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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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)
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Anasth Intensivther Notfallmed · Feb 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Intravenous regional anesthesia of the arm and foot using 0.5, 0.75 and 1.0 percent prilocaine].
Quality of anaesthesia and risk of intoxication are competing principles in IVRA. To evaluate the optimal prilocaine concentration with injection of 40 ml, 300 patients were randomly allocated to receive either a 0.5 (PRI 0.5), 0.75 (PRI 0.5) or a 1.0 (PRI 1.0) per cent solution. Using PRI 0.5, fifteen patients required supplementary fentanyl, with PRI 0.75 one, and with PRI 1.0 two (p less than or equal to 0.05). ⋯ Objective symptoms of local anaesthetic toxicity were not observed. The incidence of tourniquet-related pain was 25-30% in all three groups and not related to the prilocaine concentration. In conclusion, with 40 ml injection volume the 0.75% solution of prilocaine offers the optimal relation between incidence of anaesthesia and risk of intoxication.
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Anasth Intensivther Notfallmed · Feb 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Total intravenous anesthesia using propofol and alfentanil in comparison with balanced anesthesia in neurosurgery].
Anaesthesia for neurosurgical patients should provide haemodynamic stability, reduce cerebral metabolism, preserve cerebral autoregulation, avoid increases of intracranial pressure and guarantee rapid recovery without respiratory depression. A commonly used Balanced Anaesthesia (BA, n = 20) (thiopental and fentanyl bolus induction and maintenance with repetition boluses of fentanyl and droperidol, thiopental infusion, and isoflurane in N2O/O2) was compared to Total Intravenous Anaesthesia (TIVA, n = 20) with propofol and alfentanil infusion. Pancuronium was employed for muscle relaxation in both groups. ⋯ Quality of recovery after the procedure was determined by standardised psychometric tests. The time span between awakening of patients to orientation and concentration was significantly shorter in the TIVA group compared to the BA group. There was also a smaller deviation of these parameters in the TIVA group indicating a more predictable recovery.
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Anasth Intensivther Notfallmed · Dec 1989
Randomized Controlled Trial Comparative Study Clinical Trial[Effects of low molecular weight hydroxyethyl starch (HES 40) in comparison with Ringer solution on oxygen tension in skeletal muscles of infected patients].
Volume expansion for the establishment of normal to slightly hyperdynamic systemic circulation has become part of a standard concept in the treatment of septicemic patients. The goal is an improvement of microcirculation with beneficial effects on tissue oxygen supply. This study investigates the effect of hydroxyethyl starch solution (HES 6%: mean molecular weight = 40,000) versus ringer's solution on tissue oxygen tensions in human skeletal muscle during periods of septicemia in 10 mechanically ventilated ICU-patients. ⋯ In both groups no linear correlation between hematocrit and pO2-tensions could be established. It remains unclear if pO2-tensions during and after HES infusion can be correlated to an improved capillary perfusion. However, as was clearly demonstrated, different types of solutions used for volume expansion may exert different effects on pO2-tissue tension in septic patients.