Early recovery after remifentanil-pronounced compared with propofol-pronounced total intravenous anaesthesia for short painful procedures.

Background: We compared recovery from high-dose propofol/low-dose remifentanil ('propofol-pronounced') compared with high-dose remifentanil/low-dose propofol ('remifentanil-pronounced') anaesthesia.

Methods: Adult patients having panendoscopy, microlaryngoscopy, or tonsillectomy were randomly assigned to receive either propofol-pronounced (propofol 100 microg x kg(-1) min(-1); remifentanil 0.15 microg x kg(-1) min(-1)) or remifentanil-pronounced (propofol 50 microg x kg(-1) min(-1); remifentanil 0.

Small-dose S(+)-ketamine reduces postoperative pain when applied with ropivacaine in epidural anesthesia for total knee arthroplasty.

Unlabelled: Reduction of nociceptive input through blockade of N-methyl-D-aspartate (NMDA) receptors has been reported. We compared the effects of epidural S(+)-ketamine versus placebo on postoperative pain in a randomized, double-blinded study in 37 patients undergoing unilateral knee arthroplasty. After lumbar epidural anesthesia with ropivacaine (10 mg/mL, 10-20 mL), 19 patients received 0.

Preanesthetic train-of-four fade predicts the atracurium requirement of myasthenia gravis patients.

Background: The most sensitive diagnostic criterion of myasthenia gravis is a decrement in the muscular response to repetitive stimulation. The authors hypothesized that myasthenia gravis patients who show a train-of-four ratio (T4/T1) < 0.9 in the preanesthetic period will have increased sensitivity to nondepolarizing neuromuscular blocking agents compared with myasthenia gravis patients with preanesthetic T4/T1 > or = 0.

[Neuromuscular recovery following mivacurium is predictable in patients with severe systemic disease prognoses].

Objectives: Fast recovery from mivacurium-induced neuromuscular blockade is impaired in patients with decreased plasma cholinesterase activity which is often associated with dysfunction of different organs. Nevertheless, predictability of neuromuscular recovery may be given. Thus, this study evaluates parameters to predict individual neuromuscular recovery in patients with uncommon diseases.

[Visceral resorption of intra-abdominal insufflated carbon dioxide in swine].

Objectives: Total intraperitoneal carbon dioxide (CO2) resorption from CO2-pneumoperitoneum increases in relation to intraabdominal pressure (IAP) up to an upper limit of 10 to 15 mmHg. The purpose of this prospective study was to evaluate the visceral fraction of CO2 resorption in comparison to total intraperitoneal CO2 resorption in pigs to address possible reasons for this upper limit.

Methods: 16 pigs were chronically instrumented.

Effects of intraabdominally insufflated carbon dioxide and elevated intraabdominal pressure on splanchnic circulation: an experimental study in pigs.

Background: Intraabdominally insufflated carbon dioxide (CO2) during laparoscopy may have a specific effect on splanchnic circulation that may be unrelated to the effects of increased intraabdominal pressure alone. Therefore, the influences of insufflation with CO2 versus air on splanchnic circulation were compared.

Methods: Pigs were chronically instrumented for continuous recording of mesenteric artery, portal venous, inferior vena cava, and pulmonary arterial blood flow and portal venous pressure.

[Neuromuscular and cardiovascular effect of mivacurium in anesthesia induction in patients with renal failure].

Objective: Mivacurium produces a prolonged neuromuscular block (NMB) in anuric patients (13), in spite of its rapid hydrolysis by pseudocholinesterase (PChE) which is independent of renal function (17). In the present study the pharmacodynamics and the cardiovascular effects of a bolus dose of mivacurium (0.15 mg/kg) in relation to impairment of renal function were evaluated.

Effect of renal function on neuromuscular block induced by continuous infusion of mivacurium.

We have studied the effect of renal function on the pharmacodynamics of mivacurium. Sixty patients were allocated to three groups according to creatinine clearance: group C (control), creatinine clearance > 50 ml min-1; group P (preterminal renal failure), creatinine clearance < 50 ml min-1 > 20 ml min-1; group T(terminal renal failure), creatinine clearance < 20 ml min-1. Neuromuscular transmission (train-of-four) was monitored using electromyography from the hypothenar muscle with stimulation of the ulnar nerve.

[Effect of capnoperitoneum on postoperative carbon dioxide homeostasis].

After laparoscopic cholecystectomy, carbon dioxide (CO2) must be exhaled after resorption from the abdominal cavity. There is controversy about the amount and relevance of postoperative CO2 resorption. Without continuous postoperative monitoring, after laparoscopic cholecystectomy a certain risk may consist in unnoticed hypercapnia due to CO2 resorption.

[Dose-response relationship of atracurium in underweight, normal and overweight patients].

Objective: In patients with extreme stature or build, estimation of individual dosage requirements of muscle relaxants by body weight is unreliable. To define a more precise guideline for dosage of atracurium in clinical practice we compared in this prospective study in patients with a wide range of body weights the cumulative effective dose for a 95% twitch depression (ED95), the dosage necessary to maintain a 95% twitch depression (DD95) and the recovery from a 95% neuromuscular block with simple demographic data such as body weight, body size, body surface area and lean body mass (LBM).

Methods: 30 patients were divided into three groups according to the individual body weight: underweight, normal, overweight.

[Comparative study of the recovery phase. Laparoscopic cholecystectomy following isoflurane, methohexital and propofol anesthesia].

Total intravenous anaesthesia (TIVA) is increasingly used in short-stay surgery such as laparoscopic cholecystectomy. TIVA may provide fast recovery of psychomotor function, thus being of benefit to both the patient's behaviour and postoperative management. The purpose of this prospective study was to compare postoperative recovery from TIVA using propofol or methohexitone as the hypnotic component and balanced anaesthesia with isoflurane.

[The resorption of carbon dioxide from the pneumoperitoneum in laparoscopic cholecystectomy].

Laparoscopic cholecystectomy is claimed to be a minimally invasive procedure, but uptake of carbon dioxide (CO2) from the pneumoperitoneum (CO2-PP) can cause clinically relevant hypercapnia. In this prospective study, CO2 resorption during laparoscopic cholecystectomy was investigated. METHODS.

[Anesthesia for renal transplantation: continuous neuromuscular blockade with atracurium and the management of intraoperative hypertension with nifedipine].

Patients undergoing kidney transplantation often suffer from essential hypertension and coronary artery disease, for which perioperative treatment with nifedipine proved to be effective. If calcium-channel blockers and nondepolarizing muscle relaxants are used simultaneously, their synergistic effect at the neuromuscular cleft must be considered. On the other hand because of its extrarenal elimination no significantly altered effects are expected for patients with terminal renal failure.

[Blood coagulation and fibrinolysis in prostate surgery].

In 23 patients undergoing transurethral resection of the prostate (n = 11) or suprapubic prostatectomy (n = 12), hemostasis and fibrinolysis were studied. In addition to basic coagulation tests, antithrombin III, plasminogen, antiplasmin and fibrin degradation products were determined preoperatively, intra-operatively and postoperatively over a period of 6 days. Evaluation of the results revealed slightly activated blood coagulation and fibrinolysis intraoperatively and postoperatively, with no significant differences being seen between the two groups.

[Nifedipine prolongs a neuromuscular blockade caused by atracurium].

Calcium entry blockers are now widely employed in the treatment of cardiovascular diseases and perioperative hypertension. In patients with coronary heart disease nifedipine therapy should be continued perioperatively to avoid coronary artery spasm. Animal experiments have demonstrated that calcium entry blockers potentiate the neuromuscular blockade induced by nondepolarizing blocking agents.

[Anesthesia in a patient with congenital nemaline type myopathy].

We report a 28-year-old female with known nemaline myopathy who underwent general anesthesia for osteosynthesis of a femoral neck fracture. Preoperative investigations including blood count, urea, serum electrolytes, prothrombin time, partial thromboplastin time, and electrocardiogram were all normal. Pulmonary function studies showed a restrictive defect with normal blood gases.

[Coagulation changes during aortofemoral bifurcation bypass: is volume and plasma substitution possible with hydroxyethyl starch alone?].

The study explored the possibility of eliminating the need for plasma replacement with expensive human albumin (HA) and fresh frozen plasma (FFP) and instead using hydroxyethyl starch (HES). Patients undergoing infrarenal aortofemoral bifurcation grafting were randomly assigned to one group, which received FFP and HA, or another group, which received HES as volume replacement. Blood specimens were collected at five time intervals: preoperatively, prior to cross-clamping of the aorta, prior to declamping, at the end of the operation, and 6 h postoperatively.

[Potentiation of nondepolarizing muscle relaxants by nifedipine iv in inhalation anesthesia].

Calcium entry blockers are now widely used in the treatment of cardiovascular diseases. Nifedipine is established for the treatment of perioperative hypertension during anesthesia. Previous animal experiments have demonstrated that calcium entry blockers potentiate the neuromuscular response induced by nondepolarizing blocking drugs.

[Pericardial tamponade following extraction of a pacemaker electrode].

A case of pericardial tamponade in a male patient secondary to the removal of an epicardial pacemaker wire is reported, resulting in rapid circulatory deterioration. Sternotomy with subsequent pericardectomy immediately relieved the compression of the heart. The postoperative period was complicated by a cerebral infarction on the third postoperative day, probably caused by cardiac embolism while the role of intraoperative hypotension is uncertain.

[Traumatology of the midface--diagnostic and therapeutic guidelines for the practicing ENT physician from the viewpoint of the anesthesiologist].

Maxillofacial injuries are often seen in patients with multiple injury. The principal problem is control of the airway and treatment of shock. Surgical procedure and anaesthetic management have to consider the priority of stabilization of vital functions.

[Anesthesia in craniofacial interventions in childhood].

Nine children with severe craniofacial malformations underwent eleven major reconstructive craniofacial osteotomies; in two children, cranio-orbito-facial reconstructions were performed. Anaesthesia lasted from seven to eleven hours. The anaesthetic technique consisted of inhalation anaesthetics and supplementation with narcotics.

[Experiences and impressions of patients in an surgical-trauma intensive care unit].

Within the framework of a retrospective study performed by the Department of Anaesthesiology at Munich Technical University, 150 polytraumatized patients admitted to the intensive-care unit between 1976 and 1978 were questioned as to experiences and general impressions during their stay in the unit. The data obtained in this manner were recorded and systematically analysed. The average period of time between initial treatment and follow-up examination was 5 years.

[Fat emulsions in parenteral feeding. Clinical experience with multiple injury patients].

Serious injury and functional disturbances following multiple trauma make long-term parenteral nutrition necessary. Due to the significance of fats as a major source of energy and provider of essential fatty acids, parenteral fat emulsions are indicated in the treatment of severely injured patients. As soon as the excessive, trauma-induced metabolic derangement begins to subside, parenteral nutrition can be initiated.