Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[The effect of nitroglycerin on cerebrovascular circulation, cerebrovascular CO2-reactivity and blood flow rate in basal cerebral arteries].
The cerebral haemodynamic effects of vasodilators are of clinical interest because a decrease in mean arterial pressure (MAP) might alter global cerebral blood flow (CBF). Luxury perfusion of the brain, contrast, might be unfavourable in patients with reduced intracranial compliance. Despite the widespread use of nitroglycerine (NTG), little is known about the cerebral haemodynamic consequence of NTG infusions in humans. This prospective, controlled study was designed: (1) to investigate the effects of NTG on CBF and cerebrovascular CO2 reactivity and (2) to compare reference measurements of global CBF with transcranial Doppler monitoring (TCD) of middle cerebral artery flow velocity (VMCA). ⋯ This study demonstrates that during fentanyl/midazolam anaesthesia NTG may cause a major increase in CBF as long as CPP does not decrease considerably. Our results further suggest that NTG causes vasodilation of basal cerebral arteries, inducing a discrepancy between relative changes in CBF and VMCA. Consequently, TCD measurements during infusion of NTG should not be directly compared with preceding measurements of MCA flow velocity.
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Randomized Controlled Trial Clinical Trial
[Variation in inspiratory gas flow in pressure support ventilation. The effect on respiratory mechanics and respiratory work].
During pressure support ventilation (PSV), the timing of the breathing cycle is mainly controlled by the patient. Therefore, the delivered flow pattern during PSV might be better synchronised with the patient's demands than during volume-assisted ventilation. In several modern ventilators, inspiration is terminated when the inspiratory flow decreases to 25% of the initial peak value. However, this timing algorithm might cause premature inspiration termination if the initial peak flow is high. This could result not only in an increased risk of dyssynchronization between the patient and the ventilator, but also in reduced ventilatory support. On the other hand, a decreased peak flow might inappropriately increase the patient's inspiratory effort. The aim of our study was to evaluate the influence of the variation of the initial peak-flow rate during PSV on respiratory pattern and mechanical work of breathing. ⋯ COPD patients had significantly higher pressure support than control patients. With decreasing inspiratory flow, Wpi increased significantly in COPD patients.(ABSTRACT TRUNCATED)
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effect of the laryngeal mask airway on the postoperative incidence of vomiting and sore throat in children].
100 ASA I and II children, aged 4 to 14 years, and scheduled for strabismus surgery, were randomly assigned to one of the following groups: group 1 (n = 50): endotracheal tube, group 2 (n = 50): laryngeal mask airway. Apart from airway management, the anaesthesiological procedures were identical in both groups: induction with 2-3 mg/kg propofol, 0.02 mg/kg alfentanil, 0.05 mg/kg vecuronium, and 0.01 mg/kg atropine. After endotracheal intubation or insertion of the laryngeal mask, anaesthesia was continued with 6-15 mg/kg.h propofol and 10-30 micrograms/kg.h alfentanil. All patients were ventilated with N2O/O2 (2:1). No antiemetics were given, gastric contents were not aspirated. Postoperative nausea and vomiting (PONV) were recorded by 24 h, the incidence of sore throats was recorded 8, 12, and 24 h post-operatively. ⋯ In children undergoing strabismus surgery, the laryngeal mask airway was superior to the endotracheal tube in terms of PONV and was associated with fewer local complications such as sore throat.
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Treatment of pulmonary hypertension is an important issue in intensive care. One therapeutic regimen involves the intravenous administration of prostacyclin (PGI2). This, however, is accompanied by diminished hypoxic pulmonary vasoconstriction, reduced arterial oxygenation, and systemic vasodilation. ⋯ Furthermore, some patients do not respond to the treatment. In some individuals a reduction in pulmonary hypertension can be seen, while others lack even pulmonary vasodilation. The exact pathophysiological mechanisms remain to be investigated.
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Pain is a major, but largely neglected problem in AIDS patients. The aim of this article is to review the etiology of pain manifestations in AIDS patients in different organ systems and to discuss appropriate treatment strategies. The most common pain symptoms in AIDS patients are headache, oral cavity pain, dysphagia and adynophagia, chest pain, abdominal pain and pain related to peripheral neuropathy. ⋯ In view of the multiple organs involved in the presentation of AIDS requiring multiple drugs, careful attention to side effects, contraindications and drug interactions is warranted, when administering pain medications. Fear of the complexity of these issues should, however, not prevent effective pain management for these patients, who suffer from a fatal disease. A multidisciplinary approach to pain in AIDS patients, similar to the approach in patients with cancer, is desirable.