Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Onset of the effect and intubation conditions following atracurium, verocuronium and suxamethonium].
1. The onset of neuromuscular blockade following i.v. injection of atracurium 0.3, 0.4, or 0.5 mg/kg; vecuronium 0.08 or 0.1 mg/kg; and succinylcholine 1.0 mg/kg was studied in 205 adult patients during induction of anesthesia by means of the compound action potential (EMG) of the hypothenar muscle, which was indirectly stimulated via the ulnar nerve above the wrist, using the Datex Relaxograph. At the same time, the intubation conditions at 0.5, 1, 2, or 3 min after injection were assessed using a scoring system (Crul 1983) related to ease of laryngoscopy, movement of vocal cords and coughing, and reflex movements of the extremities. 2. ⋯ Motor blockade 1 min after succinylcholine was 98 +/- 2% and intubation conditions scored 11.3 +/- 0.3. Relating intubation conditions to neuromuscular blockade yielded a close correlation and surprisingly good or very good intubation conditions (score more than 10) at a motor blockade of 80% (resp. 20% transmission). 3. Although succinylcholine is still the muscle relaxant with the most rapid onset of action, the new drug atracurium seems to satisfactorily facilitate tracheal intubation within an acceptably short time interval of 2 min after injection.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
[Propofol infusion for the maintenance of short-term anesthesia].
The administration of propofol by infusion for maintenance of anesthesia has attracted much attention recently. We investigated the necessary infusion rate of propofol to maintain anesthesia for short surgical procedures without loss of the evident advantages of this substance. Forty unpremedicated female patients aged 18-59, scheduled for minor gynecological procedures, were randomly assigned to four groups. ⋯ After induction, arterial blood pressure decreased by systolic/diastolic 20/10-15 mmHg. With the low infusion rate, arterial pressure increased to its control value during operation; it remained at the postinduction value with high infusion rates. Side-effects: 10 patients had salivation that in some instances lead to coughing, 9 reported pain at the injection site during induction, and 9 reported dreams of a pleasant nature.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
[Dose-dependence of the analgesic action of metamizol].
Whereas dipyrone is used in many countries in clinical practice at doses up to 2.5 g, the dose-response relationship of the analgesic effect has not been investigated in humans. In the present study, doses of 0.5, 1.0, 1.5, 2.0, and 2.5 g dipyrone (Novalgin) were applied orally as film-coated tablets to 18 volunteers in a randomized, placebo-controlled, double-blind design. Pain attenuation was quantified following constant and painful electrical stimulation of tooth pulp at different time intervals up to 7 h after drug administration. ⋯ Maximal analgesia was observed 1 h after administration of the tablets, independent of the dose. An increase in analgesic effect related to dose was observed at this time, the increase being less pronounced with doses exceeding 1.5 g. Generally, analgesia persisted longer with increasing dose.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
[Suppression of blood pressure increases during intubation: lidocaine or fentanyl?].
The hypertensive response to anesthetic induction with endotracheal intubation may be harmful in patients with cardiovascular disease, increased intracranial pressure, or anomalies of the cerebral vessels. Recommendations for attenuating the reflex hypertension and tachycardia elicited by upper airway irritation are therefore manifold. Besides minimizing the cardiovascular response, anesthesia induction for patients at risk must also satisfy the following requirements: it must be applicable regardless of patient collaboration, prevent impairment of cerebral blood flow, and avoid arousal of the patient; it should neither be time-consuming nor affect the duration or modality of the ensuing anesthesia. ⋯ The two equally simple induction procedures were compared to anesthesia induction with thiopental alone. In both patient groups no significant effect of lidocaine on the pressure response could be observed. Fentanyl lowered the pressure response slightly though significantly in brain-tumor patients only (p less than 0.05), but showed a significant pressure-lowering action persisting over the whole observation period in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Plasma cortisol in experimental anesthesia with halothane, enflurane, isoflurane and nitrous oxide].
The influence of anesthesia on plasma cortisol has most often been studied in connection with routine operations. To investigate the specific effects of modern inhalation anesthetics more accurately, we examined the specific effects of four inhalation anesthetics on human plasma cortisol during volunteer studies on the influence of anesthetics on the electroencephalogramm. METHODS. ⋯ Blood samples were taken 5 min prior to induction (I), after the attainment of steady-state MAC 1.0 (II), 35 min later at MAC 0.5 (III), 40 min later at MAC 1.0 with volatile anesthetic/N2O (IV), and 15 (V) and 35 (VI) min after the end of anesthesia. RESULTS. MAC 0.5 N2O produced a marked rise in mean plasma cortisol, from 64.2 micrograms/l to 164.5 micrograms/l.(ABSTRACT TRUNCATED AT 250 WORDS)