Der Anaesthesist
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
[Initial defibrillation by emergency physicians or by first aid assistants? A prospective, comparative multicenter study in outpatients with ventricular fibrillation].
In a controlled prospective randomized study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany (basic life support by EMTs and defibrillation by emergency physicians only) in order to answer the following questions: 1. Does EMT defibrillation improve the survival rate and long-term prognosis of patients in ventricular fibrillation as compared to the current German standards in resuscitation (basic life support by EMTs and defibrillation by emergency physicians)? 2. Are the prerequisites for the use of semiautomatic defibrillators fulfilled in the emergency medical systems (EMS) of the participating centers? METHODS. ⋯ Neither the initial survival rate the number of patients discharged alive, nor the neurological long-term prognosis was significantly different for any of the groups investigated. Because of apparent differences in indirect prognostic parameters (time interval until ROSC, number of patients requiring no epinephrine) and because of the fact that the time interval to the first defibrillation was reduced by EMT defibrillation, EMT-Ds may perform defibrillation if: (a) they reach the patient before the emergency physician and (b) if they are trained intensively and supervised continuously. In order to increase the efficiency of defibrillation by EMT-Ds, far-reaching changes in our EMS are mandatory: (a) a reduction in the time interval from collapse until initiation of BCLS measures by intensifying layperson CPR training; (b) an increase in the number of emergency units equipped with semiautomatic defibril
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Regional anaesthetic procedures are not popular in paediatric anaesthesia in many institutions. However, regional anaesthesia is gaining ground, especially in a "new" concept of balanced paediatric anaesthesia. The decisive argument for the use of regional anaesthesia is the prolongation of pain relief further into the postoperative phase. ⋯ Good anatomic and pharmacologic knowledge should be a prerequisite for all physicians who use regional anaesthetic procedures. Continuous training and critical analysis are needed for good results. Only then can such methods be introduced into routine paediatric anaesthetic practice.
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Randomized Controlled Trial Clinical Trial
[Short donation intervals in preoperative autologous blood donation in the concept of autologous transfusion].
Homologous transfusion is associated with infectious and immunological risks. Preoperative autologous deposit reduces homologous transfusion requirements considerably. Usually donations are carried out at weekly intervals. ⋯ Homologous transfusion requirements were similar in the two groups (1 unit in group I, vs 3 units in one patient and 1 unit in two patients in group II). CONCLUSIONS. Short donation intervals resulted in a higher preoperative erythrocyte mass after similar preoperative deposit, and significantly higher blood loss was tolerated with similar homologous transfusion volume.
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The decrease of functional residual capacity during anaesthesia makes mechanical ventilation mandatory. Volume- and pressure-controlled modes should both be possible. Ventilator-assisted spontaneous respiration is rarely indicated during general anaesthesia, and this mode is therefore unnecessary for anaesthesia machines. ⋯ For easier management, fresh-gas-flow-compensated circle systems facilitating adjustment of tidal volume after changes of fresh gas flow are desirable. Precautions aimed at the prevention of ventilation with hypoxic gas mixtures are still insufficient: the oxygen failure devices (nitrous oxide flow shutoff valve) are only effective if oxygen pressure from the gas supply is low. Distinct improvements have been achieved with oxygen ratio systems, preventing the administration of hypoxic gas mixtures at fresh gas flows higher than 1 l/min.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Postoperative pain therapy. The efficacy of a serotonin antagonist (GR 38032F;ondansetron) and the prostaglandin synthesis inhibitor lysin acetylsalicylate (Aspisol)].
Serotonin is one of the many neurotransmitters involved in nociception. Serotonin antagonists may therefore reduce postoperative pain. In the present study we examined whether the new 5-HT3 receptor antagonist GR 38032F (ondansetron) reduced postoperative pain after minor surgery and compared its effectiveness with that of lysin acetyl salicylate (Aspisol). ⋯ For 42 out of 100 patients no analgesics were needed within the first 3 h after end of surgery. Ondansetron was no more effective than placebo in reducing postoperative pain. Lysin acetylsalicylate, however, may be an effective alternative to opioids for the treatment of postoperative pain.