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  • 1990-1994  (3)
  • Acute respiratory failure  (1)
  • Bronchodilator agents  (1)
  • Key words: Total intravenous anaesthesia: propofol, methohexitone, alfentanil – Stress response  (1)
  • Pulmonary mechanics  (1)
  • 1
    ISSN: 1432-055X
    Schlagwort(e): Schlüsselwörter: Totale intravenöse Anästhesie: Methohexital, Propofol, Alfentanil – Inhalationsanästhetikum: Isofluran – Streßreaktion: Katecholamine, Prolaktin, Kortisol, Metabolite ; Key words: Total intravenous anaesthesia: propofol, methohexitone, alfentanil – Stress response
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract. Total intravenous anaesthesia (TIVA) using a combination of a hypnotic and an analgesic agent is gaining increasing popularity as an alternative to balanced anaesthesia with volatile anaesthetics for abdominal surgery. Among the required characteristics of the drugs used in this technique are a good correlation between dose, plasma concentrations, and effect as well as rapid elimination from the circulation, allowing close control of anaesthetic depth. Two hypnotic drugs with similar pharmacokinetic and pharmacodynamic profiles are propofol and methohexitone, both of which can be employed as a component of a TIVA technique. Two TIVA combinations utilising either of these drugs with alfentanil were tested against isoflurane-nitrous oxide in a balanced regimen. Methods. Twenty-seven healthy women undergoing hysterectomy for non-malignant diseases participated in the study after having given written consent. They were randomly allocated to receive either isoflurane (Iso), methohexital-alfentanil (M-A), or propofol-alfentanil (P-A). Blood samples for determination of cortisol, prolactin, catecholamines, glucose, lactate, non-esterified fatty acids, and pharmacon concentrations were drawn repeatedly from before induction until 360 min after surgery. Anaesthesia was induced in group Iso with fentanyl 0.1 mg and M 1.5 mg⋅kg−1 and maintained with Iso-N2O. In the TIVA groups M or P was given in a two-step infusion to load peripheral compartments and then maintain plasma concentrations within the hypnotic range. A was given as a continuous infusion in an identical dose (0.1 mg⋅kg−1 initial, 0.125 mg⋅kg−1⋅h−1 maintenance) in both groups. If signs of insufficient depth of anaesthesia occurred (heart rate or systolic blood pressure 〉25% above baseline), then first A (0.5 – 1 mg), and if that was ineffective, then 50 mg hypnotic was administered. The A infusion was stopped 30 min before the end of surgery, and Iso or the hypnotic was stopped at skin closure. Recovery time was the time until the patients were able to give their birth date after stopping the Iso or hypnotic. Results. The three groups were comparable with regard to age, weight, and duration of surgery. The total doses of M and P were 1,357±125 mg (mean±SEM) and 1,315±121 mg, respectively, and the total A doses were 20.7±2.5 mg (M-A) and 23.4±3.5 (P-A). The peak plasma concentrations were P 10.6±1.5 µg⋅ml−1 and M 12.4±2.6 µg⋅ml−1. At the end of surgery the P concentrations were in the projected range while those of M were somewhat lower than expected (P3.7±0.4 µg⋅ml−1; M 3.5±0.6 µg⋅ml−1). Three patients each in the P-A and M-A groups required supplementary A injections. Five patients in the P-A group required additional bolus injections of the hypnotic as compared to 2 in the M-A group. The median recovery times were Iso 15 min, M-A 50 min, and P-A 25 min (P〈0.05). The incidence of shivering was Iso 3/9, M-A 5/9, and P-A 0/9 (P〈0.05); vomiting occurred with equal frequency in all groups (Iso 33%, M-A 33%, P-A 22%). The patients were somewhat more restless in group M-A. Systolic blood pressure dropped in a similar manner in all groups after induction of anaesthesia (Iso −31%, M-A −37%, P-A −36%) but recovered during surgery. The intraoperative response of cortisol (Iso +216%, M-A +92%, P-A +43%) and catecholamines (noradrenaline Iso +56%, M-A +30%, P-A −21%) was lower in the TIVA groups, whereas prolactin increased after induction in all groups. Plasma concentrations of glucose, lactate, and fatty acids were lower in the TIVA groups than in the Iso group intraoperatively, but increased to comparable postoperative levels. Conclusions. Both TIVA regimens are acceptable alternatives to balanced anaesthesia with Iso N2O. Both are similar with regard to haemodynamic, endocrine, and metabolic changes and are able to reduce the stress response more effectively than Iso N2O. Of the two, P seems to offer the advantage of a somewhat shorter recovery time, less shivering, and calmer patients in the immediate postoperative period, although M might be preferred if economic considerations are important.
    Notizen: Zusammenfassung. Die totale intravenöse Anästhesie (TIVA) gewinnt zunehmend an Popularität als Narkoseverfahren auch für abdominalchirurgische Eingriffe. Bei weniger traumatisierenden Eingriffen, bei denen eine absichtlich verzögerte Aufwachphase nicht erforderlich ist, bieten sich Methohexital und Propofol aufgrund ihrer Pharmakokinetik als hypnotischer Bestandteil eines solchen Anästhesieverfahrens an. In der vorliegenden randomisierten und kontrollierten Studie an 27 gesunden Frauen, bei denen eine Hysterektomie durchgeführt wurde, wurden beide Hypnotika in Kombination mit Alfentanil als Analgetikum miteinander und mit einer balanzierten Anästhesie (Isofluran-Lachgas, Fentanyl) verglichen. Als Zielparameter dienten Hämodynamik (arterieller Blutdruck, Herzfrequenz), postoperative Befindlichkeit (Übelkeit-Erbrechen, Zittern, Schmerzmittelbedarf) sowie endokrine und metabolische Streßreaktionen (Katecholamine, Kortisol, Prolaktin, Glukose, freie Fettsäuren, Laktat). Es fanden sich kaum nennenswerte Unterschiede zwischen den beiden TIVA-Verfahren, wohl aber zwischen den TIVA-Verfahren und der balanzierten Anästhesie. Der hämodynamische Verlauf war in allen Gruppen im wesentlichen gleich, aber die intraoperativen Streßreaktionen wurden durch die TIVA effektiver gedämpft. Die Aufwachzeit war nach der balanzierten Anästhesie, die Inzidenz des postoperativen Zitterns nach der Propofol-Alfentanil TIVA am geringsten. Die Häufigkeit postoperativen Erbrechens war in allen Gruppen gleich. Die Ergebnisse der Studie belegen einige Vorteile der TIVA gegenüber der balanzierten Anästhesie. Sie geben jedoch keine eindeutige Entscheidungsgrundlage für oder gegen eines der untersuchten Hypnotika.
    Materialart: Digitale Medien
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 2
    Digitale Medien
    Digitale Medien
    Springer
    Intensive care medicine 19 (1993), S. 467-471 
    ISSN: 1432-1238
    Schlagwort(e): Status asthmaticus ; Artificial respiration ; Magnesium sulfate ; Bronchodilator agents
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract In severe status asthmaticus basic medical treatment often fails to improve the patient's condition. Mechanical ventilation in this situation is associated with a high incidence of serious complications. After the bronchodilating effect of moderate-dose magnesium sulfate in asthmatic patients had been demonstrated in previous studies we treated five mechanically ventilated patients with refractory status asthmaticus successfully with high dosages of MgSO4 IV (10–20 g within 1 h depending on the bronchodilating effect). MgSO4 resulted in a significant decrease of peak airway pressure (43.0±6.8 to 32.0±8.0 cmH2O) and inspiratory flow resistance (22.7±7.0 to 11.9±6.0 cmH2O·l−1·s−1) within 1 h. The resulting serum magnesium levels after one hour were up to threefold of the normal serum levels. Although a main-tainance dose of 0.4 g/h had been administered continuously during the following 24 h serum magnesium decreased towards normal values within this time. The only relevant side-effect was a mild to moderate arterial hypotension in two of the five patients during the high dose administration period of MgSO4 which responded readily to dopamine treatment.
    Materialart: Digitale Medien
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 3
    ISSN: 1432-1238
    Schlagwort(e): Static compliance ; Pressure volume curve ; Pulmonary mechanics ; Acute respiratory failure ; Adult respiratory distress syndrome
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract A new method for determination the static compliance of the respiratory system is described (“static compliance by automated single steps”-SCASS). In 12 ventilated patients pressure/volume (P/V) curves were determined by automated repetitive occlusion (6 s) at single volume steps and compared to the conventional syringe method (SM). All measurements were corrected for effects of temperature, humidity and pressure (THP). SM was found to be significantly influenced by intrapulmonary gas exchange causing an effective mean volume deficit of 217.4±65.7 ml (BTPS) at the end of the deflation. In contrast to that, the short duration of occlusion in SCASS minimize the gas exchange effects. The methodical differences between both methods result in overestimation of the inflation compliance in the uncorrected SM (SMuncorr: 83.4±12.6; SCASS: 76.0±11.9 ml/cmH2O.p〈0.01) and underestimation of the deflation compliance resp. (SMuncorr: 58.3±7.5; SCASS: 79.1±15.0 ml/cmH2O.p〈0.005). In contrast to the P/V curves by SM no significant hysteresis was found by SCASS. Gas exchange seems to be the main reason for the hysteresis. Even after correcting gas exchange and THP effects a significant hyseresis remained. The SCASS method avoids these problems and allows furthermore an accurate checking of leaks.
    Materialart: Digitale Medien
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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