Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effect of propofol on vomiting after strabismus surgery in children].
Strabismus surgery in children is associated with a high incidence of postoperative nausea and vomiting (PONV). METHODS. ⋯ All patients were mechanically ventilated during anaesthesia and gastric contents were aspirated. Recovery scores were calculated for 2 h, emetic scores for 24 h postoperatively.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Fructose vs. glucose in total parenteral nutrition in critically ill patients].
Parenteral nutrition required following surgery or injury should not only meet post-aggression caloric requirements but also match the specific metabolic needs so as not to worsen the metabolic disruptions already present in this situation. The primary objective of parenteral nutrition is body protein maintenance or restoration by reduction of protein catabolism or promotion of protein synthesis or both. Whether all parenteral energy donors, ie., glucose, fructose, other polyols, and lipid emulsions, are equally capable of achieving this objective continues to be a controversial issue. The objective of the present study was to answer the following questions: (1) Do glucose and fructose differ in their effects on the metabolic changes seen following surgery or injury, the changes in glucose metabolism in particular? (2) Can the observation of poorer glucose utilization in the presence of lipids be confirmed in ICU patients? ⋯ As demonstrated, parenteral fructose, unlike parenteral glucose, has a significantly less adverse impact than glucose on the glucose balance, which is disrupted initially in the post-aggression state. In addition, the less pronounced increase in insulin activity during fructose infusion than during glucose infusion can be assumed to facilitate mobilization of endogenous lipid stores and lipid oxidation. Earlier workers pointed out that any rise in free fatty acid and ketone body concentrations in the serum produces inhibition of muscular glucose uptake and oxidation, and of glycolysis. These findings were recorded in a rat model and could not be confirmed in our post-aggression state patients receiving lipid doses commensurate with the usual clinical infusion rates. The serious complications that can result from hereditary fructose intolerance are completely avoidable if a careful patient history is taken before the first parenteral use of fructose. If the patient or family members and close friends, are simply asked whether he/she can tolerate fruit and sweet dishes, hereditary fructose intolerance can be ruled out beyond all reasonable doubt. Only in the extremely rare situations in which it is not possible to question either the patient or any significant other, a test dose will have to be administered to exclude fructose intolerance. The benefits of fructose-specific metabolic effects reported in the literature and corroborated by the results of out own study suggest that fructose is an important nutrient that contributes to metabolic stabilization, especially in the post-aggression phase and in septic patients. Hyperglycaemic states are largely prevented and fewer patients require ex
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Randomized Controlled Trial Comparative Study Clinical Trial
[Qualitative comparison of modified neurolept-, balanced and intravenous anesthesia. 2. Results of a clinical study, 1992].
The safety and tolerance of neuroleptanaesthesia (NLA), balanced anaesthesia (BAL), and intravenous anaesthesia with propofol (IVA) were analysed for the first time in a prospective, randomised clinical trial. METHODS. In all, 1318 surgical patients received either NLA, BAL, or IVA. ⋯ CONCLUSION. The present results show clear clinical advantages of BAL and IVA in contrast to neuroleptanaesthesia. Due to the very low incidence of side effects such as nausea and vomiting IVA was highly recommended by the patients, at least in part because of the rapid recovery time.
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Randomized Controlled Trial Clinical Trial
[Does controlled hypotension with nitroprusside affect platelet function?].
Induced hypotension is an accepted technique to reduce intraoperative blood loss and thereby ensures satisfactory operating conditions, especially in microscopic interventions. Sodium nitroprusside (NP), which is often used for induced hypotension, was reported to inhibit platelet aggregation in vitro. Impairment of platelet function implies a higher bleeding risk, which would make the use of NP for induced hypotension questionable. ⋯ In contradiction to in vitro studies using high concentrations of NP, we could not find a decrease in platelet aggregation due to hypotensive anaesthesia with this drug in vivo. In the control group a significant increase in platelet aggregation was observed, which was probably counteracted in the hypotensive patients by the interaction of NP with cyclic guanosine monophosphate (c-GMP). NP augments the intracellular concentration of c-GMP, which is known to decrease platelet aggregation.
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Randomized Controlled Trial Multicenter Study Clinical Trial
[Erythropoietin therapy during frequent autologous blood donations. Dose-finding study].
Avoidance of homologous blood products and patients' demand for preoperative autologous blood donation programs are increasing. As many of these patients are older, with a compromised cardiovascular system and a slow response of the erythropoietic system when anemia occurs, the feasibility and benefit of autologous blood donation is often limited. Augmentation of preoperative blood donation by therapy with recombinant human erythropoietin (rHuEPO) has been described in animal models and in patients. ⋯ No such disturbances were observed in the present study. CONCLUSION. rHuEPO ameliorates the preoperative decrease of haemoglobin and haematocrit values due to autologous blood donations in a dose-related fashion. The individually adjusted dosage of rHuEPO and iron supplementation merits further investigation.