Der Anaesthesist
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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.
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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.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Tramadol in postoperative pain therapy. Patient-controlled analgesia versus continuous infusion].
Patient-controlled analgesia (PCA) is a well-proven procedure for individual pain relief in the post-operative period. Despite its superior approach regarding pharmacokinetic and pharmacodynamic considerations, PCA equipment is not available to many in the clinical practice. The goal of this study was to compare the efficacy and safety of PCA with continuous infusion (CI), an easily feasible method, using tramadol (T) as a centrally acting opioid with minor side effects on circulation and ventilation. ⋯ T is well suitable for postoperative pain relief after major gynecological surgery using both PCA and CI. PCA ensures adjustment of the medication to the individual demand, whereas CI provides better analgesia after sleeping periods. We recommend antiemetic prophylaxis before treatment with T.
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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".
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Anesthesiologists have always played a leading role in research into pain and its treatment. Their efforts, however, have been focused on acute or postoperative pain problems. It was the American anesthesiologist John J. ⋯ Organizational skills are also needed for efficient running of multidisciplinary pain treatment facilities. Clinical practice in surgical anesthesia means that anesthesiologists are experienced in interdisciplinary work and familiar with the advantages and dangers of team work. Despite international acceptance of the multidisciplinary approach to chronic pain, there is still a lack of appropriate facilities in the German-speaking countries, and we consider it important that anesthesiologists commit themselves to increasing general awareness of what is needed.