Der Anaesthesist
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Multicenter Study Clinical Trial
[Postoperative cognition disorders in elderly patients. The results of the "International Study of Postoperative Cognitive Dysfunction" ISPOCD 1)].
Cognitive dysfunction is a known problem after operations and may be especially relevant in the elderly. The aim of this international multicentre study was to investigate short- and long-term cognitive dysfunction in elderly patients and to elucidate the relevance of hypoxaemia and hypotension as causative factors. ⋯ With this investigation long-term cognitive dysfunction could be proven definitively for elderly patients after major operations under general anaesthesia. No factors with prophylactic or therapeutic influence were detectable so that aetiology and pathophysiology of POCD could not be further determined.
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Clinical Trial
[Respiratory pattern and respiratory strain in automatic tube compensation and inspiratory pressure support].
To investigate whether automatic tube compensation (ATC) or conventional pressure support (PS) is suitable to compensate for the work of breathing imposed by the breathing circuit without altering the breathing pattern. ⋯ From the presented data in healthy volunteers it might be concluded that ATC and PS 5 mbar and 10 mbar are suitable modes for unloading the respiratory system from work imposed by the breathing circuit. ATC does not alter the breathing pattern in contrast to PS which results in an increased tidal volume. Therefore, the exact compensation of the work imposed by the ETT during ATC seems to be advantageous over ATC to assess the actual breathing pattern.
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Minor laryngopharyngeal complaints following anaesthesia considerably determine postoperative patient comfort. They cannot be eliminated but reduced by experience and careful preparation and insertion technique. The incidence of minor laryngopharyngeal symptoms following the use of the laryngeal mask airway is similar to that following endotracheal intubation. ⋯ Measurement of cuff pressure is not obligatory, instead reduction of cuff volume to a "just seal" situation seems to be a reasonable approach. The laryngeal mask airway has definitely changed anaesthesiology airway management. Whether this is due to its supposedly less invasiveness compared to endotracheal intubation has not been proven by scientific investigations.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Analgo-sedation in intensive care: a quantitative, EEG-based trial with propofol 1% and 2%].
The primary aim of this study was to find out whether adequate long-term sedation (> or = 72 h) can be achieved in critically ill patients with an EEG median frequency controlled closed-loop system for the application of propofol 1% and 2%. Moreover, we investigated the pharmacokinetics and pharmacodynamics of propofol with respect to possible tolerance and compared the quality of sedation of both propofol formulations and their lipid load. ⋯ The EEG median frequency can be used for closed-loop control of propofol even for long-term sedation in critically ill patients. EEG median frequencies were similarly low as in deeply anaesthetised patients. No differences in quality of sedation were seen between the two propofol formulations, but propofol 2% seems to be advantageous due to lower lipid load and triglyceride values. Increasing concentrations of propofol at unchanged sedation scores and EEG median frequencies may indicate development of tolerance.