Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[TIVA with propofol-remifentanil or balanced anesthesia with sevoflurane-fentanyl in laparoscopic operations. Hemodynamics, awakening and adverse effects].
This study was designed to investigate the differences between TIVA with propofol/remifentanil (P/R) and balanced anaesthesia with sevoflurane/fentanyl (S/F) in gynaecological laparoscopic surgery. Emphasis was put on haemodynamic reaction, recovery profile, postoperative side effects and patient satisfaction. ⋯ Compared with patients given balanced anaesthesia with sevoflurane and fentanyl, TIVA with propofol and remifentanil proved to be particularly suited for gynaecological laparoscopic surgery. Its major advantages are haemodynamic stability, significantly shorter times of emergence, and the exceptional acceptance by the patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Analgo-sedation in intensive care: a quantitative, EEG-based trial with propofol 1% and 2%].
The primary aim of this study was to find out whether adequate long-term sedation (> or = 72 h) can be achieved in critically ill patients with an EEG median frequency controlled closed-loop system for the application of propofol 1% and 2%. Moreover, we investigated the pharmacokinetics and pharmacodynamics of propofol with respect to possible tolerance and compared the quality of sedation of both propofol formulations and their lipid load. ⋯ The EEG median frequency can be used for closed-loop control of propofol even for long-term sedation in critically ill patients. EEG median frequencies were similarly low as in deeply anaesthetised patients. No differences in quality of sedation were seen between the two propofol formulations, but propofol 2% seems to be advantageous due to lower lipid load and triglyceride values. Increasing concentrations of propofol at unchanged sedation scores and EEG median frequencies may indicate development of tolerance.
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Preoperative starvation in order to prevent pulmonary aspiration is mandatory in elective pediatric surgery. Hypoglycemia, thirst and unwellness have been reported as undesired side effects. ⋯ Accumulation of beta-hydroxybutyrate und acetoacetate in blood can lead to ketoacidosis. We report a case of a severe intraoperative ketoacidosis in a fourteen months old child complicating 36 hours of starvation.
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Case Reports
[One-lung respiration in a nasally intubated patient using a single-lumen endobronchial tube].
We report the case of a 57-year-old patient who underwent a right-sided thoracotomy. The preoperative examination of the patient already revealed a clear diminution of the mouth opening (Mallampati class 4). Ventilation per mask following the induction of anaesthesia was unproblematic. ⋯ The operation itself was performed on the collapsed right lung. At the end of the operation the right lung could be ventilated once again by deflating the bronchial cuff (tracheal cuff inflated). This example demonstrates that one-lung ventilation is possible even under difficult intubation conditions.