Anaesthesiologie und Reanimation
-
The postoperative care of patients usually is characterized by the fact that the individual need of pain killers is not sufficiently recognized. An opioid given only when asked for, results in an underdosage as the patient does not receive the analgesic in time, so that he suffers pain. As there is insufficient knowledge with regard to the pharmacology of opioids which can be used for postoperative pain therapy, physicians and nurses usually tend to give a lower dose in order to avoid any possible side-effects. ⋯ Piritramide has a fast onset of action, 2-5 minutes after intravenous injection and a peak action after 10 minutes. In comparison to pethidine it has no cardiovascular effects, in particular no myocardial depression or increased myocardial oxygen demand (MVO2). Last but not least, the cost-effectiveness is a financial factor of increasing importance to the institution that runs the hospital.
-
Anaesthesiol Reanim · Jan 1991
[An attempt at a mathematical prediction of the depth of insertion of the needle in peridural anesthesia].
The purpose of the investigation was to correlate the distance from the skin to the flaval ligament with the individual data of patients such as bodyweight, height, sex and age with the aim of predicting the depth of insertion of the needle. In a retrospective study we examined 448 patients (217 men and 231 women). In the anaesthetic records the depth of insertion of the needle was noted together with the patients' personal data. ⋯ With these formulae a rough prediction for the depth of insertion can be made, with x representing the bodyweight and y the expected depth in cm. The measured values fluctuated between 3.5 and 7.4 cm in the 217 men, with the medium value at 4.08 cm. In the 231 women the measured values fluctuated between 3.3 and 6.9 cm with the medium value at 4.67 cm.
-
Anaesthesiol Reanim · Jan 1991
Review Comparative Study Clinical Trial Controlled Clinical TrialCardiac dysrhythmias during dental surgery. Comparison of hyoscine, glycopyrrolate and placebo premedication.
The incidence of cardiac dysrhythmias was investigated in 60 patients undergoing dental operations under halothane anaesthesia following either hyoscine, glycopyrrolate or placebo as a supplement to nalbuphine for premedication. Forty-five percent of the patients given 6 micrograms/kg hyoscine exhibited cardiac dysrhythmias compared to 25 percent of the group given 4 micrograms/kg glycopyrrolate and to 5 percent in the placebo group. ⋯ There was neither a connection between the frequency of cardiac dysrhythmias and the demographic characteristics of the patients nor with their PaCO2. The author recommends to avoid premedication with anticholinergic combined with halothane anaesthesia with spontaneous respiration during dental operations.
-
Anaesthesiol Reanim · Jan 1991
ReviewPain control with intrathecally and peridurally administered opioids and other drugs.
Sharp pain is conducted rapidly by myelinated delta A fibers and diffused pain slowly by nonmyelinated C fibers to pseudobipolar neurons in the posterior ganglion and from there to neurons located in the posterolateral horn of the spinal cord. From here on nociferous impulses are transmitted by excitatory peptides (e.g. substance P) or amino acids (e.g. glutamate, aspartate) through interconnecting neurons of the pain pathways, primarily on the contralateral side, to the brain stem and from there to the sensory cortex, where they are appreciated and acted upon. There are specific inhibitory receptors located on axon terminals, near to the release sites of the excitatory amino acids and peptides. ⋯ Several different approaches are being investigated for the production of selective spinal analgesia without side effects. They include: a. the use of more lipophilic, long-lasting opioids (e.g. lofentanil) which would be almost completely absorbed by the spinal cord and therefore would not reach the medullary centers; b. the development of opioids with specific affinity to kappa- and for delta- and little or no affinity to mu-receptors, primarily responsible for side effects; and c. combining lower doses of opioid agonists with alpha 2-adrenergic agonists (e.g. clonidine) or with somatostatin. It is conceivable that in the not-too-distant future, it will be possible to achieve through these measures, selective spinal analgesia without side effects.
-
With the combination of a noninvasive saturation measurement and plethysmography, pulse oximetry has become an important monitoring method for peripheral perfusion and oxygen supply. Indications for pulse oximetry is practically every anaesthesia especially in geriatric patients and patients with one-lung-anaesthesia, obesity, asthma and emphysema. Pulse oximetry has proved its worth in the transport of emergency patients. ⋯ Accuracy of response of most currently available pulse oximeters lies between 2-3% (SD) with oxygen saturations between 80-100%. Deviations increase at lower oxygen saturations. Pulse oximetry will soon be regarded as minimal monitoring standard worldwide together with the ECG, blood pressure, pulse and respiratory monitoring.