Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1996
Review[Clinical use of antiemetic drugs for prevention and therapy of postoperative nausea and vomiting].
The incidence of postoperative nausea and vomiting (PONV) has not decreased significantly for decades. This study was done to evaluate whether there is a standard method or a preferred substance in German hospitals in the prophylaxis and treatment of PONV. Twenty-one randomly selected hospitals were asked to give details about substances, doses and application times and forms in PONV prophylaxis and treatment. ⋯ Summarising, this study found no routine standard in the prophylaxis and therapy of PONV. Droperidol and metoclopramide were the most frequently used antiemetics. An overview of the antiemetics involved is given.
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As a result of more offensive therapeutic measures and the given abilities of modern medicine and the increasing number of geriatric patients who are characterized by multimorbidity, more perioperative complications, in particular those of cardiac origin, can be expected. As in any other medical discipline, the safety of anaesthesiological care of the patient very much depends on the individual professional qualification and competence of the physician. For the field of anaesthesiology it can be concluded that it is necessary to tackle the specific problems of this risk group in order to reduce the rate of complications to a minimum. ⋯ Three main symptoms--increasing oxygen uptake (as a product of pain or shivering), hypoventilation and hypoxaemia--should be avoided in the postoperative period. Therefore, respiratory insufficiency should be diagnosed without fail by respiratory monitoring. If required, artificial ventilation must be continued, with particular attention being given to circulatory effects during artificial ventilation and weaning from the ventilator.
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Anaesthesiol Reanim · Jan 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Combination of intravenous patient-controlled analgesia with epidural anesthesia for postoperative pain therapy].
The aim of this study was to prove the hypothesis that a combination of epidural anaesthesia with intravenous patient-controlled analgesia (PCA) could improve perioperative pain management. Patients of the urological department undergoing lower abdominal surgery were randomized for two different pain managements. Patients of group 1 (n = 37) were narcotized, intubated and ventilated for the operation; arriving at the recovery room, they were given a PCA-pump, the drug used was piritramide and the parameters were bolus 2.5 mg, blocking time 20 minutes and no basal infusion rate. ⋯ The benefits of better pain management contrast with the risks resulting from combining the two techniques. In our patients we found an improvement of pain management in the early postoperative period. The combination of epidural anaesthesia with intravenous patient-controlled analgesia can be regarded as a further possibility for treating postoperative pain in the sense of "balanced pain management".
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Mivacurium is a potent, short-acting, nondepolarizing relaxant of the benzylisoquinoline series. In adults endotracheal intubation can be performed after a 2 x ED95 dose of 0.15-0.2 mg/kg within 2-2.5 minutes. In infants onset time and clinical duration of mivacurium are significantly shorter than in adults. ⋯ The properties of mivacurium described above are related to patients with normal pseudocholinesterase activity. Particularly patients with atypical pseudocholinesterase show a marked increase in clinical duration. Side-effects due to significant histamine release with flush, tachycardia and hypotension are seldom observed if mivacurium is injected slowly over a period of more than 30 seconds and bolus injections of more than 2 x ED95 or 3 x ED95 are avoided.
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Anaesthesiol Reanim · Jan 1996
Case Reports[Intraosseous puncture as vascular access in pediatric emergency and intensive care medicine].
In paediatric resuscitation scenarios, emergency physicians have sufficient skills in endotracheal intubation. They are successful in about 80% of the cases as US studies indicate. However, vascular access is much more of a critical problem and emergency physicians succeed in only 50%. ⋯ Eleven patients survived who would not have done so without quick intravenous access. As complications we recorded a minor fracture, one compartment syndrome, which did not require surgical intervention, and a postmortally discovered minor fat embolism, which was of no clinical significance. Courses teaching this method should be offered in Germany to spread knowledge of this life-saving technique.