Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
Venous pain and involuntary muscular movements during and after administration of etomidate. A comparison of two different formulations.
Anaesthesia was induced in 209 patients with etomidate, using either the two vidal formulation, i.e. a solution of 30 mg etomidate sulphate in 20 ml phosphate buffered solution or the new formulation i.e. 5ml ampoules containing 2% etomidate base in polyethylene glycol 1000 (PEG 1000), a ready-for-use solution. Amongst patients who received the two vial formulation of etomidate (n = 105), 26 reported pain on injection as compared with six patients who received etomidate in PEG 1000 (n = 104). In the former group, involuntary muscle movements were reported in 12 patients, three of them being disturbing. In the latter group slight involuntary muscle movements occurred in 15 patients, but were never disturbing.
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Recent progress in narcotic drug research is briefly reviewed. Several investigators were able, independently to identify stereospecific opiate receptors, which mediate the specific effects of narcotic analgesics. ⋯ The chemical structure of some of these endorphines could be analyzed. Endorphines are suggested to be involved in pain perception, electroanalgesia, acupuncture analgesia, psychiatric disorders, synthesis and release of pituitary hormones.
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A case of human rabies is reported showing a peculiar course in some respects. The lack of a satisfactory history concerning an animal bite 5 months earlier as well as a misleading psychiatric history led to difficulty and delay in reaching a diagnosis. ⋯ The clinical course and the pathological findings are described in detail and the etiology and prognosis of the disease are discussed. The latter remains rather hopeless de spite modern intensive care.
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Three different low pressure cuffed endotracheal tubes (Lanz, Portex soft-seal, Kamen-Wilkinson) were studied in cadaver tracheas and patients in our intensive care unit during ventilation. In the air filled low pressure cuffs without controlled pressure system the cuff pressure and the ventilation pressure are almost identical. Rises of intrathoracic pressure during mechanical ventilation are reflected by increased cuff pressure. Tubes with controlled pressure system or foam-filled cuffs have lower peak cuff pressures, especially during sighing, coughing and suctioning.