Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Pharmacoeconomical model for cost calculation using a study on prophylaxis of nausea and vomiting in the postoperative phase as an example. Cost effectiveness analysis of a tropisetron supplemented desflurane anaesthesia in comparison to a propofol total intravenous anaesthesia (TIVA)].
Postoperative nausea and vomiting (PONV) are among the most frequent complications after general anaesthesia. Avoiding these symptoms is of utmost importance for most patients; PONV is not only a major source of discomfort for patients but also a cause of additional costs for the patients and the health care provider. The economical impact of PONV will become even more important in the near future because the number of surgical procedures performed on an ambulatory basis is increasing. The following article gives a short overview of the terminology and measures used in pharmacoeconomical studies concerning PONV. Furthermore the economical aspects of a low-flow anaesthesia supplemented with the 5-HT(3)-antagonist tropisetron compared with a total intravenous anaesthesia (TIVA) using propofol are described. ⋯ Total intravenous anaesthesia with propofol is more cost-efficient than balanced anaesthesia with desflurane and additional tropisetron as a prophylactic antiemetic.
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Former preterm infants with postconceptual age <50-60 weeks are at risk of postoperative apnea and bradycardia when operated under general anaesthesia. In addition, after general anaesthesia with endotracheal intubation preterm infants, who had suffered from severe respiratory distress syndrome, often require prolonged postoperative mechanical ventilation. Pure regional anaesthetic techniques can avoid most of these postoperative respiratory complications. ⋯ Recently, pure caudal anaesthesia for this indication has become a promising alternative. If a pure regional anaesthesia technique is not indicated or feasable, the combination of light inhalational anaesthesia with a caudal block seems appropriate. Overnight cardiorespiratory monitoring is mandatory in these patients regardless of the anaesthetic technique used.
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Randomized Controlled Trial Clinical Trial
[Does intraoperative hyperventilation improve neurological functions of older patients after general anaesthesia?].
The purpose of the study was to investigate the effect of intraoperative hyperventilation on postoperative cognitive functions. ⋯ In older patients, POCD occurred more frequently after intraoperative normoventilation. We assume that a reduced amount of noxious substances reach the brain after hyperventilation, because hyperventilation reduces the cerebral blood flow.
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Clinical Trial
[Patient evaluation of postoperative recovery. An evaluation of the QoR scores in 577 patients].
In 1999 Myles and co-workers presented their quality of recovery score (QoR score) as a tool to evaluate postoperative recovery and to measure patient satisfaction. It was developed according to predefined psychological standards and its reliability and validity had been proven in large clinical trials. The aim of this study was to evaluate a German version of the QoR in a heterogeneous group of surgical patients. ⋯ The German translation of the QoR score is easily applicable to a heterogeneous surgical population and thus can be used as a valuable measure of quality of anaesthesia care and patient satisfaction.