Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1993
Randomized Controlled Trial Comparative Study Clinical Trial[A comparison of the two anticholinergic agents atropine and glycopyrrolate during antagonism of a muscle relaxation with pyridostigmine].
Central, peripheral and cardiac side-effects of both anticholinergic drugs atropine and glycopyrrolate were compared during the antagonism of muscle relaxation with pyridostigmine. In a randomized, double-blind fashion 50 patients were given 10 micrograms/kg of atropine and 50 were given 5 micrograms/kg of glycopyrrolate with 125 micrograms/kg pyridostigmine intravenously. Continuous Holter ECG-monitoring over 3 hours was performed. ⋯ Atropine as well as glycopyrrolate caused an increased heart rate within the first 4 minutes (atropine 47% vs. glycopyrrolate 27%, p < 0.01). During phase III after atropine, the heart rate decreased below the control value (p < 0.05). None of the patients showed central anticholinergic syndromes after either drug.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anaesthesiol Reanim · Jan 1993
[Soda lime--service life, consumption and costs in relation to fresh gas flow].
The utilisation time of carbon dioxide absorbers in anaesthesia textbooks is nearly identically specified to last about 5 hours. Therefore in most departments the soda lime of the absorbers is changed routinely on a daily schedule. As rebreathing volume increases considerably with fresh gas flow reduction, the question arises as to whether the soda lime should be changed at even shorter intervals--if low-flow anaesthesia is performed routinely--to to guarantee carbon dioxide absorption safely. ⋯ If, however, minimal flow anaesthesia is performed routinely in clinical practice, the percentage of time in which the fresh gas flow can really be reduced to 0.5 l/min does not exceed 50 to 80%. Under these conditions the utilisation time of the absorbers decreases to between one half (1/2) and one quarter (1/4) of the utilisation time which can be gained if a flow of 4.4 l/min is used. Thus, the performance of minimal-flow anaesthesia increases the consumption of soda lime two- to fourfold.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anaesthesiol Reanim · Jan 1993
Review[The importance of neuromuscular monitoring during anesthesia for neuroradiologic diagnosis].
Muscle relaxants are essential in anaesthesia for neuroradiological diagnosis. In addition, neurosurgical and neurological patients often face, because of their basic illness, respiratory danger, which can increase postoperatively through the use of muscle relaxants during anaesthesia. Because of their pharmacodynamic properties and side-effects, muscle relaxants must be clearly differentiated from one another and used selectively for the different phases of anaesthesia-intubation, calmness during examination and recovery from neuromuscular block with extubation. ⋯ For investigations with planned extubation, only the muscle relaxants atracurium and vecuronium with their medium-long effect should be applied. A high degree of safety is provided by neuromuscular block and especially in the recovery phase. Using relaxometers it is possible to determine individual relaxant requirements, avoid under- and overdoses, carry out an antagonism at the correct time and prevent residual relaxation situations so that respiratory insufficiency can be reliably excluded.
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Anaesthesiol Reanim · Jan 1993
[Early recognition of brain death--a contribution to organ explantation].
The criteria for brain death are presented and reference is made to the legally required observation period. To shorten the observation period, the Federal Medical Council (Bundesärztekammer) set out in 1986 possible aids to making decisions. The time at which extensive additional investigations should start makes it necessary to approximately determine the moment of brain death. The tear secretion test presented in this paper could be a further decision aid.