Der Anaesthesist
-
Randomized Controlled Trial Clinical Trial
[Famotidine dosage in children. The effect of different doses on the pH and volume of the gastric juice].
Children undergoing general anesthesia are at increased risk of severe aspiration pneumonitis. Cimetidine and ranitidine, specific histamine (H2-receptor) antagonists, when given 1-3 h preoperatively markedly reduce the acidity and volume of gastric content. A newer compound, famotidine, is a more specific antagonist with no inhibitory effect on the drug metabolizing microsomal enzyme systems of the liver (cytochrome P-450), in contrast to cimetidine. ⋯ Preoperative famotidine application produces pH values of gastric contents higher than 2.5 in all dosage groups (84%, 94%, 75%), and these differences were highly significant (P less than 0.001), whereas the gastric volume reduction with these doses was not significant. The incidence of pH less than 2.5 and volume of gastric contents exceeding 0.4 ml/kg did not vary with the different doses of famotidine. As there were no measurable differences in the effect of famotidine, we recommend that children at high risk of pulmonary aspiration receive 0.15 mg/kg famotidine orally at least 1.5 h but not later than 6 h before induction.
-
The determination of MAC values (minimum alveolar concentrations) for inhalation anesthetics and, correspondingly, of MIR values (minimum infusion rates) for i.v. anesthetics necessarily requires the use of therapeutically ineffective doses so that reactions to skin incision can be observed. EEG feedback-controlled dosing systems for i.v. anesthetics make it possible to determine dose requirement curves, allowing the definition of effective therapeutic infusion rates (ETI). During total i.v. anesthesia in 11 patients treated with fentanyl the mean effective infusion rate for methohexitone was found to be 4.68 +/- 1.39 mg/min, while for propofol the mean ETI in 11 volunteers was determined at 9.90 +/- 2.46 mg/min. The implications of feedback-controlled dosing systems for the study of clinico-pharmacologic problems in anesthesia are discussed.
-
Randomized Controlled Trial Comparative Study Clinical Trial
[Etomidate using a new solubilizer. Experimental clinical studies on venous tolerance and bioavailability].
Pain following intravenous injection as well as thrombophlebitis are substantial side effects of etomidate that have been reported from the first clinical study (1972-1973) onwards. Investigations of our own and by Gran et al. have pointed out that injectable etomidate with intralipid as a solvent removes side effects without impairing the good hypnotic action. The idea of using a lipid emulsion as a solvent was presented a few years later, inducing two further studies. ⋯ The same results have been obtained in the study with volunteers. CONCLUSION. Two unpleasant side effects of etomidate, pain on injection and postoperative thrombophlebitis, were abolished by the solvent "lipid emulsion".
-
Randomized Controlled Trial Comparative Study Clinical Trial
[Continuous application of morphine is more effective than a bolus administration in the postoperative analgesia and sedation of children].
In ventilated children the cardiorespiratory and metabolic reserve capacities can be extremely limited. Therefore, these children have low thresholds of tolerance for additional stress factors. One of the most obvious aims in the critical postoperative period after heart surgery in children is protection of the cardiorespiratory system against stress reactions. ⋯ Continuous application of morphine was more effective in sparing VO2 than bolus injections in ventilated children after cardiac surgery. We conclude that continuous application of morphine represents stress prevention whereas bolus application of morphine is stress therapy. From the clinical point of view it is more effective to prevent than to treat pain and other stress factors in pediatric patients.
-
Comparative Study
[The dose-response relationship and time course of the neuromuscular blockade by alcuronium].
Although alcuronium has been in clinical use for almost 40 years, there is still considerable controversy in the literature regarding its neuromuscular blocking potency, the time course of the drug action and the side effects. The aim of this study was to investigate the dose-response relationship of alcuronium and to compare the time course of its neuromuscular effects with vecuronium following intubation doses of both compounds. METHODS. ⋯ The ED50 and ED95 values for alcuronium found in this study are in the same order of magnitude as 106.8 micrograms/kg and 135 micrograms/kg for ED50 and with 280 micrograms/kg for ED95, respectively, as reported by others. The long duration with slow recovery and the wide individual variation in the neuromuscular effects observed in our study have been reported earlier. Based on the above observations and because of the availability of better alternatives with fewer side effects, we conclude that alcuronium should be added to the list of obsolete neuromuscular blocking agents, together with gallamine and d-tubocurarine.