Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Critical aspects of an outside evaluation of postoperative pain in infants. A placebo-controlled double-blind study of the question of the reliability and validity of the measurement system].
Postoperative analgesia in infants and young children is a topic of growing interest in pediatric anesthesia. Two systems measuring postoperative pain in this group of patients have been offered recently: CHEOPS (Childrens Hospital of Eastern Ontario Pain Scale) by McGrath et al. and OPS (Objective Pain Scale) by Hannallah et al. and Broadman et al. [3, 7, 8]. Both systems are economical and not reactive, but their validity is not satisfying. ⋯ The design of the study was accepted by the ethic committee with the provision that neither a sedative nor an analgesic drug should be withheld from any child if indicated. Therefore, all children who seemed to feel discomfort according to the subjective impression of the anesthetist received midazolam intraveneously to a maximal dose of 2 mg. All the behavioral data were included in a factor analysis (principal components)...
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An incorrect fluid therapy can lead to serious complications considerably more rapidly in children, especially in newborns and infants, than in adults. The pediatric patient has a limited range of compensation for maintenance of fluid and electrolyte balance. Precise knowledge of the physiological age-dependent fluid balance, i.e. the large extracellular space, the developing renal function, the increased metabolism, the acid-base state, the electrolyte balance with the relatively higher sodium and chloride requirements must be the basis of an adequate fluid therapy. ⋯ For intraoperative fluid therapy infusions with an increased sodium concentration (70-100 mmol/l) or Ringer's lactate (Na+ = 130 mmol/l) must be used. On no account must electrolyte-free solutions, e.g., 5-10% glucose, be used intraoperatively, as they can lead to water intoxication. The third-space requirements compensate for the additional losses by drainage, third-space deficits by evaporation and gastric and enteral secretions.(ABSTRACT TRUNCATED AT 250 WORDS)
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To re-evaluate dosage requirements for i.v. and endobronchial (e.b.) lidocaine therapy under the conditions of cardiac arrest, we investigated the pharmacokinetics of lidocaine after i.v. and e.b. administration in an animal cardiopulmonary resuscitation (CPR) model. METHODS. We induced cardiac arrest by ventricular fibrillation in 16 normoventilated pigs under i.v. anesthesia. ⋯ CONCLUSION. An i.v. bolus of lidocaine during CPR should not exceed 2 mg/kg. During CPR without i.v. access the e.b. instillation of lidocaine can be recommended, but to ensure therapeutic concentrations a minimum dosage of 2 mg/kg is suggested.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The hemodynamic effects of various hydroxyethyl starch solutions in heart surgery patients].
Blood conservation is gaining more and more interest because of the increasing risks involved in homologous blood transfusions. Acute normovolemic hemodilution (ANH) is becoming an established technique even in cardiac surgery patients. The "optimal" kind of volume replacement, however, is still controversial. ⋯ The different physiochemical attributes of various HES solutions seem to be important, thus influencing their hemodynamic response. In this study, low-concentration (3% HES 200/0.5) and low-molecular (6% HES 40/0.5) HES solutions were less effective in stabilizing hemodynamics until the beginning of ECC. Additionally, their negative influence on fluid balance during ECC, followed by a deterioration in pulmonary function led to the conclusion that other solutions are preferable; in particular, 10% HES seems to be of advantage in these situations.