Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[The significance of tramadol as an intraoperative analgesic. A randomized double-blind study in comparison with placebo].
Tramadol-N2O anaesthesia as recommended by Stoffregen was studied in 40 patients (ASA I-II) undergoing elective orthopaedic or lower abdominal surgery. Fentanyl and droperidol (Thalamonal)/atropine were given as i.m. premedication, induction was performed using methohexitone, succinylcholine and pancuronium, ventilation was controlled by means of a Takaoka respirator (N2O/O2 79:21, 4 breaths/min). Intraoperative analgesia was provided by a biphasic tramadol infusion. ⋯ When enflurane had not been necessary (tramadol n = 13, placebo n = 10), mean percentage rises of blood pressure or pulse rate, related to preoperative values, were found to be slightly higher in the tramadol group. Postoperative analgesic requirement was reduced significantly after tramadol. Striking differences between the two groups, on the other hand, were shown with respect to intraoperative awareness: while patients receiving placebo proved to be amnaesic, 65% of tramadol patients were aware of intraoperative music.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Analgesia and adverse effects of nalbuphine (Nubain) in comparison with morphine following hysterectomy].
In a randomized double-blind-study nalbuphine 20 mg i.m. was compared with morphine 10 mg i.m. in 49 patients over the first 48 postoperative hours after hysterectomy. Nalbuphine proved to be a good analgetic, not statistically different from morphine but having statistically significantly fewer side effects.
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Randomized Controlled Trial Clinical Trial
[The effect of intraoperative PEEP ventilation and postoperative CPAP breathing on postoperative lung function following upper abdominal surgery].
The problem of how to improve postoperative pulmonary function after upper abdominal surgery was investigated in a randomized study involving 64 patients who were subjected to various treatment regimens designed to increase airway pressure. Intraoperative ventilation was carried out with either zero or positive end exspiratory pressure, and postoperatively either CPAP or a nasal oxygen catheter were applied. The following groups were formed: 1. ⋯ The typical reduction in vital capacity occurred postoperatively, the lowest value being recorded on the 2nd postoperative day, an alteration in respiratory pattern with reduced tidal volume and increased respiratory rate together with an initially low, later normal alveolar ventilation, and an initial hypoxaemia which was at first associated with a moderate hypercapnia, on the second postoperative day with a normocapnia, were observed. At no point in time could a difference be found between the 4 groups, no measurable improvement in respiratory function being found as a result of the treatment given. Intra- and post-operative increase in airway pressure was however found to be associated with a reduction in the incidence of post-operative pulmonary complications.
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Randomized Controlled Trial Clinical Trial
[Ranitidine (Zantic) for aspiration prevention].
The new H2-receptor antagonists have been shown to be effective against the risk of gastric acid aspiration. The recommended dosage schedules, however, are not satisfactory in a clinical routine practice. Therefore the effect of the long acting agent ranitidine on pH and volume of gastric secretion after a single administration at 22.00 h on the previous evening has been investigated. ⋯ Ranitidine 150 mg and cimetidine 400 mg are not satisfactory, as expected. If an anaesthetic is scheduled to start later than 09.00, an additional dose of ranitidine should be administrated at 07.00. Ranitidine 300 mg provides an efficient prophylaxis against acid aspiration in one single dose and without additional medications at a time inconvenient for patient and nursing staff.
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Randomized Controlled Trial Clinical Trial
[Investigations on epidural morphine. Efficacy, solvent, analgesic supplementation].
The effects of epidural morphine for pain relief after orthopaedic surgery of the lower extremity were examined in 60 patients. Intraoperative analgesia was achieved with epidural administration of 2% mepivacaine. The patients were divided in a double-blind, random fashion into 3 groups. ⋯ The solution (glucose or normal saline) had no influence on morphine effectiveness. The side effects were urinary retention in 8 patients (20%) and pruritus in one (3%). It is concluded that 2 mg of morphine base administered epidurally is an effective method of postoperative pain relief in orthopaedic patients.