Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
Mivacurium or vecuronium for paediatric ENT surgery. Clinical experience and cost analysis.
The present study compared the quality of neuromuscular block and costs after equipotent doses of mivacurium and vecuronium in the context of paediatric ENT surgery. ⋯ In conclusion, mivacurium-induced NMB is of very short duration in paediatric patients, and therefore repetitive doses are required to maintain a deep neuromuscular block. Nevertheless, residual paralysis is less frequent after mivacurium. The neuromuscular block after mivacurium was more expensive and residual paralysis less frequent compared to vecuronium.
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Sepsis and SIRS are characterised by increased hepatosplanchnic blood flow and oxygen transport due to sepsis-associated hypermetabolism with enhanced oxygen uptake. Regional hypermetabolism may be linked with a mismatch of oxygen availability and demand potentially resulting in a pathological splanchnic oxygen uptake/supply dependency. ⋯ The response of splanchnic haemodynamics and oxygen kinetics, however, to therapeutic interventions does not necessarily parallel the different metabolic pathways. Therefore, understanding of both tissue perfusion and oxygenation as well as metabolism is pivotal for evaluating the effects of different therapeutic strategies in intensive care medicine.
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Clinical characteristics of neuropathic pain, i.e. pain after nervous system lesions, are burning spontaneous pain, shooting pain attacks and evoked pains. Partly interacting pathophysiological mechanisms at the peripheral and central nervous system may be responsible for initiation and maintenance of chronic neuropathic pain. (1) Peripheral nociceptive fibers can be abnormally sensitized. (2) Central nociceptive second order neurons in the spinal cord dorsal horn can also be sensitized, i.e. they are hyperexcitable and start responding to non-noxious stimuli. (3) Degeneration of nociceptive neurons may trigger anatomical sprouting of low-threshold mechanosensitive terminals to central nociceptive neurons and may subsequently induce synaptic reorganization in the dorsal horn. By this mechanism activity in mechanosensitive neurons may be perceived as painful. (4) Peripheral nerve injury may induce a pathological interaction of the nociceptive system and the efferent sympathetic system. ⋯ Therefore, a thorough analysis of sensory symptoms may reveal the underlying mechanisms that are mainly active in a particular patient. In the next step novel drugs will be developed that address specifically the relevant mechanism combination. Drug therapies that are available today include NSAIDS, opioids, tricyclic antidepressants, anticonvulsives (carbamazepine, gabapentin), GABA-agonists, Capsaicin and NMDA-antagonists.
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During general anaesthesia gas climate significantly is improved by performance of low flow techniques. Gas climatisation, however, markedly also will be influenced by the temperature loss at, and corresponding water condensation within the hoses, factors which are related to the technical design and material of the patient hose system. The objective of this prospective study was to investigate 1. how anaesthetic gas climatisation during minimal flow anaesthesia is influenced by the technical design of different breathing hose systems in clinical practice. 2. to investigate, whether a sufficient gas climatisation also can be gained with higher fresh gas flows if that hose system is used, proven beforehand to optimally warming and humidifying the anaesthetic gases. ⋯ Using conventional hose systems and coaxial hosings acceptable, but not optimal climatisation of the anaesthetic gases can be gained if minimal flow anaesthesia is performed. The use of a coaxial hose system seems to lead to improved climatisation in long lasting procedures only. In routine clinical practice, however, conventional and coaxial hose systems are similar in respect to the climatisation of breathing gases. Heated breathing hoses performed markedly better in terms of climatisation of the breathing gas than the coaxial and the conventional hose system. With this hosing not only sufficient but optimal moisture and temperature values are realized. Optimal climatisation, however, only can be gained if low flow anesthetic techniques with fresh gas flows equal or less than 1 l/min are performed. With higher fresh gas flow rates the humidity decreases markedly while high gas temperatures are maintained. (ABSTRACT TRUNCATED)
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This survey collected and analyzed data on the current practice of clinical neuroprotection in neuroanesthesia in Germany. ⋯ These findings demonstrate that the neuroprotective therapy administered in anesthesiological departments in Germany is not yet standardized, i.e., there is a wide variation. Although outcome was not assessed with this survey, it is conceivable that algorithms based on logical approaches in the sense of evidence-based medicine could serve as tools to reduce morbidity and mortality.