Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Psychometric changes as well as analgesic action and cardiovascular adverse effects of ketamine racemate versus s-(+)-ketamine in subanesthetic doses].
The intravenous anaesthetic ketamine is widely used in subanaesthetic doses as a potent analgesic in emergency and disaster medicine. At present, ketamine is commercially available only in its racemic form, although the S(+)-isomer has proved to be approximately three times as potent than the R(-)-isomer. In first clinical trials in Germany, S(+)-ketamine was reported to be markedly advantageous with regard to analgesia in anaesthetized patients. ⋯ S(+)-Ketamine at half-dose of ketamine-racemate is as potent as ketamine-racemate in subanaesthetic doses with powerful analgesic properties. The (+)-isomer exerts less adverse effects on measurable cerebral functions and induces a significantly smaller increase in heart rate. Since states of impaired consciousness and disorientation are especially disturbing under emergency conditions, further investigations should be carried out to define S(+)-ketamine's position as a potent analgesic for therapeutic use in emergency and disaster medicine.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Different opioids in patients at cardiovascular risk. Comparison of central and peripheral hemodynamic adverse effects].
Efficient analgesia may be the major objective in the cardiovascular risk patient following myocardial infarction, acute occlusion of peripheral vessels, or dissection/perforation of major abdominal vessels. It was the purpose of the study to investigate the haemodynamic and respiratory side effects of eight different opioids in 57 circulatory risk patients prior to major vascular surgery. METHODS. ⋯ CONCLUSIONS. For interpretation of the results, factors such as respiratory depression, histamine release, secretion of endogenous catecholamines, and hypoxia-induced pulmonary vasoconstriction have to be discussed. Tramadol, an opioid with moderate potency, seems to offer some advantages due to its minor cardiovascular and respiratory side effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effect of different anesthetic procedures on hormone levels in women. Studies during an in vitro fertilization-embryo transfer (IVF-ET) program].
Different anaesthetic procedures that were used during an in vitro fertilisation and embryo transfer (IVF-ET) program have been analysed in order to determine their influence on plasma levels of estradiol, progesterone, prolactin, and beta-endorphin and results of IVF-ET. METHODS. Fifty-four patients awaiting transvaginal oocyte aspiration were randomised into three groups: (1) anaesthesia with ketamine as an induction agent and analgesic (n = 20); (2) general intubation anaesthesia using thiopentone for induction and enflurane for maintenance (n = 18); and (3) no anaesthesia (n = 16). ⋯ CONCLUSIONS. The increased prolactin and beta-endorphin plasma levels associated with ketamine and general anaesthesia reflect a significant alteration of the observed hormone levels. When anaesthesia is indicated, we try to avoid general intubation anaesthesia in favor of ketamine.
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
[Esmolol as a bolus for prevention of sympathetic adrenergic reactions following induction of anesthesia].
In addition to laryngoscopy, endotracheal intubation, and other stressful intraoperative phases, hypertension occurs during recovery from anaesthesia, provoking post-operative complications like bleeding and increased intracranial or intraocular pressure. Furthermore, these hypertensive reactions result in life-threatening complications, especially in patients with pre-existing cardiovascular diseases. In this study, the effect of the new, short-acting beta-blocker esmolol given as a single bolus for preventing the increases in blood pressure and heart rate during recovery from anaesthesia and extubation in patients with hypertension was investigated. ⋯ Thus, the potential risks of beta-blockers due to half-life are minimised. The results of this study show that a dangerous increase in BP and HR with increased myocardial oxygen consumption can be prevented by a single bolus, and better by a double bolus of 100 mg esmolol. Although bradycardia with HR below 50.min-1 in 8 patients might indicate a risk of cardiac instability, the systolic BP did not fall below 100 mm Hg, and the episode of bradycardia was so short that there was no risk to the patients.
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Randomized Controlled Trial Clinical Trial
[Endocrine stress reaction, hemodynamics and recovery in total intravenous and inhalation anesthesia. Propofol versus isoflurane].
This prospective, randomised study compared total intravenous anaesthesia (TIVA) and inhalation anaesthesia with respect to endocrine stress response, haemodynamic reactions, and recovery. METHODS. The investigation included two groups of 20 ASA I-II patients 18-60 years of age scheduled for orthopaedic surgery. ⋯ Slightly shorter recovery times did not lead to an increased stress response. With respect to intra- and postoperative stress reduction, significant attenuation of sympatho-adrenergic reaction comparable SAP and reduced HR, sympatholytic and hypodynamic anaesthesia with propofol and fentanyl seems to be advantageous for patients with cardiovascular and metabolic disorders. For this aim, careful induction and application of individual doses is essential.