Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Intravenous versus thoracic-epidural patient-controlled analgesia following extended abdominal or thoracic surgery].
Intravenous patient-controlled analgesia (PCA-i.v.) has has markedly improved postoperative pain-relief. Alternatively, peridural anesthesia has been used successfully in high risk patients with the disadvantage of a more intense postoperative care. In this study we compared the applicability of intravenous vs. peridural patient-controlled analgesia on a general ward. ⋯ This study demonstrates that epidural PCA can be used on a general surgical ward as an alternative method compared to intravenous PCA. PCA-PDK may be advantageous over intravenous PCA since both techniques require similar intense monitoring and side effects in the PCA-PDK group appear to be less.
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Randomized Controlled Trial Clinical Trial
[The effects of dopexamine. Transpulmonary shunt volume in thoracic surgical procedures with one-lung respiration].
To study the influence of dopexamine on pulmonary shunt and hypoxic pulmonary vasoconstriction during major thoracic surgery with one-lung ventilation (OLV). ⋯ It is concluded that dopexamine can be used to improve haemodynamics and oxygen delivery during thoracic surgery without increasing venous admixture during one-lung ventilation.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Propofol and postoperative nausea and/or vomiting].
The objective of this prospective, randomised study was to investigate the incidence of postoperative nausea and/or vomiting (PONV) during the first 24 h postoperatively. For a quality assurance study on PONV, we compared two established general anaesthetic procedures in 239 patients undergoing four different types of surgery (subtotal thyroidectomy, laparotomy for gynaecological procedures, laparoscopy, and surgery for extra-abdominal procedures). ⋯ We found that the antiemetic effect of propofol was considerable in the early postoperative period. The higher cost of propofol as compared to other induction agents can be covered by not using nitrous oxide for maintenance of anaesthesia and by the decreased need for antiemetic drugs postoperatively. According to the calculations of our clinical pharmacy, the costs of the propofol infusion regimen exceeded those of balanced anaesthesia by 8.50 DM/h; the need for antiemetics was one-half that of the non-propofol group. Considering a cost of 16 DM for cleaning the bed after vomiting, improvement of the patient's condition during the postoperative period can be achieved without additional expense.
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Effects of anaesthesia and analgesia on postoperative morbidity and mortality remain controversial. Numerous studies have demonstrated that epidural anaesthesia and pain relief by epidural analgesia reduces perioperative stress responses and thus may reduce postoperative morbidity and mortality. In patients undergoing vascular surgery, epidural anaesthesia diminished postoperative hypercoagulability. ⋯ One reason for this disappointing finding may be the missing integration of improved postoperative pain relief into general surgical care. A multimodal therapeutic approach, which consists of preoperative patient information, sufficient analgesia, early mobilisation and enteral feeding, may solve this discrepancy. Therefore, prospective controlled studies are needed to assess the influence of this perioperative approach on outcome.
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Postoperative neurological sequelae in patients that have received epidural anaesthesia are not necessarily caused by the epidural anaesthetic technique. As a whole, adverse neurological outcomes following epidural anaesthesia may be subdivided into 3 different ethiological categories. A first category involves events that are not at all caused by the epidural, but merely due to the interference of anaesthesia and/or surgery with a preexisting medical condition. ⋯ These complications include some of the most dramatic sequelae of major neuraxial blockade, such as spinal epidural abscess, spinal infarction, and spinal hematoma. Although extremely rare, the latter complications often result in permanent major neurological deficits. The present manuscript is a review of the most recent, literature addressing post-anaesthetic sequelae, and will discuss their incidence, pathophysiology, clinical course, diagnosis, prevention, and treatment.