Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Glucose-xylitol 35% (1:1) versus glucose 40%. Effectiveness and metabolic effects after major surgery].
Injury and stress are accompanied by a characteristic hormonal response and altered energy utilisation. Hyperglycaemia and negative nitrogen (N) balance are the leading symptoms of the metabolic changes in the post-operative state. In a prospective, randomised study the efficacy and metabolic effects of glucose-xylitol (GX) 35% (1:1) versus glucose (G) 40% were investigated in patients undergoing major surgery. ⋯ Similar blood G profiles were in accordance with comparable glucagon and insulin levels. Because of the high standard deviations of N balances, differences in efficacy could not be proven. A significantly lower level of pseudocholinesterase (PCHE) for G40% on day 7 might indicate enhanced hepatic protein synthesis in the GX group.
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Randomized Controlled Trial Clinical Trial
[Wound infiltration with bupivacaine following pelviscopy does not reduce postoperative pain intensity. Results of a placebo-controlled, double-blind study].
The analgetic efficacy of intraoperative infiltration with bupivacaine 0.5% or saline of the skin incisions for the endoscopic trocars was examined in 30 female patients following operative endoscopic pelviscopy in a double-blind study. Infiltration of the peritoneum, abdominal wall, and subcutaneously was performed by endoscopic view before skin suture. There were no significant differences between the two groups in age, duration of surgery, operative technique, intensity of preoperative acute and chronic pain, or state of anxiety. ⋯ Pain due to skin incision was noted less, but in equal numbers in both groups. Of the patients in the bupivacaine group 77% and in the control group 80% started with PCA due to increasing pain scores within 60 to 120 min. The numbers of tramadol demands and given doses did not differ (Fig. 2).(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effect of different types of anesthetic respirators on oxygenation and ventilation in infants during short-term anesthesia. A study using transcutaneous PO2 and PCO2 monitoring].
Monitoring of ventilation in infants is difficult and often not very reliable. In this study, transcutaneous measurement of blood gas tensions was used to investigate the influence of four different modes of ventilation on oxygenation and ventilation in anaesthetized infants. METHODS. ⋯ The group-specific differences in degree of dysventilation with manual ventilation show that the type of breathing system is important with regard to the size of the tidal volume delivered. Thus, tidal volumes will be unintentionally increased by the high fresh gas flow needed when a T-piece system is used. The lower flow and preadjusted pressure limit may prevent the delivery of excessive tidal volumes with the paediatric circuit system...
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Randomized Controlled Trial Clinical Trial
[Electroencephalographic demonstration of central nervous system effects of different premedication regimens].
For many years, the main goal of premedication was prevention of the dangerous side effects sometimes encountered in anesthetics with anticholinergics, antiemetic antihistaminics, and opioids. Because the rules were always preoperative fasting, premedication was administered i.m. Thus, the onset of action was within 15-30 min from administration. In recent years, with the introduction of newer anesthetics with fewer side effects, anxiolysis became the main aim in premedication. Moreover, the oral route became popular since it obviously did not increase the acidity or volume of the gastric content. However, the uptake and thus onset of action of orally administered drugs may take longer and can differ considerably between individual patients. Therefore, the optimum interval between administration and induction of anesthesia remains controversial. The present study was carried out to examine the time course of drug action and the effects of different premedication regimens on the electroencephalogram (EEG). ⋯ All data are presented with respect to reference period. The power density of each frequency range for each electrode is integrated over the selected period and mean values are shown. Changes in power density with time are expressed as percentage change from reference period. Biometrical data showed no significant differences between groups. The median vigilance score 30 min after premedication (end of study period) was 4 in groups M, AP, and APP, and 3 in group N. In both benzodiazepine groups, a distinct increase in power density was found in the beta-bands, while in groups AP and APP the increase was most pronounced in the delta and theta bands. In group M, there was a linear increase in beta 1 power up to 310%, while in the beta 2 range there was a 170% maximum within the second period of 10 min. In group N, there was a similar course with a lower increase in beta 1 (220%) and beta 2 (130%). Increases in both beta-bands were most pronounced with frontal electrodes. While group M showed an increase in delta power (150%), together with moderate suppression in alpha (alpha 1 50%, alpha 2 40%), nordazepam caused only a slight increase in delta (124%) and a distinct increase in alpha 2 to 150%, predominantly in the frontal areas. Group APP showed a linear increase in both delta up to 210% and theta power to 190%. (ABSTRACT TRUNCATED)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Postoperative analgesia with tramadol. Continuous infusion versus repetitive bolus administration].
Postoperative pain relief can be achieved by several methods, including the use of systemic opioids and regional anaesthesia with intrathecal or epidural opioids or local anaesthetics. On-demand analgesia using a PCA (patient-controlled analgesia) system is regarded as the ideal option for systemic opioid analgesia. While PCA devices are not yet commonly used in all recovery units, the use of repetitive boluses on demand is still the most frequent form of administration in postoperative pain therapy. ⋯ Six hours after surgery, when analgesia was evaluated by the patients, there was no significant difference between the two groups. Not until the maintenance infusion had been administered for a further 18 h, was the tramadol consumption within the infusion group significantly higher. Thus, we should consider continuing unreduced administration of the maintenance infusion 6 h after operation.