Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Feb 1988
Comparative Study Clinical Trial Controlled Clinical Trial[Postoperative pain therapy by transdermal fentanyl].
Several investigations have shown that constant rate infusions of opioids are highly effective in the provision of postoperative pain relief. However, such treatment require intravenous access, the availability of infusion pumps and adequate monitoring system. We have studied a transdermal fentanyl formulation (F-TTS, developed by ALZA Corporation, Palo Alto, USA) which should avoid these problems. ⋯ Fentanyl blood concentrations increased (verum) during the 24 hours period (removal) and decreased slightly after that. At the end of the investigation (36 h) fentanyl concentration remained significantly elevated (about 60% of 24-hours value). F-TTS provided good postoperative pain relief although 11 patients (of 20) required supplemental pethidine. Patients with F-TTS, however had very little pethidine compared to patients with placebo. Two patients (one of each group) had to be eliminated from the study due to severe respiratory depression or inadequate pethidine requirement respectively. The incidence of other side effects such as nausea, vomiting and micturition difficulties were similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anasth Intensivther Notfallmed · Oct 1987
["Round the clock"--an information service for malignant hyperthermia emergencies].
A 24-hour 7-day telephone service has been created for emergency consultation: MH-hotline 030/3035504 (daytime) or 030/30351 (after office hours). In emergencies callers should ask for a consultant, indicating the code word "malignant hyperthermia" and give their name, the name of the institution and the telephone number.
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Anasth Intensivther Notfallmed · Oct 1987
Case Reports Comparative Study[Erroneous determination of arterial blood pressure depending on the site of measurement, in excessive catecholamine therapy in low cardiac output syndrome].
Five cases are presented where invasive measurement of blood pressure in the femoral or radial artery alone resulted in considerable underestimation of the systemic pressure. This underlines the need to compare measurement values obtained by an invasive method, critically with the overall clinical pattern presented by the patient and to countercheck on these data--as the case may be--by effecting appropriate measurements in other arteries as well.
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Anasth Intensivther Notfallmed · Aug 1987
Clinical Trial Controlled Clinical Trial[Behavior of adrenaline, noradrenaline, blood pressure and heart rate in intubation in relation to different doses of fentanyl].
In 24 patients undergoing ENT surgery the reactions of blood pressure, heart rate and plasma catecholamines were studied during standardized induction of anaesthesia as well as after additional fentanyl administration of 0.1 or 0.2 mg before intubation. In the control group (n = 8) six measurements were performed, i.e. one minute before and after the administration of the drugs for induction, as well as immediately after the insertion of the laryngoscope and one minute after intubation. In the reference groups two measurements were performed: before induction of anaesthesia and one minute after intubation, in the period of maximal circulatory reaction. 0.1 or 0.2 mg were administered in the fentanyl groups (n = 8 in each) after precurarization before injecting thiopentone. ⋯ The administration of 0.1 mg fentanyl proved to be insufficient to depress the sympathoadrenergic reaction during intubation. Although plasma catecholamines did not rise, a marked increase in blood pressure and heart rate could not be avoided. The difference compared to 0.2 mg fentanyl was significant in the parameters blood pressure and heart rate (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anasth Intensivther Notfallmed · Aug 1987
Case Reports[Lesion of the brachial plexus, caused by wrong positioning during surgery].
We report three patients, which showed plexus palsies after routine operations. Compression and stretch of the nerves despite pads leaded to nerve injury in patient A. ⋯ Hyperreclination of the head in semisitting position caused the lesion in patient C. The anaesthetist should know the risks of positioning to prevent nerve injuries.