Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Anesthesia in geriatric patients. The determination of physiological variables for cognitive function in geriatric patients after regional or general anesthesia].
The aim of the present study was to show the influence of the parameters of gas exchange (arterial oxygen pressure paO2, arterial oxygen saturation SatO2) and haemodynamics (arterial systolic and mean blood pressure RRs and MAP) on the restitution of cognitive functions in geriatric patients scheduled for elective hip arthroplasty. ⋯ The restitution of cognitive functions during the first three postoperative days in geriatric patients scheduled for elective hip surgery does not depend on the anaesthetic technique. According to our results regional anaesthesia does not show any advantage for geriatric patients undergoing elective hip arthroplasty.
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The additive properties of general and regional anesthetic techniques are brought together in combined anesthesia to minimise side effects of the individual techniques. Despite a wide experience with both used as single anesthetic techniques, no definite recommendations regarding indications, general contraindications and procedure exist for their combination. Beneficial effects on haemodynamics, respiratory function, intestinal motility and postoperative stress response have been demonstrated for a combination of general anesthesia and thoracic epidural anesthesia (TEA). ⋯ Nevertheless, until now no reduction of perioperative morbidity and mortality has been demonstrated. Since the combination of two anesthesia techniques theoretically increases the rate of complication, the expected benefit for the patient must predominate. To estimate the risks and benefits of combined anesthesia, the anesthesiologist must be familiar with each single method, as well as with the synergistic effects of both techniques in order to evaluate the individual indication.
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A paper published in various US journals on Emergency Medicine in 1997, has raised considerable concerns. The authors question if it is justified to continue to recommend initial ventilation as part of basic CPR when performed by lay-bystanders. A few aspects need to be discussed and some questions have to be answered before any changes in the current recommendations may even be considered: e.g. 1. ⋯ Ad 2: Pepe's argument regarding the efficacy of endotracheal intubation (ETI) in VF-patients has not been scientifically proven and lacks conclusive evidence. ETI serves to protect the airways and lungs against aspiration of regurgitated material and to facilitate artificial ventilation including PEEP, both under anaesthesia and resuscitation. The efficacy of ETI in the OR has long b