Der Anaesthesist
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Between 2% and 5% of the population suffer from bronchial asthma. The disease is characterized by bronchial hyperreactivity to physical, chemical, pharmacological, and/or immunological irritants. The incidence of perioperative complications is higher in asthmatics than in non-asthmatics. ⋯ The skill of the anesthesiologist, early recovery from general anesthesia, and good postoperative care greatly reduce the incidence of complications. Besides the changes in pulmonary function that occur following anesthesia and surgery, asthmatics may suffer from abnormalities in control of ventilation and mucociliary function postoperatively. The patient with a history of asthma needs close supervision during the postoperative period: many sudden deaths from asthma and many episodes of ventilatory arrest occur during the night and in the early morning.
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Randomized Controlled Trial Clinical Trial
[Midazolam and pethidine/promethazine for intramuscular premedication].
The main reason for premedication is the reduction of preoperative stress. Despite the proven fact that benzodiazepines best reduce preoperative stress, combinations of opioids and neuroleptic drugs are preferred for premedication by many on reviewing the journal Der Anaesthesist. This double-blind study was performed to investigate midazolam and meperidine/promethazine for intramuscular premedication. ⋯ We conclude from these results that anesthesiologists still premedicate with meperidine/promethazine because the patients accept this premedication very well when asked the day after surgery. Nevertheless, premedication with midazolam provides significantly better anxiolytic and antidepressive effects with significantly less side-effects. Therefore, midazolam should be preferred to meperidine/promethazine for intramuscular premedication.
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Propofol (Disoprivan) is a rapid and effective hypnotic comparable with etomidate. Up to now, the effects on intracranial pressure (ICP) have only rarely been investigated, especially in cases with pre-existing increased ICP [4, 18]. The aim of this study was the evaluation of ICP after i.v. propofol administration in comparison with thiopental. ⋯ Conclusions. The data now available permit the conclusion that both propofol and thiopental can be used in patients with possibly elevated ICP. The marked cardiovascular side effects of propofol must be taken into consideration.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Midazolam (Dormicum) as oral premedication for local anesthesia].
Good physician-patient rapport and an anxiolytic, sedative, and amnesic premedication are necessary for comfortable, stress-free surgery under local anesthesia. Sufficient experience exists with the intramuscular and intravenous administration of the new benzodiazepine midazolam (Dormicum), while knowledge relating to its oral administration is still scant. Therefore, in a randomized double-blind study midazolam was investigated for oral premedication prior to local anesthesia: two dosages of midazolam were studied and compared with diazepam and placebo. ⋯ Anxiety increased little following the placebo; it decreased significantly following 10 mg diazepam and more markedly following 7.5 and 15 mg midazolam. Sedation increased little following the placebo; it increased more and similarly 50 min after the benzodiazepines; after 90 min the sedative effect was most marked for 15 mg midazolam. However, sedation was of shorter duration after midazolam than after diazepam.(ABSTRACT TRUNCATED AT 250 WORDS)
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The treatment of cerebral edema has changed during recent years. On the one hand, knowledge of the pathophysiology of brain swelling has expanded; on the other, the analysis of biodata such as intracranial pressure, cerebral blood flow, and blood volume has become routine. The methods of measuring intracranial pressure (nowadays without risk due to the use of microtipepidural probes, e.g. ⋯ Barbiturates are used as sedatives or in a loading dose until burst suppression is seen in the EEG. The risk of hemodynamic side effects such as reduced cardiac output and cerebral perfusion pressure is decreased by measuring pulmonary arterial pressure and the use of catecholamines. The acidotic impairment of cerebral autoregulation can be regulated using THAM (thrometamine) and the response of the vascular system to hypocapnia can be improved.(ABSTRACT TRUNCATED AT 250 WORDS)