Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[Effect of glucocorticoids on extravascular lung water following extra-corporeal circulation].
The influence of 3 different, preoperatively given glucocorticoids (30 mg/kg bw methylprednisolone, 3 mg/kg bw dexamethasone, 30 mg/kg hydrocortisone) on extravascular lung water (EVLW) was investigated in a randomised study consisting of 60 patients undergoing elective aortocoronary bypass surgery and compared to a control group having received 0.9% NaCl as placebo. EVLW-measurements were performed by using the double indicator dilution technique with indocyanine green and a microprocessed lung water computer. Besides EVLW-measurements haemodynamics and various laboratory data were studied before as well as after (15 min, 45 min, 5 h) extracorporeal circulation (ECC). ⋯ Pulmonary gas exchange, too, did not differ statistically, in spite of a less pronounced (p = 0.1) deterioration of paO2 in the dexamethasone-group. Haemodynamics and laboratory data in the corticoid-group did not show any significant difference compared to the non-treated control group. It was concluded, that pretreatment with corticoids in pharmacological doses in cardiac surgery had no beneficial effects on extravascular lung water and pulmonary function.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Morphine and scopolamine in premedication. A comparison of peroral and transdermal administration with intramuscular injections].
A randomized clinical study was undertaken to compare the feasibility and effectiveness of two different premedications. Thirty-eight patients admitted for elective tonsillectomy gave informed consent and were randomly assigned to two groups. One group received morphine orally and scopolamine transdermally. ⋯ The following parameters were evaluated: psychological state, sedation, hemodynamics, salivation, pain and side effects. General anesthesia was maintained with thiopental, fentanyl, N2O/O2, and enflurane; alcuronium was used for muscle relaxation. The results showed no significant differences between the groups for any of the parameters considered.
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Randomized Controlled Trial Clinical Trial
[Rectal administration of midazolam as an adjuvant in the premedication of infants].
In a randomized, double-blind study of premedication in 69 infants aged between 13 and 48 months the effects of 0.82 mg/kg midazolam or diazepam rectally plus 2.0 mg/kg ketamine i.m., or the administration of 2.4 mg/kg ketamine i.m. alone was studied. A satisfying result of 94.1% following the premedication with midazolam/ketamine, of 82.9% with diazepam/ketamine and of 81.3% with ketamine alone was observed. ⋯ The amnestic action of midazolam extinguished the infants' memory of the i.m.-injection. The dose of midazolam/ketamine is suitable as an effective and positive method for premedication of infants within 20 min.
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Malignant hyperthermia is one of the most devastating crises encountered in anaesthesia and it frequently occurs unexpectedly. Although malignant hyperthermia develops in young individuals (mean age approximately 22 years), older people can also be affected. ⋯ Because treatment with dantrolene and hyperventilation with 100% O2 was started immediately, the symptoms of malignant hyperthermia were stopped within a short time. It should always be remembered, that the life threatening crises which can be caused by malignant hyperthermia can occur at any age and even after several uneventful anaesthetics.