Anaesthesiologie und Reanimation
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The routine use of nitrous oxide as a component of the carrier gas has been unanimously called into question in recent surveys, in fact, its use is now recommended in indicated cases only. Whereas a lot of contraindications are listed in the surveys, precise definitions of justified indications are not given. In clinical routine practice, there are absolutely no problems in carrying out inhalational anaesthesia without nitrous oxide. ⋯ Furthermore, these calculations disregard the cost of the technical maintenance fo the central gas piping system and of the regular measurement of workplace contamination with nitrous oxide by a certified institute, which in Germany, ad least, is obligatory. The additional costs of nitrous oxide-free inhalational anaesthesia seem to be balanced by the savings. Given the numerous justified arguments against the routine use of nitrous oxide, the lack of precisely-defined indications and the clinical experience showing that doing without nitrous oxide is uncomplicated, self-financing and ecologically beneficial, the use of nitrous oxide should be given up completely.
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Anaesthesiol Reanim · Jan 2000
Randomized Controlled Trial Comparative Study Clinical Trial[Effects of sevoflurane versus propofol on oculocardiac reflex--a comparative study in 180 children].
Oculocardial reflex (OCR) occurs particularly through manipulation of the medial rectus muscle and results in a bradycardic arrhythmia. In children the incidence is between 60 and 80%. After using sevoflurane in clinical practice, the absence or non-occurrence of this reflex was observed. ⋯ Under sevoflurane the occurrence of the reflex was significantly (p < 0.05) reduced to 14% of all patients as compared to 75% in patients who received a propofol infusion. Sufficient reflex reduction according to the depth of narcosis under sevoflurane in combination with the sympathomimetic effects of this drug could therefore be discussed as a reason for its positive effects. In our opinion, the use of sevoflurane should be considered as an option for general anaesthesia in strabismus surgery.
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Anaesthesiol Reanim · Jan 2000
Comparative Study[Continuous recording of cardiac output volume with the OptiQ system--experiences with clinical application].
This report discusses initial experiences with the clinical application of continuous cardiac output measurement (OptiQ SvO2/CCO-System). The system was used in 9 intensive care patients suffering either global cardiac insufficiency or systemic inflammatory response syndrome. Continuous cardiac output measurement was recorded during a period of stable blood pressure conditions and compared with the results of the conventional thermodilution method (bolus technique) in these patients. ⋯ After a period of two days, the costs of the conventional bolus technique significantly exceeded those of continuous measurement. The expenses for the conventional thermodilution technique are largely determined by the frequency of application and, hence, by the personnel and laboratory costs. In our experience, easy component handling and stable measuring properties make this new method of continuous cardiac output monitoring a valuable method in the diagnose and care of patients who are critically ill.
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Anaesthesiol Reanim · Jan 2000
Historical Article[25 years "Anesthesiology and Reanimation"--a historical review].
The 25th anniversary of the foundation of the journal "Anaesthesiology und Reanimation" seems to be a good occasion, first of all, to look back at the special situation regarding the opportunities open to East German anaesthetists for publishing anaesthesiological papers before and after the Berlin Wall was built and then to give a review of the history of this journal. As the author's own publication list shows, East Germans could publish papers in West German journals without any problems before a major reform of the universities, bringing drastic changes, was introduced in East Germany in 1969. It became practically impossible to publish papers in West German journals because the "Directorates of International Relations", which had been installed at all universities in 1969, supervised the entire correspondence with persons and institutions in all foreign countries, in particular West Germany, the other West European countries and the countries of North and South America. ⋯ The next problem was that the publisher "VEB Verlag Volk und Gesundheit", Berlin and "Verlag Gesundheit GmbH", Berlin respectively ceased to exist in 1992 and we had to look for another publisher. We were very happy that "Selecta Verlagsgesellschaft mbH", Munich, later Wiesbaden, was interested in this journal and took it on in the same year and has now published it since that time with a circulation of 1,000 copies. The chequered history of "Anaesthesiology und Reanimation", the subtitle of which has been changed to "Journal of Anaesthesiology, Intensive Therapy, Emergency Medicine and Pain Therapy" in 1991, clearly shows, on the one hand, the difficult political circumstances under which the development of anaesthesiology took place in East Germany, and demonstrates, on the other, the special problems of the foundation of a medical journal under socialist conditions with which the editorial board in general and the editor-in-chief in particular were confronted and how they tried to overcome the
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Anaesthesiol Reanim · Jan 2000
[Exposure of anesthetists to sevoflurane and nitrous oxide during inhalation anesthesia induction in pediatric anesthesia].
Inhalational mask induction with nitrous oxide and sevoflurane in young children is an appropriate alternative to intravenous induction and is considered safe and of rapid onset. Disadvantages of this technique are environmental pollution and occupational exposure to the inhalation agents used. Moreover, the potential health hazards are not yet completely clear. ⋯ Nonetheless, applicable German health law regulations were never infringed. The trace concentrations measured during inhalational mask induction and maintenance of anaesthesia were very low. With regard to modern workplace laws and health care regulations, gaseous induction in paediatric anaesthesia does not threaten the personnel's health.