Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of neuromuscular blockade by mivacurium and atracurium].
The aim of our randomized controlled study was to compare the neuromuscular characteristics of mivacurium and atracurium by evaluating the intubation conditions, intubation times, onset times and the duration of action of these two muscle relaxants using two different dosing principles. Forty-eight patients were included in this study. All patients were premedicated orally with 0.2 mg/kg diazepam. ⋯ The patients of group 3 (n = 12) were intubated with 0.46 mg/kg atracurium (2 x ED95) and the patients of group 4 (n = 12) received a priming dose of 0.046 mg/kg atracurium (20% of ED95) and an intubation dose of 0.23 mg/kg atracurium (ED95) four minutes later. The patients were intubated under normocapnic conditions and following stabilisation of the palmar skin temperature after a 90% neuromuscular block (T1) had occurred. The intubation conditions were measured semiquantitatively using an intubation score.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anaesthesiol Reanim · Jan 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Improved climatization of anesthetic gases by modifying the Sulla 808 V anesthesia equipment].
Maintenance of a physiological airway climate is one of the goals of anaesthesia ventilation. This may be achieved by integration of heat and moisture exchangers (HME's) or--more economically--by reducing fresh gas flow rate down to the minimal-flow-range. Conventional bag-in-bottle ventilators with hanging bellows do not allow operation with minimal-flow-rates; flow reduction results sooner or later in a positive-negative-pressure ventilation pattern; especially so in patients suffering from COPD. ⋯ Twenty-four consenting patients were randomly assigned to be ventilated with either high (6.0 L/min, n = 12) or minimal (0.6 L/min, n = 12) fresh gas flow rate. The time course of inspiratory temperature and humidity was measured over a period of 120 minutes; water content was calculated from relative humidity and temperature. In the minimal-flow-group, already after 60 minutes a temperature of 28.6 +/- 0.9 degrees C and a water content of 17.6 +/- 1.9 mg H2O/L were achieved (mean +/- SD).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anaesthesiol Reanim · Jan 1995
Comparative Study[Plasma catecholamine level and clinical parameters--quality criteria for premedication in childhood].
Stress hormones noradrenaline and adrenaline were measured in plasma before and after premedication to objectivate the anxiolytic potency of different premedication methods in children. In addition indirect signs of sympathoadrenergic activity (heart rate and blood pressure) as well as children's behavior and reaction to face mask were documented. Each group consisted of 16 children (aged 3 to 15 years). ⋯ After mask exposition in all groups noradrenaline and adrenaline levels increased with the exception of adrenaline in the midazolam-group, where the levels remained low. Mask acceptance and anxiolysis were better in the midazolam-group than in other groups. Reduction in heart rate and blood pressure, catecholamines in plasma, anxiolysis and a high mask acceptance indicate that intravenous administration of midazolam is very effective in premedicating children.
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Anaesthesiol Reanim · Jan 1995
Case Reports[Severe pulmonary complications following venous air embolism in neurosurgical operations in sitting position--2 case reports].
The occurrence of air embolism during neurosurgical operations in sitting position is described in two cases. Besides the Doppler ultrasound evidence, relevant effects on the cardiopulmonary situation during surgery were observed, which in one case forced an early end of the operation. ⋯ In severe intraoperative cardiopulmonary complications in connection with venous air embolism, the existence of pulmonary oedema should be assumed. Confirmation of the diagnosis and the correct therapy depend upon frequent postoperative chest X-rays.
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Anaesthesiol Reanim · Jan 1995
Comparative Study[Interactions between renal and general hemodynamics in fentanyl, droperidol, ketamine, thiopental and in peridural anesthesia--animal studies].
The main focus of this paper is to show regulative interactions between cardiac index (CI) and renal blood flow (RBF) with various intravenous anaesthetics under steady state conditions. Several experimental series were carried out on dogs with the following anaesthetic doses (as given per hour and per kilogram body weight-h-1 x kg-1): fentanyl 50 micrograms, ketamine 4 and 10 mg, and thiopentone 10 and 20 mg. The basic anaesthesia used was halothane (0.7 vol.%) in N2O/O2 (ratio about 3:1), because renal function, renal autoregulation and responsiveness to renally effective drugs remain nearly unaltered by this anaesthetic procedure. ⋯ The effect of each anaesthetic drug on RBF has principally to be taken as regulative adaptation to altered circulatory conditions. Increasing plasma renin levels are mainly a compensatory reaction following a decline in arterial blood pressure due to anaesthesia induced sympathicolysis. With regard to renal function, the additional use of epidural anaesthesia (functional "denervation" of the kidney) can be recommended especially for highly invasive surgical procedures to antagonize reduction of RBF, which is often induced sympathetically by pain or by commonly used anaesthetic drugs.