Der Anaesthesist
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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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Randomized Controlled Trial Comparative Study Clinical Trial
[Vecuronium: onset of effect and intubation conditions in comparison to pancuronium and suxamethonium].
The onset of neuromuscular blockade following the i.v. injection of vecuronium and pancuronium 0.05, 0.08 or 0.1 mg/kg and suxamethonium 0.5 or 1.0 mg/kg was studied in 304 patients during induction of anaesthesia by means of the compound action potential derived from the adductor pollicis muscle, which was indirectly stimulated via the ulnar nerve. The intubation conditions 1-5 min after injection were assessed using a scoring system related to ease of laryngoscopy, movement of vocal cords and coughing, and reflex movements of extremities. Development of motor blockade was time- and dose-dependent. ⋯ Although suxamethonium acts the fastest and tracheal intubation can be achieved within 0.5-1.0 min, its use involves certain side effects and disadvantages. Vecuronium acts considerably faster than pancuronium and good or excellent intubation conditions are present within 2 min. Suxamethonium is no longer the muscle relaxant of choice for intubation except for crash intubation, e.g., in patients with a full stomach.
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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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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.