Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Intubation conditions following administration of atracurium and vecuronium. Bolus method versus priming technique].
Prompted by the ongoing discussion of the pros and cons of using succinylcholine, this study was conducted to compare the responses to bolus injections of atracurium or vecuronium with those after sequential injection of these drugs (priming principle). We evaluated the earliest possible intubation times, intubating conditions, and the onset times (i.e. times from the end of injection to the maximum blockade) under conditions approaching real use as closely as possible. METHODS. ⋯ The administration of the relaxants in divided doses significantly shortened the intubating time after atracurium (100 vs 124 s) and improved the intubating conditions of vecuronium (good vs tolerable), but had no effect on the time course of the neuromuscular blockade (onset times in the bolus groups 224 +/- 84 s for atracurium and 209 +/- 64 s for vecuronium; in the priming groups 249 +/- 112 s for atracurium and 205 +/- 52 s for vecuronium). CONCLUSIONS. The priming technique presented here is clinically superior to the bolus method and therefore should be preferred in all elective cases and in those patients in whom succinylcholine is contraindicated.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Preventive pain therapy. Preventive tramadol infusion versus bolus application in the early postoperative phase].
Even today, adequate postoperative analgesia is still a great problem. Based on positive results of former studies using a continuous infusion of tramadol for postoperative pain relief, we aimed to improve this regimen. In order to investigate the effectiveness of preventive analgesia, one group of patients was given 100 mg tramadol (Tramal) at the time of extubation, followed by a maintenance infusion. ⋯ The patients in the preventive group asked, on average, 30 min later for treatment for pain. The subsequent pain relief in both groups was comparable, although the amount of tramadol administered at that time was higher in the on demand group than in the preventive group (100 mg versus 50 mg+ amount given by infusion). These facts show the efficacy of the preventive infus
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Randomized Controlled Trial Clinical Trial
[Air conditioning with a high-performance HME (heat and moisture exchanger)--an effective and economical alternative to active humidifiers in ventilated patients. A prospective and randomized clinical study].
Heat and moisture exchangers (HME) are used as artificial noses for intubated patients to prevent damage resulting from dry and cold inspired gases. HME collect a large fraction of the heat and moisture of the expired air, adding them to the subsequent inspired breath. In a prospective clinical study the air conditioning capacity of a heated humidifier was compared with a hygroscopic HME. ⋯ These data show that modern HMEs are able to maintain physiological air-conditioning even in long-term ventilated patients. The small increase in airway resistance associated with HMEs (3.1 +/- 2.5 mbar/l.s) has to be noted in difficult weaning procedures. Both labour and costs per day are significantly less with HMEs (8.60 vs. 21.70 DM).
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Randomized Controlled Trial Clinical Trial
[Conduction block in man is stimulation frequency dependent].
The action of local anaesthetics on isolated nerves is enhanced by high stimulation frequencies. The aim of our study was to investigate whether high-frequency stimulation enhances regional anaesthesia in man. METHODS. ⋯ The spread of sensory block at the end of the experiments was also enhanced by stimulation with high frequencies, whereas the onset of vasomotor block (rise in skin temperature) remained unaltered. CONCLUSION. Non-oxious electrical stimulation with high frequencies significantly accelerates the onset of anaesthesia and extends the spread of sensory block.
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Selecting a route for drug administration during CPR requires consideration of the speed with which access can be obtained, the technical difficulties involved in performing the procedure, the associated risk of complications, delays in drug delivery to the central circulation, and the duration of effective drug levels following injection. The peripheral venous route is the safest method, and drug delivery can be enhanced by a fluid bolus after injection of the medication. The circulation time is shortest after central venous injection, but there is some risk of complications. ⋯ The endotracheal tube provides an accessible route for administration of most drugs, but peak concentrations are lower than those obtained by other routes. While the results are almost the same as an intravenous injection, the intraosseous route is currently underrepresented in clinical practice. This method must not only be considered in pediatric patients, but in adult patients as well.