Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Aug 1990
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial[Postoperative course and endocrine stress reaction of geriatric patients with para-articular hip fractures. Prospective randomized study comparing spinal anesthesia and halothane intubation narcosis].
During a period of one year, all patients above the age of 60 with surgical repair of fractured neck of femur were investigated in a prospectively randomized design. A follow-up study included a total number of 56 patients, 32 were allocated to halothane anaesthesia with intubation, 24 received spinal anaesthesia. In addition, 15 patients of the halothane group and 17 patients with spinal anaesthesia were investigated with regard to endocrine stress response. ⋯ Noradrenaline was markedly increased even before the operation, and concentrations increased in the halothane group in the course of the operation. There was a linear correlation to time between accident and the beginning of the operation. With regard to endocrine parameters, prompt surgical treatment is beneficial.
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Postoperative artificial ventilation by using an endotracheal tube may cause a pulmonary infection. A possibly necessary permanent sedation and relaxation may result in an additional danger for the patient. ⋯ The degree of the sedation was monitored both intraoperatively and postoperatively using an automatic EEG classification. The performance spectrum of the respiratory curve enabled very early detection of the onset of spontaneous respiration.
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Anasth Intensivther Notfallmed · Jun 1990
Comparative Study[Local anesthetic mixtures in various regional anesthesia procedures].
The use of local anaesthetic mixtures in regional anaesthesia has been discussed controversially. This assumption led us to conduct an inquiry on anaesthesiologist opinion on local anaesthetic mixtures. The study was performed on 131 anaesthesiologists answering a questionnaire. ⋯ The results of the inquiry demonstrate that the use of local anaesthetic mixtures in regional anaesthesia is common practice. However, mixing local anaesthetics may produce unpredictable interactions. We conclude that mixtures of local anaesthetics should be used only in exceptional cases.
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Anasth Intensivther Notfallmed · Apr 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Postoperative pain therapy with 1-methadone and metamizole. A randomized study within the scope of intravenous on-demand analgesia].
Methadone, a potent long-acting opioid analgesic, is only seldom prescribed for postoperative pain relief in Germany. It was the aim of the present investigation to evaluate its efficacy and to establish an adequate dose range using intravenous patient-controlled analgesia (PCA), as well as to determine possible drug interactions with the antipyretic analgesic metamizol (dipyrone). 120 patients recovering from elective major abdominal, gynaecological or orthopaedic surgery under standardized balanced anaesthesia were randomly allocated to three groups to self-administer intravenous 1-methadone. Demand doses were 0.573 mg (group LD), 1.145 mg (group HD) or 0.573 mg to which 50 mg metamizol (dipyrone) were added (group LM). ⋯ Cardiovascular and respiratory status during the observation period was always normal. 88-93% of patients preferred PCA in comparison with earlier experienced conventional postoperative pain treatment. It is concluded that patients are able to control adequate drug consumption, i.e. to avoid overdosage, by adjusting demand frequency if variable demand dosages are offered. Thus 13-19 mg 1-methadone per day can be recommended as reasonable dose range for pain relief during the early postoperative period.(ABSTRACT TRUNCATED AT 250 WORDS)