertheless, potential side-effects may result from degradation in dry absorbents and subsequent release of CO, from its extreme pungency and irritating airway effects. Thus, desflurane is not recommended for induction of anaesthesia, especially in children. The tendency for desflurane transiently to stimulate sympathetic activity, especially at concentrations above 1.0 MAC, limits its application in patients with cardiac disease.
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Erythropoietin, the hematopoietic growth factor, is synthesised in the kidneys and liver and regulates red blood cell production. Within the last few years, recombinant DNA technology has produced synthetic erythropoietin (rhEPO). Some patients, especially Jehovah's Witnesses, will not accept blood transfusion. The perioperative administration of rhEPO increases the patients' hematocrit (HCt) to a higher than physiological level. ⋯ The case report describes perioperative management using human rhEPO in Jehovah's Witnesses. Treatment with rhEPO increases preoperative Hb levels to a point making it possible to compensate for operative blood loss. RhEPO combined with daily iron substitution may be useful in patients who refuse transfusion based on religious convictions.
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Randomized Controlled Trial Clinical Trial
[Ropivacaine for spinal anesthesia. A dose-finding study].
Several clinical studies have demonstrated the efficacy of ropivacaine in different regional anaesthesia techniques, e.g., epidural anaesthesia. However, the efficacy of ropivacaine for spinal anaesthesia has only been demonstrated in animal experiments up to now. The objective of this study was the investigation of the efficacy and appropriate dosage of isobaric ropivacaine for spinal anaesthesia in humans. ⋯ At concentrations of 0.5% and 0.75%, ropivacaine results in long-lasting spinal anaesthesia. (A