Der Anaesthesist
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Clinical Trial
[Primary cesarean section. Use of phenylephrine during anesthesia in a patient with hypertrophic obstructive cardiomyopathy].
We report on anaesthesia management for elective Caesarean section in a parturient woman with hypertrophic obstructive cardiomyopathy (HOCM). Special considerations for anaesthesia are associated with this condition. Women with HOCM need a closed diagnostic and therapeutic follow-up during pregnancy. ⋯ Adequate hemodynamic monitoring is essential. Phenylephrine is a pure alpha-adrenergic vasoconstrictor without inotropic effects. It is suitable for therapy of blood pressure drops induced by peripheral vasodilation.
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Randomized Controlled Trial Clinical Trial
Mivacurium or vecuronium for paediatric ENT surgery. Clinical experience and cost analysis.
The present study compared the quality of neuromuscular block and costs after equipotent doses of mivacurium and vecuronium in the context of paediatric ENT surgery. ⋯ In conclusion, mivacurium-induced NMB is of very short duration in paediatric patients, and therefore repetitive doses are required to maintain a deep neuromuscular block. Nevertheless, residual paralysis is less frequent after mivacurium. The neuromuscular block after mivacurium was more expensive and residual paralysis less frequent compared to vecuronium.
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Sepsis and SIRS are characterised by increased hepatosplanchnic blood flow and oxygen transport due to sepsis-associated hypermetabolism with enhanced oxygen uptake. Regional hypermetabolism may be linked with a mismatch of oxygen availability and demand potentially resulting in a pathological splanchnic oxygen uptake/supply dependency. ⋯ The response of splanchnic haemodynamics and oxygen kinetics, however, to therapeutic interventions does not necessarily parallel the different metabolic pathways. Therefore, understanding of both tissue perfusion and oxygenation as well as metabolism is pivotal for evaluating the effects of different therapeutic strategies in intensive care medicine.