Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1997
Randomized Controlled Trial Comparative Study Clinical Trial[Drug onset time of atracurium after pancuronium priming in elderly patients].
Synergism occurs between some combinations of non-depolarising muscle relaxants. To test the effect of pancuronium as a priming dose of atracurium, 45 adults were anaesthetised with 25 micrograms/kg alfentanil. 75 micrograms/kg midazolam, and 0.25 mg/kg edomidate, O2/N2O and enflurane, and were randomised to one of three groups. After induction, 15 patients received 0.5 mg/kg atracurium, 15 were primed with 0.075 mg/kg atracurium and another 15 with 0.0125 mg/kg pancuronium and three minutes later 0.45 mg/kg atracurium. ⋯ The pancuronium priming group showed a significantly faster onset of neuromuscular blockade (tI = 0%: control group I: 76.3 +/- 15.4 sec vs. pancuronium group III: 64.3 +/- 11.3 sec) and a prolonged recovery. Pancuronium priming can shorten the onset time of atracurium while atracurium priming alone showed no shortening. This suggests a synergism for pancuronium priming in combination with atracurium.
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Anaesthesiol Reanim · Jan 1997
Review Case Reports[Epiduritis after long-term pain therapy with an epidural catheter--review of the literature with a current case report].
Patients suffering from vascular disease are often a challenge for the acute pain service. Ischaemia, impaired wound healing, stump and phantom limb pain often require a complex analgesic regimen. Invasive measures such as spinal or epidural catheters can be very helpful but carry the risk of infection, as shown by this case report. ⋯ A little necrotic material and residues of an old haematoma were removed and the epidural space was lavaged. Specimens taken from the epidural material revealed colonisation with staphylococcus epidermidis, which was sensitive to the broad spectrum antibiotics formerly given to the patient to treat the infection in the left stump. By the next day, all signs of epiduritis had disappeared and the patient recovered completely.
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Anaesthesiol Reanim · Jan 1997
Review[Pharmacokinetics from the viewpoint of the clinical anesthetist].
Pharmacokinetics describes the time-depend course of plasma concentration of a drug. Pharmacodynamics describes the pharmacological effect of the substance. Both together form the pharmacological model used in clinical practice. ⋯ The main clinical use of pharmacokinetics is to sustain dosing schemes based on scientific data. It also may be helpful in creating new administration schemes especially for continuous infusion of intravenous hypnotics or analgetics. New developments such as Target-Controlled Infusion (TCI) are based on pharmacokinetic data and computations and may be an improvement for the clinically working anaesthetist.
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Anaesthesiol Reanim · Jan 1997
Review[Artificial humidification of inspired gas--status of knowledge and technique].
Artificial humidification of inspired air serves to maintain or restore physiological heat and moisture conditions in the bronchial system in intubated or tracheotomized patients. The need to condition the respiratory gases in these patients is undisputed. The present paper reviews the pathophysiology and methods of the artificial active and passive humidifying of inspired gases. ⋯ Present-day medical knowledge indicates that passive artificial humidifying of respiratory gases (heat and moisture exchanger, HME) is adequate to meet most requirements for warming and moistening the inspiratory air in patients whose upper airways are devoid of natural conditioning of respiratory gases in consequence of intubation and tracheotomy. This applies to artificial ventilation in prehospital situations, artificial ventilation in anaesthesia and long-term artificial ventilation on the intensive care unit. With appropriate restrictions, the respiratory air of patients who breathe spontaneously via an artificial air vent (e.g. tracheal cannula) can also be conditioned by HME.
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Anaesthesiol Reanim · Jan 1997
Review[Ventilation modes and strategies in intensive care medicine].
Advances in ventilator technology and recent findings in pathophysiological mechanisms have resulted in a remarkable decrease in classical volume controlled and pressure controlled ventilation modes as treatment for severe acute respiratory insufficiency. New modes of ventilatory support enabling and encouraging patients' spontaneous breathing, such as Biphasic Positive Airway Pressure (BIPAP) and Airway Pressure Release Ventilation (APRV), make it possible to adapt ventilatory support better and more easily to suit patients' needs than conventional modes of controlled ventilation. Preservation and support of patients' spontaneous breathing improves pulmonary gas exchange and reduces stress imposed by mechanical ventilation. ⋯ Through this, the need for sedation and analgesia is considerably reduced and this may minimize systemic side-effects and complications from analgo-sedation and mechanical ventilation. The drugs should be administered in an adequate, individually adapted manner. Routinely-ordered and fixed combinations of drugs administered continuously are not adequate adequate as they further carry the risk of overdosing a different single drug with the corresponding side-effects (depression of respiratory drive, gut motility, etc.).