Anaesthesiologie und Reanimation
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"Gut injury" and a corresponding impaired gut barrier function are thought to have a high impact on the development of multiple organ failure (MOF) in the critically ill. Mucosal lesions and increased intestinal permeability can provoke translocation of bacteria and endotoxins and initiate local and/or systemic immune-inflammatory response, bearing the risk of development of multiple organ failure. Enteral nutrition using the physiological pathway provides the intestinal mucosa with nutrients, which is thought to reduce bacterial translocation and septic complications. ⋯ Although only little data from randomised trials are available, enteral nutrition has advantages and is cheaper than total parenteral nutrition. In the critically ill, the goal of enteral feeding is not coverage of total caloric requirements, but continuous administration of at least a small amount in order to prevent gut mucosa atrophy. Nutrition is an important aspect in critical care medicine, and enteral feeding should be attempted at least partially.
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Anaesthesiol Reanim · Jan 1999
Randomized Controlled Trial Clinical Trial[Total intravenous anesthesia (TIVA) and balanced anesthesia with short-acting anesthetics for ENT surgery in children].
It was the aim of this study to compare total intravenous anaesthesia (TIVA) with balanced anaesthesia using modern short-acting anaesthetics for ENT-surgery in children regarding the influence on haemodynamics, recovery, side-effects and costs. After approval of the Ethics Committee of the Medical Faculty of the University of Rostock, 80 children in the age of 3 to 12 years, rectally premedicated with midazolam (0.3 mg/kg) and atropine (0.01 mg/kg), were randomly assigned to TIVA (group 1, n = 41) and balanced anaesthesia (group 2, n = 39), respectively. TIVA was induced with propofol (2 mg/kg) and remifentanil (1 microgram/kg) and maintained with propofol (6 mg/kg/h) and remifentanil (0.2 microgram/kg/min). ⋯ We conclude that both TIVA and balanced anaesthesia performed with short-acting anaesthetics, are suitable anaesthetic methods for ENT operations in children. Because balanced anaesthesia with sevoflurane led to higher heart rates, this kind of anaesthesia should be used with caution in children with heart diseases. The main advantage of both methods is their short recovery time.
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Anaesthesiol Reanim · Jan 1999
[Value of the laryngeal mask in emergency care--a survey of North German emergency physicians].
In clinical routine, the laryngeal mask airway (LMA) has proved an alternative to both endotracheal intubation and mask ventilation. In a survey among North German emergency physicians, aspects such as doctors' acquaintance with the LMA, the degree of ist distribution, its use and its potential benefits under non-hospital emergency conditions were evaluated. ⋯ Sixty-three per cent considered the LMA the first-choice alternative in an unexpected "can't-ventilate-can't-intubate" situation. Use of the LMA should be extended in emergency medicine especially as its application is relatively easy to learn in clinical routine.
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Anaesthesiol Reanim · Jan 1999
Comparative Study[General anesthesia or spinal anesthesia for hip prosthesis replacement? Studies of acceptance of both procedures by patients].
Patients undergoing total hip replacement are given general anaesthesia or spinal anaesthesia. The aim of this study was to investigate the experiences of patients before, during and after general anaesthesia (68 patients) or spinal anaesthesia (77 patients). Our investigation revealed that with regard to complications (nausea and vomiting, headache and back pains), no differences between the two methods occurred. ⋯ We found that the time of postoperative analgesia after spinal anaesthesia (210 minutes) was significantly longer than after general anaesthesia (90 minutes). The majority of the patients in both groups (approximately 90%) were satisfied with the chosen method of anaesthesia and with the postoperative pain therapy. These findings make it possible to conclude that with the exception of differences in the postoperative analgesia time, there are no differences between general anaesthesia and spinal anaesthesia regarding complications and satisfaction of the patients with both methods of anaesthesia.
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Anaesthesiol Reanim · Jan 1999
Randomized Controlled Trial Comparative Study Clinical Trial[Preemptive effects caused by co-analgesia with ketamine in gynecological laparotomies?].
The preemptive use of analgetics makes it possible to influence sensitization proceedings caused by a trauma. Various mechanisms are effective in central pain treatment. The NMDA receptor plays an important role. ⋯ In addition, the pain intensity showed no differences regarding an improved postoperative analgesia through the combination of analgetics with different points of contact. The intraoperative combination of ketamine and alfentanil does not lead to a reduction of postoperative pain. No preemptive analgesia is clinically provable.