Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[The use of ketamine and midazolam for analgesia and sedation in ventilated patients subject to obligatory treatment with catecholamines].
This study was undertaken to compare two regimens for analgesic sedation in intensive care patients with exogenous catecholamine therapy, giving special regard to catecholamine demand and hemodynamic parameters. A total of 20 ventilated patients in a surgical intensive care unit were investigated in a prospectively randomized design. Exogenous catecholamine therapy with epinephrine and/or norepinephrine was started at systolic pressure (SAP) less than 85 mmHg or mean arterial pressure (MAP) less than 65 mmHg to maintain cardiovascular function. ⋯ In time course, PAP increased by about 5 mmHg in the ketamine group but not in the fentanyl group (P = 0.009). The average central venous pressure (CVP) was 12 mmHg in both groups. At the end of the investigation, CVP decreased in the fentanyl group and increased in the ketamine group (P = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Acoustic evoked potentials of medium latency and intraoperative wakefulness during anesthesia maintenance using propofol, isoflurane and flunitrazepam/fentanyl].
Auditory evoked potentials have been used as an indicator of awareness. During combined local and general anesthesia clinical signs of adequate anesthesia are difficult to evaluate. In the present study we combined peridural analgesia with three techniques of general anesthesia. ⋯ CONCLUSIONS. The maintenance of MLAEP and the primary cortical complex Na/Pa correlates with the incidence of motor signs of wakefulness. During the combination of regional and general anesthesia, isoflurane and propofol seem to provide better suppression of intraoperative wakefulness than bolus injections of flunitrazepam/fentanyl.
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In 1985 Brain et al. published their first experience with the laryngeal mask, developed by themselves. With this mask it is possible to seal the larynx and ventilate a patient during anesthesia without endotracheal intubation. Meanwhile, further reports of successful use have been published, especially in Great Britain. ⋯ Our investigation confirmed the previously described advantages of the laryngeal mask. We consider its use to be especially indicated in general anesthesia for short surgical or diagnostic procedures or if specific complications of endotracheal intubation should be avoided. A critical aspect in the use of the laryngeal mask is the fact that there is no complete isolation of the trachea and, therefore, an insufflation of the stomach or aspiration could occur, especially during critical situations (e.g. bronchospasms).(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Propofol for induction and maintenance of anesthesia during heart surgery. Results of pharmacological studies in man].
Numerous reports have concluded that propofol is suitable for maintenance of anesthesia by continuous infusion. The aim of this study was to evaluate the use of propofol and fentanyl for coronary bypass surgery in patients with good left ventricular function. The effects of this anesthetic combination on quality of anesthesia, hemodynamic status, and endocrine and metabolic responses were assessed. ⋯ CONCLUSION. In summary, it can be concluded that a propofol infusion technique positively enhances the recovery period after cardiac surgery and provides good control during anesthesia. However, the use of propofolfentanyl for induction of anesthesia in patients with limited coronary perfusion is not recommended because of its hypotensive effect.