Der Anaesthesist
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In cases of craniofacial and mandibulofacial malformations, which are mostly treated during childhood, difficult intubation conditions must generally be expected. In such cases, the laryngeal mask airway (LMA) an alternative instrument for use in endotracheal intubation is a new aid for ventilation. In certain instances, it can be used alone to induce general anaesthesia. Reports of endotracheal intubation by means of the LMA in adults have also been published. ⋯ Therefore, the LMA is not only a ventilation aid, but also a valuable tool in difficult intubation conditions. In our opinion, it is necessary to provide this tool in every anaesthetic unit.
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Perioperative, mostly silent ischaemia in patients with coronary heart disease is difficult to detect by clinical examinations. ⋯ Perioperative Holter ECG monitoring is time-consuming, expensive, not very sensitive, and therefore not generally applicable for all patients with prior MI.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
[The cardiovascular effects of sevoflurane].
The cardiovascular effects of sevoflurane as published from clinical and experimental studies are reviewed with respect to general haemodynamics and organ perfusion. Sevoflurane appears to be quite similar to isoflurane, with some minor exceptions. In adult patients and volunteers, sevoflurane has not been associated with increases in heart rate, whereas isoflurane and desflurane caused significant increases in heart rate at higher concentrations. ⋯ In several multi-center studies where patients with coronary artery disease or at high risk for coronary artery disease were randomised to receive either sevoflurane or isoflurane for cardiac or non-cardiac surgery, the incidence of myocardial ischaemia and infarction did not differ between treatment groups. In both human and animal models, sevoflurane preserves cerebral blood flow and reduces cerebral metabolic rate much like isoflurane. Considering its favourable pharmacokinetic properties, the introduction of sevoflurane into clinical practice appears to be a promising extension of the anaesthetic spectrum.
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Randomized Controlled Trial Multicenter Study Clinical Trial
[Comparison of sevoflurane and isoflurane in ambulatory surgery. Results of a multicenter study].
A multicenter, randomized, comparative phase III study evaluating the effect of sevoflurane versus isoflurane in adult outpatients was performed. The aim of the study was to compare (1) maintenance of anaesthesia and (2) how rapidly and easily the patients emerge from the anaesthetic and recover. ⋯ Sevoflurane was as safe as isoflurane for anaesthesia in adult outpatients. Patients who received sevoflurane had statistically significantly shorter recovery parameters than isoflurane patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Incidence and quality of dreaming during anesthesia with propofol in comparison with enflurane].
Since the introduction of propofol into clinical practice, dreaming during general anaesthesia has been frequently reported with this drug. We investigated the incidence and character of these dreams with regard to distinction from intraoperative awareness and in comparison with habitual dreams or dreams during general anaesthesia with enflurane. ⋯ We conclude that sensory experiences during propofol anaesthesia are not stimulus-related perceptions or awareness, but dreams similar to normal ones. In view of the absence of clear signs of stimulus-related response, we presume that dreaming is a specific side effect of propofol. Because of the absence of difficulties, dreaming during propofol anaesthesia appears not to be a disadvantage with regard to the quality of anaesthesia.