Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[Randomized, double-blind study with ketoprofen in gynecologic patients. Preemptive analgesia study following the Brevik-Stubhaug design].
The clinical effect of ketoprofen is based not only on the inhibition of prostaglandin synthesis. Ketoprofen also acts through kynurenic acid as a central antagonist on the NMDA receptor. Due to this central analgesic mechanism of ketoprofen, we expected an analgesic preemptive effect. This study was carried out following the Breivik/Stubhaug preemptive effect study design. ⋯ We showed a preemptive effect with ketoprofen, which was expressed significantly both in terms of the time to first analgesic request and by the lower analgesic consumption in the first 24 hours after surgery.
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In addition to renal elimination and gastrointestinal metabolism (amylase; splenic and hepatic dextranase) colloid plasma solutions like dextran and hydroxyethyl starch deposit in tissues, especially in the reticuloendothelial system (RES). This tissue storage is limited in time (weeks to months), is influenced by the employed solution and other factors (lysosomes) and has usually no clinical importance (no RES blockade). ⋯ This storage may have impaired ventilation, transport of bile acids and renal function. A possible role of tissue storage of colloids in organ failure is discussed.
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Turnaround time for analysis of prothrombin time (PT) and activated partial thromboplastin time (APTT) by standard laboratory methods ranges between 40 min and several hours. The delay in obtaining the test results limits their clinical utility for treatment of perioperative coagulation disorders and adequate anti-coagulation therapy. In this study, we compared on-site coagulation testing (OCT) of whole blood, which takes about 3 min, with standard laboratory plasma coagulation tests by our institutional laboratory (LAB) to assess the accuracy of the OCT in a clinical setting (abdominal and postcardiac surgery). ⋯ On-site coagulation monitoring provides a rapid, convenient, and accurate assessment of coagulation that can both guide specific anti-coagulation therapy and optimize therapy control of coagulation disorders after cardiac and abdominal operations. As a consequence, OCT offers a valuable tool to reduce the inappropriate use of fresh frozen plasma and to improve cost-effectiveness.
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We report our initial experience with an improved model of the laryngeal mask airway, the intubating laryngeal mask airway (ILMA, commercial name Fastrach), which was designed by A.I.J. Brain to improve blind endotracheal intubation through a laryngeal mask. ⋯ The ILMA improved ventilation compared to a face mask and almost doubled the success rate of blind intubation compared to a SLM in our hands in a variety of intubation situations. The ILMA has the potential to be useful in difficult to intubate patients--except those with cervical pathology--or in emergency medicine. Handling can be trained during every day routine. Experienced judgement of definite endotracheal tube placement is mandatory.