Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[Complaints in the postoperative phase related to anesthetics].
In two prospective, randomized studies the frequency of headache, nausea, vomiting, and analgesic requirement during the first postoperative 24 h was observed in order to study differences between the sexes and the inhalation anesthetics halothane, enflurane, isoflurane, or balanced anesthesia with enflurane/alfentanil. Nausea and vomiting were more frequent after enflurane than after halothane or isoflurane. There was no significant difference between anesthetics and frequency of headache, but there were significant differences in postoperative analgesic requirements which were highest after halothane and lowest after isoflurane. ⋯ The second study indicated that balanced anesthesia did not reduce the analgesic requirement compared to enflurane without alfentanil, but lead to a higher incidence of vomiting. After premedication with flunitrazepam and atropine and combined with 70% N2O/30% O2, isoflurane was the most favorable anesthetic agent with regard to the parameters studied. Balanced anesthesia with enflurane/alfentanil did not show any advantages for patients in the postoperative phase under the given conditions.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Etomidate versus etomidate and hydrocortisone for anesthesia induction in abdominal surgical interventions].
The imidazole derivative etomidate has been shown to block (reversibly) adrenocortical steroid synthesis. Long-term sedation with etomidate has been associated with adrenocortical insufficiency and increased mortality in severely ill patients. The significance of adrenocortical blockade after a single induction dose of etomidate remains a matter of debate. ⋯ At the end of surgery patients were extubated after oxygenation. In all patients blood pressure, heart rate, central venous pressure, and ECG were monitored continuously, both intra- and postoperatively. During induction, patients received 1,000 ml 0.9% NaCl, followed by continuous administration of 0.9% NaCl, 6 ml/kg per hour intraoperatively and 40 ml/kg per 24 hours post-operatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
[Patient-controlled analgesia. A technical toy or a contribution to the treatment of pain?].
PCA (patient-controlled analgesia) was used to treat postoperative pain after general surgery and gynecological operations in a total of 82 patients. In a prospective randomized study, 20 of these patients received pentazocine and 20 were treated with Fentanyl. The bolus quantity for pentazocine was 15 mg in 5 ml NaCl, and that for Fentanyl 0.05 mg in 5 ml NaCl. ⋯ The majority of patients reported very positive experience with PCA. There were few side effects. Problems arose from the negative attitude of other doctors and the nursing staff, and from some misunderstandings.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Does directed bronchoscopic bronchial cleansing have an advantage over conventional suctioning? A prospective study of hemodynamics, gas exchange and suction-induced mucosal lesions in long-term ventilated patients].
Hypoxic complications and epithelial damage to the trachea and bronchi during conventional blind suctioning have been described in the literature. Fiberoptic suctioning and examination of the trachea of each long-term ventilator patient as a routine method has been recommended in recent studies. We investigated the effect of a conventional tracheal suction technique compared to precise fiberbronchoscopic suction on cardiocirculatory function and gas exchange in mechanically ventilated patients. ⋯ There was no effect on cardiocirculatory function in either group (Figs. 1 and 2), but we found a decrease in arterial PO2 after suctioning in all patients (group I from 99 +/- 25 to 81 +/- 19 mmHg, group II from 104 +/- 23 to 80 +/- 17 mmHg [Fig. 3]). The time needed to re-establish the initial PaO2 after suctioning was significantly different in both groups. Whereas the PaO2 returned to the initial value within 2 min after conventional suctioning, we found a decrease in PaO2 in the bronchoscopic group even after 15 min.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Effect of different pre-oxygenation procedures on arterial oxygen status].
There are different opinions regarding efficiency, duration, and techniques of preoxygenation. It was the aim of our study to systematically investigate the effectiveness of different preoxygenation methods by means of arterial blood gas parameters (paO2, SaO2, and CaO2). METHODS. ⋯ Most important was the manner of holding the face mask. With a tightly fitting mask, preoxygenation was more effective than with the face mask one digit away from mouth and nose, independent of preoxygenation time and oxygen flow (Table 3). The SaO2 (Fig. 2) increased in the same manner with the different preoxygenation techniques from 94.0% to 97.5% (Table 3); CaO2 (Fig. 3) was influenced in a similar way (16.7 ml/dl to 17.4 ml/dl).(ABSTRACT TRUNCATED AT 250 WORDS)