Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Aug 1988
Randomized Controlled Trial Comparative Study Clinical Trial[Methohexital/alfentanil-thiopental/alfentanil for total intravenous anesthesia for direct laryngoscopy with 100% O2 jet ventilation].
For the direct laryngoscopy and microscopic examination of the larynx with exploratory excision and pulpectomy using low frequency jet-ventilation with 100% oxygen we used total intravenous anaesthesia with a strong acting opioid and a barbiturate. Because the achievement of sufficient reflexes and a high degree of vigilance postoperatively are to be aimed, Methohexitone (M) and Thiopentone (T) were investigated in the regard of the suppression of vigilance in the postoperative period. 40 patients were randomly assigned to the group M (n = 20) or T (n = 20). The evening before operation, an intelligence test and a syndrome-short-test (SST) were performed for the measurement of attention and memory (functional psychosis). ⋯ The following parameters were measured: Blood pressure, heart rate, duration of operation and anaesthesia, parameters of vigilance 30, 60 and 120 minutes after operation (SST) and the ability of performance. The groups were comparable with respect to all data except the parameters of vigilance. The patients receiving M were significantly more vigilant 30 min., 60 min. (SST) and 120 min (SST) after the end of anaesthesia than patients receiving T (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anasth Intensivther Notfallmed · Aug 1988
[The reliability of pulse oximetry monitoring of arterial oxygen saturation in centrally intubated and hypothermic patients].
The present study tests the effectiveness of pulse oximetric measurement in attaining reliable saturation values even in patients with hypothermia and centralization. 20 patients who had all required endoprosthetic surgery of the lower extremities were included in the study. During the process of removing 98 samples for arterial blood-gas analysis, pulse oximetric saturation, heart rate (pulse oximeter and ECG), rectal temperature, peripheral temperature at the back of the fingers, arterial pressure (catheter) and central venous pressure were registered. The results can be summarized as follows: 1. ⋯ In the area examined, the reliability of pulse oximetric measurement is influenced neither by blood pressure fluctuations nor by intravascular hypo- or hypervolemia. 4. There is merely a sharp increase in the Pulsoximeter when the temperature decreases. The Pulsoximeter still indicates the correct saturation as long as the peripheral pulse rate corresponds to the heart rate on the ECG Monitor.
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Anasth Intensivther Notfallmed · Jun 1988
[Effect of flumazenil on global cerebral blood flow and on intracranial pressure in the reperfusion phase following incomplete global cerebral ischemia].
Sedation with benzodiazepines in intensive care patients with head injuries has become part of a standard concept in controlling intracranial pressure (ICP) and metabolic demands of an injured brain. The specific benzodiazepine antagonist flumazenil, which is supposed to exert no direct effect on cerebral blood flow (CBF) in healthy volunteers, suggests that rapid reversal from midazolam sedation might be achieved without any deleterious side effects. It remains however ambiguous if the same holds true in subjects with head trauma. ⋯ Within 60 sec after application of the antagonist an increase of CBF by 30-165% and of ICP by 25-310% was noted in 5 goats. Simultaneous changes in arterial pressure, CBF and ICP suggest a severe impact of the benzodiazepine antagonist after midazolam sedation on ICP and CBF during periods of impaired cerebral autoregulation. Until the cerebrovascular and cerebral metabolic effects of flumazenil have been elaborated in detail, it is recommended to titrate the effect of flumazenil over long intervals in head injured patients.
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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.