Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[The use of propofol during diskectomy in neurosurgery].
The intravenous anaesthetic agent propofol has become more and more popular not only for induction but also for the maintenance of anaesthesia in all fields of surgery. For this purpose, different infusion rates and also combinations of propofol with opioids, nitrous oxide and volatile anaesthetic agents have been described. The present study was designed to find the best dosage regimen for short operations and rapid changes. ⋯ An additional administration of fentanyl can prevent hypertensive reactions or tachycardia with intubation, but on the other hand fentanyl can also increase the cardial depression of propofol with a dangerous decrease in blood pressure and heart rate. Therefore in combination with opioids lower doses of propofol should be used for induction and maintenance of anaesthesia. If opioids are administered, signs of a residual postoperative respiratory depression have to be taken seriously.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Cognitive and psychomotor performance following isoflurane, midazolam/alfentanil and propofol anesthesia. A comparative study].
Mental and psychomotor abilities are impaired to varying degrees after general anaesthesia. This has important implications for the time over which patients are monitored in the recovery room and for the discharge of outpatients after day surgery. The present study was undertaken to compare recovery and mental and psychomotor skills in the first 60 min following general anaesthesia with isoflurane, midazolam/alfentanil and propofol. ⋯ The results indicate that in operations of approximately 90 min duration the return of motor and mental abilities is faster following propofol anaesthesia. At 30 min after extubation following propofol anaesthesia patients had test results that allow their transfer from the recovery room, while it took 60 min for patients in the two other groups to reach the same levels of motor and mental function. This is important for the duration of monitoring in the recovery room and, especially, for day case anaesthesia.
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The Magill forceps are used for nasotracheal intubation, endotracheal suctioning, passing gastric tubes, placement of tampons in the nasopharynx and extraction of foreign material from the pharynx. There are several disadvantages of the standard Magill forceps; however: the danger of cuff perforation, the necessity of readjusting the forceps when placing a tube or catheter, and the risk of injury to the mucous membrane. For these reasons the standard Magill forceps have been modified: the jaws of the forceps have been changed to give curved atraumatic parts without any serrations or sharp edges. ⋯ The resulting benefits are as follows: Reduced risk of injuring the mucous membrane and perforating the cuff. Tubes and catheter are safely guided between the semiround jaws, making it unnecessary to open the forceps repeatedly to advance the tube. Tampons being placed in the throat no longer get caught between the serrations, and even small foreign objects can easily be extracted from the pharynx.
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Twenty-eight healthy volunteers of both sexes (14 male, 14 female, age 31 +/- 7 years, weight 70 +/- 12 kg) breathing room air were monitored for cutaneous partial pressures of oxygen and carbon dioxide (pctO2, pctCO2) and partial oxygen saturation (psO2) as determined by pulse oximetry. Data triplets were collected and stored by a personal computer at 30-s intervals during a 4-h resting period to establish a confidence range for the devices in use (TCM 3 with a combination electrode E 5270, and Pulse Oximeter, Radiometer). This data range was intended to be used in later noninvasive, continuous respiratory studies with postoperative patients. Means, standard deviations, and ranges were calculated for individual data and data pooled from 15-min intervals. Data distribution over time was calculated for 30-min intervals. ⋯ Monitoring of spontaneous respiration in the recovery room is regarded as essential to prevent serious complications resulting from surgery and anesthesia. This has become particularly true with newer analgesic techniques like spinal opiates or patient-controlled analgesia. Since minor degrees of opiate-induced respiratory depression are easily influenced by external stimulation, it is mandatory that any monitoring of spontaneous respiration must be nonstimulant, and prefereably noninvasive. The present communication is the first of a series of investigations to develop of monitoring technique for postoperative patients. Because normal values for the parameters studied are either lacking or dependent on the monitoring devices in use, the present paper defined the respective data ranges. It is concluded that pulse oximetry and pctCO2 measurement are both useful and sensitive for continuous, non-invasive respiratory monitoring in adults, whereas pctO2 measurements are of lesser value. Results in volunteers treated with opiates and postoperative patients under patient-controlled analgesia using the above mentioned equipment will be reported in following publications.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Post spinal headache. Its incidence following the median and paramedian techniques].
A lack of uniform methodology used by different authors in the assessment of different puncture techniques in spinal anesthesia formed the basis of the current study, which compared under randomized conditions the incidence of post spinal headache after a median or paramedian (lateral) approach. MATERIALS AND METHODS. Two hundred and fifty ASA physical status II and III patients, aged 50-85 years, scheduled for transurethral prostate surgery under spinal anesthesia were investigated. ⋯ The results indicate that the incidence of post spinal headache is higher in younger patients when using the paramedian (lateral) approach. However, our findings suggest that the choice of lumbar puncture technique--median or paramedian--is of little importance in regard to post-puncture headache in elderly patients. The paramedian approach is especially useful when degenerative changes are encountered in the interspinous structures in elderly patients, when an ideal position is difficult to achieve.