Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[Potentiation of nondepolarizing muscle relaxants by nifedipine iv in inhalation anesthesia].
Calcium entry blockers are now widely used in the treatment of cardiovascular diseases. Nifedipine is established for the treatment of perioperative hypertension during anesthesia. Previous animal experiments have demonstrated that calcium entry blockers potentiate the neuromuscular response induced by nondepolarizing blocking drugs. ⋯ Our results confirm previous assumptions of synergistic effects of neuromuscular blocking drugs and nifedipine in patients. This synergistic effect includes both duration and intensity of neuromuscular blockade. In the postoperative period patients may be endangered by nifedipine therapy if recovery from the neuromuscular depression is not complete.
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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.