Der Anaesthesist
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Review
[Tropisetron for prevention of postoperative nausea and vomiting: a quantitative systematic review].
A quantitative systematic review of randomised controlled trials investigating the efficacy of tropisetron versus placebo to prevent postoperative nausea (PN) and vomiting (PV) as well as PN and/or PV (PONV). ⋯ Tropisetron significantly reduced the incidence of PONV. There is no clear evidence for a dose response between 2 and 5 mg iv. For children a dose of 0.1 mgxkg(-1) of body weight is effective. Sufficient data for the oral application of tropisetron are lacking.
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Hemodynamic instability in the polytraumatized patient is a predominant feature and most commonly secondary to blood loss accompanying injury. In these patients restoration of intravascular volume attempting to achieve normal systemic pressure faces the risk of increasing blood loss and thereby potentially affecting mortality. ⋯ In patient care, several concepts exist for the reduction of blood loss in conjunction with systemic hypotension: these involve "deliberate hypotension" (synonym "controlled hypotension", used intraoperatively under conditions of normovolemia and stable hemodynamics), "delayed resuscitation" (where the hypotensive period is intentionally prolonged until operative intervention), and "permissive hypotension" (synonym "hypotensive resuscitation", where all kinds of therapy are commenced including fluid therapy, thereby increasing systemic pressure without, however, reaching normotension). In this review the concept of "permissive hypotension" is delineated on the basis of macro- and microcirculatory changes secondary to hypovolemia and low driving pressure, and potential indications as well as limitations for the care of the traumatized patient are discussed.
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Since imbalances in the immune system of the critically ill patient have been demonstrated, the role of the gastrointestinal tract for the pathogenesis of multiple organ failure has been a focus of research in intensive care medicine. Particularly, the integrity of the intestinal barrier function has been studied experimentally and clinically. The enormous number of gram-negative bacteria up to 10(11)/ml intestinal liquid inducing the release of significant amounts of endotoxin, is considered to be a vital threat to the intensive care unit (ICU) patient. ⋯ Maintenance of hemodynamic stability is a mainstay of therapy of the critically ill. In addition, the intestinal integrity can be preserved by the early onset of enteral nutrition. Moreover, recent concepts of enteral nutrition using immunomodulating nutrients like omega-3-fatty acids, glutamine, arginine, and nucleotides are under clinical evaluation.
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Clinical Trial
[Narcotrend stages and end-tidal desflurane concentrations. An investigation during recovery from desflurane/remifentanil anaesthesia].
[corrected] As indicated by the manufacturer the EEG monitor Narcotrend trade mark (MonitorTechnik, Bad Bramstedt) can be used to analyse EEG effects of volatile anaesthetics, however, published data are missing. This study evaluated the emergence from a desflurane/remifentanil anaesthetic and was designed to investigate the relationship between Narcotrend stages (version 2.0 AF) and end-tidal desflurane concentrations and to identify the pattern of changes of the Narcotrend stages during recovery. ⋯ During emergence from desflurane/remifentanil anaesthesia, a reduction of end-tidal desflurane concentrations was detected by the EEG monitor Narcotrend and classified as a typical change of distribution of Narcotrend stages.