Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Single-dose spinal anesthesia with a mixture of isobaric bupivacaine 0.5% and hyperbaric mepivacaine 4%].
Single-dose spinal anaesthesia with hyperbaric local anaesthetic provides profound analgesia and motor blockade and allows exact assessment of the analgesic level. The present prospective, randomised study compares a mixture of plain 0.5% bupivacaine and hyperbaric 4% mepivacaine with hyperbaric 0.5% bupivacaine with regard to onset time of analgesia and duration of the sensory and motor blockade. ⋯ The local anaesthetic mixture may be preferred to hyperbaric 0.5% bupivacaine in patients requiring a fast onset of analgesia associated with a 2-3 h duration of sensory and motor block.
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
[Circulatory reactions under spinal anesthesia. The catheter technique versus the single dose procedure].
Life-threatening cardiovascular complications are a serious risk even for healthy patients during spinal/epidural anaesthesia. The incidence of fatal cardiovascular complications for epidural anaesthesia is 1:10000, for spinal anaesthesia 1:7000. In contrast, general anaesthesia has an overall mortality of only 1:28000. Administration of IV fluids to minimise the haemodynaemic reactions of beginning sympatholysis is not always sufficient. In this study, we examined whether fractionated application of local anaesthetics via a spinal catheter would provide better haemodynamic stability. ⋯ With the use of CSA, the haemodynamic effects of sympatholysis can be minimised. This method thus has advantages, especially for high-risk cardiovascular patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Transcranial doppler sonography. Effect of sevoflurane in comparison to isoflurane].
Using transcranial Doppler sonography (TCD), we studied the effects of sevoflurane compared to equipotent doses of isoflurane on blood-flow velocity in the middle cerebral artery (MCA) before, during, and after general anaesthesia. In random order, 30 patients received sevoflurane (n = 15) or isoflurane (n = 15) given in stepwise-increasing doses of 0.5, 1.0, and 1.5 MAC in oxygen/air (FiO2 = 0.5). Oxygen/air was then replaced by oxygen/nitrous oxide 33%/65% with decreasing doses (1.5, 1.0, 0.5 MAC) of sevoflurane or isoflurane. During each step, ventilation was controlled to provide first normocapnia (end-tidal pCO2 = 38 mmHg) and then hypocapnia (end-tidal pCO2 = 27 mmHg). MCA blood-flow velocity and pulsatility, arterial blood pressure, heart rate, and body temperature were recorded simultaneously at the end of each period. For statistical analysis, within-group comparison was made by one-way ANOVA. Differences between groups were determined by two-way analysis of variance. Age, weight, and height of the patients were compared using Student's t-test; P < 0.05 was considered significant. ⋯ We conclude from our TCD data that equipotent doses of sevoflurane and isoflurane comparably affect cerebral perfusion, especially when nitrous oxide is given simultaneously.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Intravenous sedation of spontaneously breathing infants and small children before magnetic resonance tomography. A comparison of propofol and methohexital].
The purpose of the present study was to compare two sedation regimens with either propofol (P) or methohexital (M) for elective magnetic resonance imaging (MRI) in children with respect to safety, side effects, recovery, and discharge time. ⋯ Intravenous sedation with M or P using the reported technique is a safe regimen for children undergoing elective MRI. The fast recovery and discharge times seem to offer advantages over general anaesthesia with endotracheal intubation. The faster recovery and discharge of only a few minutes after P compared with M is without clinical relevance.
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Randomized Controlled Trial Comparative Study Clinical Trial
[RO 48-6791--a short acting benzodiazepine. Pharmacokinetics and pharmacodynamics in young and old subjects in comparison to midazolam].
The objectives of the present study were to compare in a randomized double-blind crossover study design the concentration-effect relationships of Ro 48-6791, a new benzodiazepine agonist, and midazolam, following infusion in young and elderly male volunteers. Therefore, linearly increasing plasma concentrations were generated by computer controlled infusion pumps to achieve a deep hypnotic effect. The endpoint of the infusion was defined by loss of response to loud verbal commands and a median frequency of the recorded EEG power spectrum below 4 Hz. ⋯ The major advantages of Ro 48-6791 compared to midazolam were its shorter duration of action as well as the faster recovery and thus the better controllability. Further investigations would have to confirm these results in a greater number of patients. The applied method of pharmacokinetic-pharmacodynamic modeling not only allowed to quantify the efficacy of Ro 48-6791 but also provided data to augment the safety for further investigations.