Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[The application of n-acetylcysteine as an antioxidant and mucolytic in mechanical ventilation in intensive care patients. A prospective, randomized, placebo-controlled, double-blind study].
Oxygen radicals and oxygen radial mediators are thought to be important components in the development of acute lung injury, sepsis, and multiple organ failure. Injured patients, patients with pulmonary diseases, and multiple trauma patients also showed an elevated lipid peroxidation, indicating increased oxidant stress. N-Acetylcysteine (NAC) has been used as an antioxidant in a wide variety of experiments. ⋯ CONCLUSION. The present data do not support routine use of NAC in ventilated patients, either as an antioxidant or as a mucolytic agent. Intravenous administration of 3 g NAC/day had no clinically relevant effect on glutathione levels, lipid peroxidation products, tracheobronchial mucus, and clinical condition.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Multidimensional psychometric assessment of preoperative mood. Effects of zolpidem compared to phenobarbital combined with promethazine as premedication].
The following double-blind, randomised study dealt with three questions: (1) Is a multidimensional psychometric rating scale suitable for the measurement of mood before anaesthesia? (2) What are the effects of the new benzodiazepine-like drug zolpidem on preoperative mood compared with phenobarbital? (3) Is the combination with Promethazine suggestive? METHODS. Three hundred and four patients were assigned to four groups (group 1: zolpidem 8.03 mg/promethazine 50 mg; group 2: zolpidem 8.03 mg/placebo; group 3: phenobarbital 100 mg/promethazine 50 mg; group 4: phenobarbital 100 mg/placebo). The drugs were given the evening before anaesthesia (09:30-10:00 p.m.). ⋯ The study shows that a combination with promethazine is suggestive, because promethazine has a selective deactivating effect. The finding that promethazine lowers the dose of thiopentone required for induction of anaesthesia is an additional interesting point. The results of this study highlight the importance of using multidimensional rating scales for the measurement of mood before anaesthesia.
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Oxygen (O2) for clinical application is generally provided from either a central gas supply via a hospital pipeline system or is delivered to the working place in cylinders as compressed gas. An alternative source is the one-site generation of O2 from air using O2 concentrators based on molecular sieve technology. Whereas O2 concentrators for anaesthesia in remote areas or underdeveloped countries are wide-spread, in Germany their use is common in neither hospitals nor anaesthesiological practice. ⋯ For the future, the use of O2 concentrators for anaesthesia seems to be a practicable alternative to compressed O2 from cylinders. The main application could be in small operating units or anaesthesia practices. The method is safe and without additional risk of hypoxia, even in rebreathing systems and closed circuits, when the O2 concentration in the inspired gas is measured.
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To demonstrate the safety of autologous blood donation in an obstetric practice. ⋯ Our experience demonstrates that autologous blood donation is a safe practice in the setting of obstetrics, when the indications and contraindications are considered. Further studies in larger patient populations are necessary to expand or restrict the indications for autologous transfusion in obstetrics.
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Oesophageal malposition of an endotracheal tube is among the leading causes of anaesthesia incidents. While clinical manoeuvres for detection of tube malposition are unreliable, monitoring (i.e. capnography) can prevent such incidents. The problem is particularly important in prehospital care, where capnography is not (yet) widely available. ⋯ These devices are useful for preclinical practice. According to the literature and our experience, the ODD is superior for the initial control of tube position, especially in cardiac arrest. Capnometry is needed, however, for continuous control of ventilation.