Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Less pain on injection by a new formulation of propofol? A comparison with propofol LCT].
Pain on injection is a major disadvantage of propofol, experienced by the vast majority of patients. Since the traditional formulation has almost normal osmolality and pH, it is hypothesised that the concentration of free propofol in the aqueous phase of the emulsion is responsible for the pain and that reducing the amount of free propofol would also reduce the frequency and intensity of pain on injection. This study was designed to investigate whether pain on injection can be reduced in frequency and intensity by a new formulation of propofol. ⋯ Propofol-MCT/LCT produced significantly less pain on injection when compared to standard propofol in ASA I and II patients undergoing elective surgery. Pain was also significantly less severe, with both effects presumably being due to the lower concentration of free propofol in the MCT/LCT-preparation. With regard to injection pain propofol-MCT/LCT offers significant a advantage over standard propofol.
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Just three months after the first application of sulphuric ether to a patient in german-speaking countries the monography Die Wirkung des Schwefeläthers in chemischer und physiologischer Beziehung was published. In this book Ernst von Bibra and Emil Harless presented their experimental research on the effects of ether on humans and compared it to those on animals. ⋯ The authors "Theory on the action of ether" will be discussed in the context of contemporary criticism. Their hypothesis affected the discussion on the mechanisms of anaesthetic action up to the twentieth century.
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Multiple organ failure (MOV) still represents the leading medical and economical problem in the care of the critically ill surgical patient. Although the incidence of MOF has tended to decrease over the last several years reflecting improved surgical and supportive therapy in the ICU, prognosis still remains serious when MOF develops. ⋯ Besides complexity and redundancy of the mediator systems involved, their beneficial local reparative as opposed to detrimental systemic effects may have contributed to the disappointing results of anti-mediator strategies in the treatment of MOF and sepsis. Although treatment of the underlying disease remains the cornerstone of the care of the critically ill patient to prevent MOF, recent results indicating a decreased mortality in severely septic patients receiving activated protein C as a supportive treatment suggest that modulation of the mediator cascades of sepsis and MOF remains a generally promising therapeutic strategy.