Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Oct 1988
Randomized Controlled Trial Comparative Study Clinical Trial[The effect of atropine, fentanyl and alfentanyl on cardiocirculatory parameters and thoracic rigidity in the induction phase of intubation anesthesia].
Fentanyl and alfentanil may cause bradycardia if used in combination with succinylcholine during induction of anaesthesia. We therefore studied the influence of atropine, fentanyl and alfentanil on the haemodynamics of 90 urological patients (ASA I, II), who were allocated at random to six groups containing 15 patients each. Induction of anaesthesia was carried out using atropine 0.01 mg/kg-1, fentanyl 0.15 mg or alfentanil 1.5 mg depending on the assigned group: I atropine + fentanyl, II: atropine + alfentanil, III: fentanyl, IV: alfentanil, V: control (no atropine, no analgetic), VI: atropine. ⋯ Arrhythmias occurred in the groups with atropine in 4 out of 45 cases, while a chest wall rigidity was not influenced by atropine. Bradycardia occurred after fentanyl or alfentanil with atropine in the same frequency as without atropine. According to our results the routine use of atropine for induction of anaesthesia with thiopentone/fentanyl or alfentanil even in combination with succinylcholine is not required in ASA I or II patients.
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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 · 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 · Jun 1986
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of volume substitutes 5 percent human albumin and 6 percent hydroxyethyl starch (40,000/0.5) in pediatric anesthesia].
Human albumin 5% (HA), frequently used in paediatric anaesthesia as a human plasma substitute, could be replaced by hydroxyethyl starch 6% (HES) 40,000/0.5 provided its use would not entail any disadvantages but rather advantages instead. This problem was studied by examining 30 children (mean body weight 32.5 kg) in general anaesthesia. During about 3 hours of surgery the patients lost up to 15 per cent (approx. 400 ml) of blood volume. ⋯ Serum [Na+] was reduced in those children who had been treated with HES, to 137.33 +/- 33.30 mmol/l; however, in those children who received HA with low sodium content (statistically significant difference = s.s.) the corresponding level was 134.15 +/- 2.36 mmol/l. Serum creatinine rose in each case from 60 to 80 mmol/l (s.s.), renal function being slightly impaired probably due to the anaesthesia and surgery. The value according to Quick's test and the partial thromboplastin time (PTT) remained in the normal range both with HA and HES treatment (in each case over 70% and below 25s, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anasth Intensivther Notfallmed · Apr 1985
Randomized Controlled Trial Comparative Study Clinical Trial[Circulatory effects of vecuronium as well as pancuronium under different conditions of anesthesia].
The cardiovascular effects of equipotent doses (1,25 X ED95) of vecuronium (70 micrograms/kg iv) and pancuronium (80 micrograms/kg iv) were studied in 16 patients scheduled for elective coronary artery bypass surgery during steady-state conditions of isoflurane (0,4-0,5 vol% end-tidal)-nitrous oxide anaesthesia. All patients were chronically treated with oral beta receptor-blocking agents. Vecuronium did not cause any significant cardiovascular changes whereas pancuronium produced increases in heart rate (13%), cardiac index (15%) and mean arterial pressure (4%) while systemic vascular resistance decreased (8%). ⋯ The administration of pancuronium (80 micrograms/kg) caused the greatest percentage increases in HR (20%), CI (22%), MAP (8%) and RPP (31%) in this group of patients. In contrast, patients (n = 8) anaesthetized with isoflurane-nitrous oxide who were not on preoperative beta-receptor blocker medication, demonstrated higher haemodynamic control values and less increases in HR (10%), CI (10%) and RPP (15%), MAP did not change. The clinical significance of these findings is discussed.