Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 2002
[Postoperative epidural analgesia--current status, indications and management].
We are reporting on postoperative pain treatment using epidural analgesia in 1,822 patients, performed between 1995 to 2000, following continuous epidural anaesthesia combined with general anaesthesia for operations in various specialized areas (general or visceral surgery, vascular and thoraxic surgery, gynaecology, urology and orthopaedics). A total of 1,727 of these postoperative epidurals were included in a detailed evaluation. The postoperative epidural analgesia consisted of a continuous application of 0.25% bupivacain or 0.2% ropivacain. ⋯ This reveals the required puncture height. The following side-effects resulting from the epidural analgesia were found: blood pressure loss of more than 20% of the starting value (21%), temporary bladder voiding disorders (8%), temporary sensory disorders of the lower extremities (6.5%), seldom nausea (2.4%) and post-puncture headaches (1.2%). The most important prerequisites for successful postoperative epidural analgesia and thus for increased patient satisfaction are correct selection of the insertion height in relation to the planned operation, constantly available medical pain service, the inclusion of trained care personnel and unequivocal written instructions.
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Anaesthesiol Reanim · Jan 2001
Review Comparative Study[Clinical administration of muscle relaxants for intubation].
Muscle relaxants are used for tracheal intubation, surgical procedures and in the intensive care unit. This review describes muscle relaxants available in Germany, with special focus on their use in endotracheal intubation. We compare the advantages and disadvantages of succinylcholine (the only depolarising agent) with those of short- and intermediate-acting non-depolarising agents in an attempt to define the characteristics of the ideal muscle relaxant. ⋯ The advantages and disadvantages of using non-depolarising instead of depolarising agents are discussed using data from our studies and those of other research groups. Possible side-effects due to the chemical structure and the necessary dosage for intubation of different agents are also discussed. Two points are emphasized: firstly, the use of non-depolarising agents for intubation requires the possibility of safe ventilation of the patient via mask, and, secondly, it is important that procedures be performed by an experienced anaesthetist.
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Anaesthesiol Reanim · Jan 2001
Randomized Controlled Trial Comparative Study Clinical Trial[Rocuronium or vecuronium for intubation for short operations in the preschool age? Effects on time in the operating room and postoperative phase].
This prospective randomized study compares the effects of rocuronium (R) and vecuronium (V) on the early postoperative period in infants. Forty-eight infants between the ages of three and six, scheduled for elective ENT procedures, were studied after prior approval of local ethics committee and informed parental consent. All children were premedicated with chlorprotixene and belladonna. ⋯ Similarly, no differences in SaO2 were noted during the recovery period in the recovery room. Significant differences between the non-depolarizing relaxants were found in the TOF-ratios at extubation (R: 0.73 +/- 0.31 min, V: 0.48 +/- 0.34 min) and arrival in the recovery room (R: 0.88 +/- 0.21 min, V: 0.69 +/- 0.26 min). 0.4 mg/kg Rocuronium and 0.075 mg/kg vecuronium can be used for intubation during short operations on pre-school children. Rocuronium may be the better alternative, due to its faster neuromuscular recovery properties.
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Measurement of heart rate variability (HRV) in the perioperative period is not yet part of routine monitoring. Because of a lack of standardization, comparison of results of different investigations is difficult. Caution is needed in interpreting data of HRV measurements because of the complexity of autonomic control of the cardiovascular system. ⋯ Because of the ongoing progress in monitoring with regard to acquisition and computer-based analysis of HRV data, it seems at least possible to measure HRV routinely in the perioperative setting. However, the need for standardization requires large prospective and standardized trials. Depending on the results, the clinical relevance of HRV as a relatively simple and non-invasive perioperative monitoring has to be re-evaluated.
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Anaesthesiol Reanim · Jan 2001
Randomized Controlled Trial Clinical Trial[Hyperoxia-induced liberation of big-endothelin into jugular venous blood of electric neurosurgical patients].
The use of hyperoxia in emergency situations is generally accepted, but the routine and uncritical application of higher oxygen concentrations is criticized. The influence of short-term application of hyperoxia on cerebral oxygenation, cerebral lactate and BIG-endothelin (BIG-ET) was studied. After approval by the Ethics Committee of the University of Leipzig, 22 patients (hyperoxia group n = 16, normoxia, control group n = 6) undergoing an elective craniotomy were included in the study. ⋯ The changes in lactate and BIG-ET were also seen after the end of the hyperoxia. In the control group (normoxia, FiO2 0.4), no significant changes in sjO2, oxygen content, lactate and BIG-ET were observed. The increase in jugularvenous BIG-ET and the decrease in the arterio-jugularvenous difference of BIG-ET following hyperoxia indicate a higher cerebral release of BIG-ET.