Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Etomidate versus methohexital for intravenous anesthesia with alfentanyl and nitrous oxide-oxygen. A double-blind study of circulatory behavior and postoperative course].
This study compared both etomidate and methohexitone for intravenous anaesthesia with alfentanil and nitrous oxide/oxygen in 2 X 20 patients scheduled for ENT-surgery, in a double blind, random fashion. Apart from the alternative use of etomidate and methohexitone the anaesthetic procedure did not differ: After a small dose of alfentanil anaesthesia was induced by a bolus dose of the hypnotic followed by a continuous infusion of the drug. In case of inadequate analgesia alfentanil was injected. ⋯ The dosage of etomidate and methohexitone was lowe than that reported in the literature. It proved to be impossible for the anaesthetist to decide which drug he was using. Hence both anaesthetic techniques compare favourably with each other.
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The neuromuscular and cardiovascular effects of vecuronium (Norcuron, Organon Teknika) were studied in 58 infants (1 day-10 months) and 65 children (1-6 years) anaesthetized either with halothane or under balanced anaesthesia. After a bolus dose of 70 micrograms/kg vecuronium the time course of neuromuscular blockade was determined using an electromyographic equipment. Onset time (time to maximal effect) was significantly shorter in infants compared with children; 1.4 +/- 0.7 min (min +/- SD) and 2.7 +/- 0.8 min, respectively. ⋯ Vecuronium (a bolus dose of 80 or 100 micrograms/kg) did not cause any significant change of blood pressure in infants and children anaesthetized either with halothane or by balanced anaesthesia. Infants under balanced anaesthesia showed a significant decrease in heart rate 15 min after administration of vecuronium. In contrast an increase in heart rate could be observed in children under halothane anesthesia, which was not attributed to vecuronium.
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Non-invasive measurements of oxygen saturation are attractive because they provide continuous information which may result in improved patient care. We evaluated a new finger pulse oximeter as a measure of arterial oxygen saturation in critically ill patients with respiratory distress. ⋯ Linear regression analysis of these pooled data yielded on excellent correlation (r = 0.97, p less than 0.001, 0.3% accuracy). The results demonstrate that non-invasive oxygen monitoring of patients with respiratory failure is feasible and can reliably detect potential life-threating arterial oxygen desaturation.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Aortofemoral bifurcation bypass--effect of anesthesia procedure (NLA, thoracic continuous catheter peridural anesthesia) on circulation, respiration and metabolism. Hemodynamic changes caused by peridural anesthesia and anesthesia induction].
In 50 patients scheduled for infrarenal aortic bypass surgery the cardiovascular effects of two anaesthetic regimes were investigated prior to surgery. A Swan-Ganz-catheter was used for haemodynamic measurements. These patients, having been randomized into two groups, were optimally volume loaded (PCWP 10 mmHg) before anaesthesia. In 24 patients a thoracic epidural was induced with 12-15 ml 0.25% plain bupivacaine. When segmental anaesthesia had extended from T4/5 to L1/2 general anaesthesia was additionally applied (flunitrazepam 1.5-2 mg, pancuronium bromide 0.1 mg/kg). In 26 patients neuroleptanaesthesia was induced (droperidol 0.1-0.2 mg/kg, fentanyl 0.01 mg/kg, pancuronium bromide 0.1 mg/kg, and thiopentone 100-150 mg. Haemodynamic measurements were made before injection into the epidural catheter, after complete spread of anaesthesia, before commencing general anaesthesia and 10-15 min thereafter. ⋯ Neither of the two procedures were associated with severe haemodynamic alterations. In the epidural group HR fell slightly during latency of complete spread and increased to the same extend following general anaesthesia. The epidural caused MAP (104 to 88 mmHg), mean PAP (20 to 14 mmHg), PCWP (10 to 7.5 mmHg), and RAP (4.5 to 2.5 mmHg) to decrease moderately but no further changes were effected by the subsequent general anaesthesia. SVR and PVR were not influenced by either epidural or by general anaesthesia. CI (3.6 to 3.41 . min-1 . m-2), LVSWI (67 to 52 p . m-1), and cardiac minute work index (55 to 40 J . min-1 . m-2) decreased during latency of complete spread but were no further influenced by general anaesthesia. The haemodynamic changes of neuroleptanaesthesia were almost identical to those of the combined epidural-general anaesthesia. For the operation which followed, a continuous infusion of 0.125 per cent plain bupivacaine (0.25 ml/kg X h) via epidural catheter (in combination with N2O/O2-anaesthesia) was sufficient for complete analgesia in the epidural group. These findings lead to the conclusion that a small bolus volume and a low concentration of bupivacaine result in good anaesthesia while avoiding serious haemodynamic alterations.