Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Apr 1988
Randomized Controlled Trial Comparative Study Clinical Trial[Endocrine reaction pattern: midazolam-fentanyl anesthesia versus inhalation anesthesia].
In a randomised controlled study in 16 orthopaedic patients, the influence of midazolam-fentanyl-N2O/O2 anesthesia (group A) resp. halothane-N2O/O2 anesthesia (group B) on the plasma concentrations of the endocrine parameters ACTH, aldosterone, cortisol, 17-DHEA, insulin, prolactin, T3, T4, TBG (thyroxine bounded globuline) as well as adrenaline, noradrenaline, and dopamine was investigated. Additionally the metabolites glucose, lactate, free glycerin, and acetacetate were measured. Beside prolactin values, only the values for ACTH, aldosterone, cortisol, and 17-DHEA differed with respect to both anesthesia methods. ⋯ The insulin secretion, however, was not significantly raised in either group during acute stress phases. As an expression of modified metabolic regulation comparable rises of plasma levels of glucose, lactate, free glycerin, and acetacetate were observed under midazolam-fentanyl-N2O/O2 anesthesia as well as under halothane-N2O/O2. According to presented data, both methods of anesthesia modulated the endocrine metabolic response of the organism to surgical stress, without showing any clinically relevant advantages or disadvantages attributable to either method.
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Anasth Intensivther Notfallmed · Apr 1988
Clinical Trial Controlled Clinical Trial[Effect of dyshemoglobinemia (methemoglobinemia and carboxyhemoglobinemia) on accuracy of measurement in pulse oximetry in operations of long duration].
In two groups - eleven patients each - who underwent long lasting surgical procedures, arterial oxygen saturation was measured non-invasively (pulse oximeter) and invasively (CO-oximeter). In addition, total haemoglobin (THb), fractions of haemoglobin (metHb) and bloodgases were monitored. All patients of group I received an epidural anaesthesia via catheter with prilocaine combined with general anaesthesia. ⋯ Because of methodological facts (the pulse oximeter registers only desoxygenated haemoglobin) the arterial oxygen desaturation (O2Hb or fractional saturation) accompanying dyshaemoglobinaemia remains undetectable to the pulse oximeter. In the cases of known or expected dyshaemoglobinaemia pulse oximetry can yield only limited information; fractions of inactive haemoglobin should be measured by other means or accounted for by the given equation for correction (SaO2 corr. = SaO2 pulse oximeter - (COHb + metHb]. Pathophysiological effects of dyshaemoglobinaemia are discussed.