Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[Recovery of psychomotor and cognitive functions following anesthesia. Propofol/alfentanil and thiopental/isoflurane/ alfentanil].
Recent changes in the medical system have resulted in a significant increase of ambulatory surgical procedures. Therefore, a safe and short postoperative recovery period and, especially, the full recovery of complex psychological function after general anaesthesia have become increasingly important. In the present study we investigated the recovery of psychomotor and cognitive function after general anaesthesia with propofol/alfentanil and thiopentone/isoflurane/alfentanil. ⋯ Also in the digit span, the scores were significantly lower 30 min after recovery from the anaesthetic. Here again the propofol group tended to be a little better than the isoflurane group 30 min, 60 min and 240 min after anaesthesia. In the Munich Verbal Learning Test both groups had lower scores 30 min and 60 min, the isoflurane group also 240 min, after recovery...
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Randomized Controlled Trial Comparative Study Clinical Trial
[Ropivacaine 1% versus bupivacaine 0.75% without a vasoconstrictor. A comparative study of epidural anesthesia in orthopedic surgery].
The long-acting local anaesthetic agent ropivacaine, S(-)-1-propyl-2',6'-pipecoloxylidid, is characterised by lower lipid solubility and lower cardiotoxicity compared with bupivacaine. This study was designed to evaluate its clinical efficacy and motor blocking properties when using lower volumes and higher concentrations of both plain substances. METHODS. ⋯ Ropivacaine 1% produced a longer duration of analgesia and better clinical efficacy than bupivacaine 0.75%. The clinical difference in motor blockade was not statistically significant. The Bromage scale is not representative for a substance with good analgesic effects and moderate motor blocking properties, as has been shown in sophisticated studies on ropivacaine motor blockade.
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Randomized Controlled Trial Clinical Trial
[Pharmacodynamics and clinical adverse effects of mivacurium. The effect of oral premedication with H1/H2 antagonists].
Duration of neuromuscular block may be prolonged by H1/H2 antagonists. This study was designed to determine the influence of H1/H2 antagonist treatment on onset, duration and recovery after mivacurium chloride (MIV), a new nondepolarizing neuromuscular blocking agent with a relatively short duration of action, which is metabolized by human plasma cholinesterase (PChE). METHODS. ⋯ The recovery of neuromuscular function, once it has begun, is prolonged neither by MIV nor by H1/H2 antagonists. As MIV is mainly broken down by PChE, it is evident that its duration of action is more prolonged by atypical PChE activity than by interaction with other drugs. Oral H1/H2 premedication may diminish haemodynamic side-effects and clinical signs of histamine release.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Fiberoptic intubation and stress].
Nasotracheal intubation of the trachea by means of fiberoptic endoscopy is an accepted approach to difficult airways. The associated avoidance of direct laryngoscopy may affect the stress response to nasotracheal intubation. We tested this hypothesis by means of a prospective, randomized, controlled clinical study. ⋯ Nasotracheal intubation does not provoke a major stress response, when performed in accordance with the protocol of this study. However, topical anaesthesia of the larynx, as well as the fiberendoscopic approach proved superior to control with respect to diastolic arterial pressure. We conclude that fiberoptic nasotracheal intubation, or laryngoscopy preceded by topical anaesthesia of the larynx may be useful in patients for whom an increase in rate pressure product would be undesirable.
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Randomized Controlled Trial Clinical Trial
[The incidence of postoperative pain on general surgical wards. Results of different evaluation procedures].
Knowledge of the incidence and significance of postoperative pain is essential for the establishment of effective pain treatment programmes. Detailed investigations on the incidence, severity and quality of postoperative pain from the surgeon's perspective are scarce in German hospitals. It was the aim of our study to investigate postoperative pain in general surgery under routine conditions. ⋯ CONCLUSIONS. We conclude from our results that patients perceive significant postoperative pain under current standardized pain treatment in our department. Effective programmes for pain relief should take account of the different patterns of pain after different operations, as identified in this study.