Acta anaesthesiologica Belgica
-
International guidelines developed recommendations in the resuscitation of the new-born: at least one person trained in resuscitation of the newly born should attend every delivery. A minority of the new-borns require active resuscitation to achieve regular respiration, heart rhythm above 100/min, pink colour and adequate tone. Establishment of adequate ventilation should be of primary concern. ⋯ Very few infants require chest compressions and much less administration of drugs. Umbilical access remains the most widely recommended access in new-born. Adequate transfer to Neonatal Unit improves outcome.
-
Acta Anaesthesiol Belg · Jan 2002
Randomized Controlled Trial Clinical TrialA randomized study of the efficacy and recovery of remifentanil-based and alfentanil anaesthesia with desflurane or sevoflurane for gynecological surgery.
We performed a prospective, randomized study comparing the efficacy and safety of the combination of remifentanil and the newer volatile anaesthetics desflurane and sevoflurane with a conventional anaesthetic technique using alfentanil and desflurane. Forty five ASA class I or II female patients were randomly assigned to one of three groups. Following induction with propofol patients received a continuous infusion of remifentanil in combination with either 0.5 MAC desflurane (n = 15) or sevoflurane (n = 15), a third group (n = 15) received 1 MAC of desflurane with bolus doses of alfentanil for maintenance of anaesthesia. ⋯ Recovery times were similar in all groups. The incidence of postoperative side effects was high in the three groups. No awareness occurred and patient satisfaction in the two remifentanil groups was comparable to the conventional anaesthetic technique.
-
Acta Anaesthesiol Belg · Jan 2002
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialRemifentanil vs. alfentanil for direct laryngoscopy: a randomized study comparing two total intravenous anaesthesia techniques. TIVA for direct laryngoscopy.
The ideal anaesthesia for direct laryngoscopy is profound and yet brief. The present study sought to determine whether a new anaesthetic technique based on infusion of the ultra short-acting opioid remifentanil was superior to our routine alfentanil multiple-dose technique in terms of haemodynamic stability, stress responses and recovery. A total of 58 patients were randomized to receive propofol and either remifentanil or alfentanil as part of a total intravenous anaesthesia. ⋯ In the remifentanil group, hypotension or bradycardia requiring intervention arose in 5 (18%) and 3 patients (11%); neither response was seen in the alfentanil group. The period from the end of propofol infusion until extubation was 5 min longer in the remifentanil group (P < 0.0001), whereas the time from extubation until discharge was similar in the two groups. Thus, neither technique showed sufficient haemodynamic stability, and further studies are needed to determine optimal dosages of propofol and opioid.
-
Acta Anaesthesiol Belg · Jan 2002
Review Comparative StudyPartial versus full agonists for opioid-mediated analgesia--focus on fentanyl and buprenorphine.
In contrast to other opioids, fentanyl and buprenorphine share a number of physicochemical properties that render both agents potentially suitable for transdermal delivery. However, there are significant differences between them in terms of their pharmacological profiles, as fentanyl is a full mu opioid receptor agonist capable of exerting a maximal response in certain tissues, while buprenorphine is a partial agonist unable to exert this maximum effect even at high doses. This review examines the hypothesis that partial opioid agonists would confer a number of benefits over full agonists, namely effective analgesia with a better tolerability and a lower propensity for addiction, with respect to fentanyl and buprenorphine. ⋯ Considerable data concerning buprenorphine suggest that the advantages initially espoused for partial opioid agonists are not borne out in clinical practice. Indeed, it may be postulated that full mu opioid agonists, particularly those with high selectivity and potency such as fentanyl, have a superior clinical profile and fulfill the above criteria more closely. Relative receptor binding, selectivity, potency and intrinsic efficacy of the opioids appear to be key determinants of their individual pharmacological profiles, contributing significantly to the heterogeneity of this class of analgesics.