Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Prophylaxis of nausea and vomiting after pelviscopy. Dolasetron or MCP in comparison with placebo].
Gynaecological surgery including laparoscopy is frequently associated with PONV. Therefore, choosing an anaesthetic with only little side effects in operations eligible for outpatient surgery is at least as important as applying anaesthetics that enable fast-tracking. ⋯ Our results confirm the increased incidence of PONV after gynaecological laparoscopic surgery under balanced anaesthesia compared to the predicted rates. Both dolasetron and metoclopramide proved to be effective prophylactic measures. Given a PONV-incidence of 38% in group D and 39% in group M, it is doubtful, whether the anaesthetic technique chosen in this study is the most suitable regimen for ambulatory gynaecological laparoscopies.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Cisatricurium in the orbicularis oculi muscle. Comparisn of the neuromuscular action of cisatracurium and atracurium in the orbicularis oculi muscle and the adductor pollicis muscle].
Muscle relaxants have different pharmacodynamic profiles in various muscles. Therefore, results obtained for one muscle cannot be extrapolated to other muscles. In the adductor pollicis muscle cisatracurium exerts a pharmacodynamic profile comparable to atracurium, despite the known difference in onset time. However, studies evaluating the neuromuscular effect of cisatracurium in different muscles are lacking. Accordingly, this study compares the pharmacodynamic profile of cisatracurium and atracurium in the orbicularis oculi muscle (OO) - which shows a neuromuscular course similar to the diaphragm and the laryngeal muscles - and the adductor pollicis muscle (AP). ⋯ Cisatracurium shows a dose-dependent shorter onset time in the OO than in the AP. This is consistent with the current view that the onset of non-depolarizing neuromuscular blockers is more rapid in the OO than in the AP. However, at least a dose of 3x ED(95) of cisatracurium was necessary to show a difference in onset time between both muscles. In contrast, atracurium is reported to lead to a significantly shorter onset of neuromuscular block in the OO following 2x the ED(95). The more rapid recovery of T(1) to 10% of its control in all three groups in the OO is due to the relative resistance of this muscle to muscle relaxants.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Accuracy and dose dependency of the train-of-four count].
The estimation of a nondepolarizing neuromuscular block using the train-of-four (TOF) count shows wide differences compared to the mechanomyographic measurement. The purpose of this study was to evaluate the clinical significance of these differences. ⋯ At reappearance of T4, a recovery of neuromuscular block of 25% is missed only by 3 to 5 min during relaxation with atracurium. We consider this margin of error as unimportant for clinical use. More-over we were able to show that the TOF-count is not dose dependent.
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Randomized Controlled Trial Clinical Trial
[Postoperative analgesia in children after hernioplasty. Wound infiltration with different concentrations of bupivacaine: a pilot study].
Wound instillation seems to be an easy and preferable way to achieve postoperative analgesia in pediatric hernioplasty. This prospective, randomized and double-blinded pilot-study was initiated to gain preliminary information in order to define the appropriate concentration of local anaesthetic for efficient posthernioplastic analgesia. ⋯ Wound instillation with 0.2 ml of bupivacaine 0.5% seems to be easy to perform, safe and efficient in controlling posthernioplastic pain. Because of the small numbers of patients included however, no statistically significant differences were observed between the groups. Neither in the LAPS on arrival and observation at the PACU nor in the need for supplementary analgesics. Despite lacking significance the clinical impression suggests a difference to be validated by larger studies. Our data implies that wound instillation with 0.2 ml/kg bupivacaine 0.5% should be regarded for routine usage.
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Randomized Controlled Trial Clinical Trial
[Pre-emptive analgesia with ropivacaine in adult tonsillectomy].
We examined whether a pre-emptive analgesic effect could be achieved with ropivacaine, which has less cardiovascular and central nervous system toxicity than bupivacaine, in adults undergoing tonsillectomy. ⋯ We could demonstrate no significant pre-emptive analgesic effect with ropivacaine in adults undergoing tonsillectomy in our study. One can, however, recommend the administration of ropivacaine post-operatively after tonsillectomy, since a reduction of pain scores can thereby be achieved. For post-operative analgesia we recommend the combination of a non-opioid analgesic with a weak opioid.