Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 1986
Comparative Study Clinical Trial Controlled Clinical TrialMidazolam for intramuscular premedication: dose-effect relationships compared to diazepam, fentanyl and fentanyl-droperidol in a placebo controlled study.
The clinical effects of midazolam (7.5, 10 and 15 mg), diazepam 10 mg, fentanyl 0.1 mg and fentanyl 0.1 mg-droperidol 5 mg, administered intramuscularly for surgical premedication, were compared in a double-blind placebo-controlled study. The degree of sedation provided by midazolam was significantly superior to diazepam, fentanyl or placebo. The largest dose of midazolam also impaired the lucidity of the patients and induced a moderate degree of muscular hypotony. ⋯ However, if expressed as percentage change, the greatest decrease occurred in the midazolam 15 mg group compared to all other treatments. Midazolam appeared to be a more effective premedicant than diazepam, analgesics or placebo. The intensity of the combined central nervous system effects suggested the dose of 10 mg might be the most suitable for intramuscular premedication.
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Acta Anaesthesiol Belg · Jan 1986
Modification of corticosteroid synthesis by etomidate/fentanyl and air anesthesia.
The characteristics of cortisol synthesis blockade by an etomidate/fentanyl combination was explored in a group of seven patients undergoing major abdominal vascular surgery. Cortisol, androstene-dione 11-deoxy cortisol (compound S) and ACTH were measured during surgery for three hours. In the fourth hour an ACTH1-24 stimulation test was performed and the reaction of the corticosteroid synthesis was assessed. ⋯ These results indicate that the infusion of etomidate and fentanyl may cause a blockade of the corticosteroid synthesis. The blockade is situated at the place where the conversion of cholesterol to pregnenolone occurs. Because the study was done in clinical setting the results should be interpreted carefully, and confirmed by experimental laboratory results.
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Acta Anaesthesiol Belg · Jan 1986
Patient-controlled analgesia with piritramid for the treatment of postoperative pain.
Patient-controlled analgesia (PCA, intravenous self-application of narcotics) was studied during the early postoperative period. Subjects were 40 ASA I-III patients recovering from elective major and minor surgery (20 each having undergone abdominal or orthopedic operations). Whenever the patients required pain relief, piritramid demand doses of 2.0 mg were given via the hand-button of a microprocessor-controlled injection pump (On-Demand Analgesia Computer, ODAC). ⋯ Side effects (sweating, nausea, emesis) occurred in about 20% but were usually of minor intensity. No serious circulatory or respiratory problems were observed during the PCA period. Patient-controlled analgesia is discussed as a promising concept for the treatment of acute pain and for clinical pain research.
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Acta Anaesthesiol Belg · Jan 1986
Randomized Controlled Trial Clinical TrialEfficacy of lorazepam and lormetazepam as intravenous premedicants for anesthesia and surgery.
Lorazepam 4 mg and lormetazepam 2 mg were compared as intravenous premedicants by assessing their effects on the level of consciousness and anxiety, sensory and motor functions, neuromuscular function and vital parameters in sixty surgical patients in a randomized study. Lormetazepam exerted a marked sedative-hypnotic effect maximal at 10 min. Lorazepam had a slower onset of action with a peak effect at 40 min on the different neurobehavioral functions but seemed to induce a longer duration of sedation and a more consistently obtunded awareness of perisurgical events than lormetazepam. ⋯ All hemodynamic changes remained clinically acceptable in both groups and no side effects were seen. The clinical anesthesiologists rated the quality of premedication as unsatisfactory in 7% of the patients treated with lorazepam and in 27% of those receiving lormetazepam. Together with its milder neurobehavioral effects and highly effective anxiolytic action, these factors favor the use of lorazepam for anesthetic premedication despite a relatively slow onset of action.
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Acta Anaesthesiol Belg · Dec 1985
Randomized Controlled Trial Comparative Study Clinical TrialA hemodynamic study of epidural versus intravenous anesthesia for aortofemoral bypass surgery.
The hemodynamic effects of two types of anesthesia on aortofemoral bypass surgery were studied in a randomised prospective trial. Epidural anesthesia supplemented with nitrous oxide (group I) and total intravenous anesthesia combining fentanyl and a continuous infusion of etomidate (group II) were compared. A high incidence of preoperative disease was found and all 18 patients were classified in ASA classes III-IV. ⋯ Cardiac work was higher in the intravenous group due to the high impedance of the cardiovascular system provoked by the absence of vasodilatory properties with this type of intravenous anesthesia. Monitoring of PWP and CI by Swan-Ganz catheter is shown to be very useful for optimalization of hemodynamics and fluid management especially during crossclamping, when normal Frank-Starling relationships might not be valid anymore. The effect of vasodilatory treatment, crossclamping and declamping could be carefully evaluated.