Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
[Neostigmine and edrophonium. Antagonism of profound and shallow mivacurium blockade].
Mivacurium has a short duration of action because it is rapidly hydrolysed by plasma cholinesterase. There is ongoing controversy concerning the antagonism of mivacurium-induced neuromuscular block, firstly because of its short spontaneous recovery time, and secondly because the metabolism of mivacurium may be inhibited by anticholinesterases. We therefore compared neostigmine and edrophonium reversal of deep and moderate mivacurium-induced blocks. ⋯ Two theoretical reasons, the very rapid onset time and the fact that it does not inhibit plasma cholinesterase, suggest edrophonium to be the preferred antagonist of a mivacurium-induced blockade. These two characteristics are reflected in our results: only edrophonium was able to shorten the recovery index significantly and, administered at a profound level of mivacurium-induced neuromuscular block, only edrophonium was successful in shortening recovery time significantly. Therefore, edrophonium should be the anticholinesterase of choice to antagonise a mivacurium-induced neuromuscular block.
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Thermoregulation and its impairment by anaesthesia and surgery has recently been brought back into focus by researchers and clinicians. All volatile and IV anaesthetics, opioids, as well as spinal and epidural anaesthesia increase the inter-threshold range of thermoregulation from 0.2 degree C to 4 degrees C between vasodilation and vasoconstriction. Thermoregulatory vasoconstriction and shivering occurs in anaesthetized patients at lower core temperatures than in awake subjects. ⋯ These hypothermia-related morbidities therefore have consequences reaching fare into the postoperative period. Prevention of inadvertent hypothermia is always indicated. Forced-air warming is the most effective and safest method to prevent perioperative hypothermia.
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In a recently published German multicenter study, 25% of the patients with witnessed cardiac arrest outside the hospital were resuscitated successfully and discharged from the hospital. Approximately 100,000 people suffer a fatal cardiac arrest in Germany annually, which is approximately tenfold the number of deaths from motor vehicle accidents. Cardiopulmonary resuscitation (CPR) performed by bystanders is an important part of the chain of survival to minimize the time interval without artificial circulation and ventilation in a cardiac arrest victim. ⋯ This strategy would decrease the inspiratory flow rate and, therefore, peak airway inflation pressure, which is associated with stomach inflation. Animal models indicate that lower esophageal sphincter pressure may decrease rapidly to 5 cm H2O during cardiac arrest, which may further increase the importance of a low peak airway pressure during ventilation with an unprotected airway. Gastric inflation may cause, besides regurgitation, aspiration, and pneumonia, an increased intragastric pressure, which may push up the diaphragm, decrease lung compliance, and induce a vicious circle of hypoventilation and stomach inflation.(ABSTRACT TRUNCATED)
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Review
[Early care or quick transport? The effectiveness of preclinical treatment of emergency patients].
"Stay and play," especially in emergency patients with unstable vital functions, offers definite advantages compared to "scoop and run" policies. Typical medical and tactical aspects can be identified to judge the amount of diagnostic and therapeutic measures necessary at the site and during transport. Scoop and run seems to be appropriate only rarely in a area with an emergency medical system in the German style.
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Nociceptors can be defined as sensory receptors that are activated by noxious stimuli that damage or threaten the body's integrity. Nociceptors belong to the slowly conducting afferent A delta and C fibres. They are classified according to their responses to mechanical, thermal, and chemical stimuli. ⋯ Experimental and clinical progress has been achieved in using the nociceptor as a target for chemical anti-nociception and treatment of pain. Substances that act directly or indirectly on the nociceptor are steroidal and non-steroidal analgesics, capsaicin analogs, bradykinin antagonists, opioids, and (in the trigeminal system) 5-hydroxytryptamine agonists.