Der Anaesthesist
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A 22-year-old male suffering from neuropathic pain in his right leg had sufficient analgesia with oral tilidin 300 mg per day. Nevertheless, the general practitioner decided to change the therapy to transdermal fentanyl. ⋯ After the patch was removed another 60 min later, the patient made a complete recovery. The risks following inappropriate application of transdermal fentanyl are discussed.
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Patients have the right to make decisions concerning their health care. The right to consent to or refuse treatment is based on the ethical principle of autonomy. Respecting a patient's autonomy has emerged as one of the leading principle in medical ethics in the last years. ⋯ I believe that defining accepted and refused interventions in advance is not an appropriate approach to DNR orders during anaesthesia and surgery, as it will be difficult to find a definition of what constitutes resuscitation in this context. Communication with the patient and exchange of information are essential factors promoting ethical decisions. Knowing the individual patient's preferences and fears, a more suitable approach seems to be the perioperative suspension of the DNR order for a limited period of time, with the assurance that therapeutic procedures instituted during surgery will be discontinued postoperatively in reconsideration of the DNR order and if the underlying disease process turns out to be non-reversible.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Remifentanil with propofol or isoflurane. A comparison of the recovery times after arthroscopic surgery].
Due to its unique pharmacokinetics, the new esterase-metabolised opioid remifentanil results in rapid post-anesthesia recovery. The aim of this clinical investigation was to compare recovery times after remifentanil anaesthesia in combination with hypnotic concentrations of either propofol or isoflurane. Dosages used in the study protocol were based on recommendations by the pharmaceutical manufacturer. ⋯ Using the manufacturer's recommended dosages, emergence after remifentanil anaesthesia is more rapid with 0.5 MAC isoflurane than with 0.1 mg/kg/min propofol. These results are most probably due to the different pharmacological properties of both co-anaesthetics, especially the applied dosages, and to different interactions with remifentanil. Present clinical experience suggests that a further dose reduction, especially for propofol, is possible. For both remifentanil groups emergence was remarkably rapid between return of consciousness and the awake state (on-off phenomenon), which might contribute to post-anaesthesia safety.