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  • 1
    ISSN: 1432-1041
    Keywords: Intraocular pressure, Alfentanil pretreatment ; suxamethonium, thiopentone
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The effects of pretreatment with alfentanil on intraocular pressure (IOP) were investigated in 40 patients undergoing ophthalmic surgery. Patients were randomly allocated to two study groups. Group 1 patients (n=20) received alfentanil 15 μg · kg−1, vecuronium 0.01 mg · kg−1, thiopentone 3-4 mg · kg−1, and suxamethonium 1 mg · kg−1 for anaesthetic induction, whereas patients in group 2 (n = 20) received vecuronium 0.01 mg · kg−1, thiopentone 3–4 mg · kg−1, and suxamethonium 1 mg · kg−1. A total of seven measurements of intraocular pressure were taken in each patient, starting before premedication and ending after extubation of the trachea. In group 2 patients, there was an increase in IOP after endotracheal incubation. In group 1 patients, a decrease in IOP occurred which was related to the decrease in arterial blood pressure. We conclude that alfentanil pretreatment can prevent the increase in IOP following suxamethonium administration.
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  • 2
    ISSN: 1432-1041
    Keywords: Propofol ; Sevoflurane ; Anaesthesia ; recovery ; outpatient
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract The aim of the study was to compare recovery characteristics in adult patients following general anaesthesia either with the new investigational volatile agent sevoflurane or with propofol. Accordingly, two groups of 25 adults undergoing outpatient surgery were entered into a prospective, randomised study. Patients who received sevoflurane were extubated at an earlier stage than those receiving propofol (6.6 vs. 9.8 min), and the times to eye opening (7.2 vs. 12.6 min) and hand squeezing (8.2 vs 13.8 min) were also shorter. As measured by the digit-symbol substitution test, patients regained the pre-operative level of cognitive function significantly earlier after sevoflurane anaesthesia. Modified Aldrete scores were also higher in this group within the first hour after anaesthesia than in the propofol group. Sevoflurane appears to be a useful alternative to propofol in outpatient anaesthesia.
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  • 3
    ISSN: 1432-1238
    Keywords: Central venous catheter ; Bacterial colonization ; Antimicrobial coating ; Teicoplanin ; Catheter-related infection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective Antibioticcoated intravascular catheters may be an effective means of decreasing bacterial colonization and subsequent catheter-related infection. The present study was designed to investigate the retention of the antibiotic teicoplanin on a hydromer-coated intravenous catheter and the effect of this antibiotic coating on catheter bacterial colonization. Design A prospective, randomized pilot study. Setting Operating rooms (ORs) and an intensive care unit (ICU) at a university hospital. Patients A consecutive group of 20 male patients undergoing major abdominal surgery. Interventions Control (C,n=10) or teicoplanin-coated (T;n=10) single-lumen central venous catheters were inserted before surgery in the OR. Catheters were withdrawn at the discretion of the physicians in the ICU after various periods. Measurements The teicoplanin content of the catheter material was assessed using a bioassay withBacillus subtilis after complete elution of the antibiotic from the catheter. Bacterial colonization was measured using a quanitative culture technique after the catheter lumen had been flushed and the catheter segments sonicated. Main results Nearly three-quarters of the initial teicoplanin coating (374±103 μg; mean±SD) were released during the first day of catheterization, and after 36 h of intravenous catheterization, no antibiotic was retained on the catheter. No significant difference could be found either in the incidence of bacterial colonization between test (n=3) and control (n=4) catheters or in the number of colony-forming units (CFU) on the catheter segments (T, 263±104 CFU/cm; C, 372±294 CFU/cm; mean±SEM). Conclusion The retention of teicoplanin antibiotic coating on hydromer catheters is only short term if catheters are inserted intravenously. This may limit clinical antibacterial efficacy.
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  • 4
    ISSN: 1432-1238
    Keywords: Weaning CPAP ; BiPAP ; Extravascular lung water ; Cardiac surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate the effects of continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) on extravascular lung water during weaning from mechanical ventilation in patients following coronary artery bypass grafting. Design Prospective, randomized clinical study. Setting Intensive care unit at a university hospital. Patients Seventy-five patients following coronary artery bypass grafting. Interventions After extubation of the trachea, patients were treated for 30 min with CPAP via face mask (n=25), with nasal BiPAP (n=25), or with oxygen administration via nasal cannula combined with routine chest physiotherapy (RCP) for 10 min (n=25). Measurements and results Extravascular lung water (EVLW), pulmonary blood volume index (PBVI) and cardiac index (CI) were obtained during mechanical ventilation (T1), T-piece breathing (T2), interventions (T3), spontaneous breathing 60 min (T4) and 90 min (T5) after extubation of the trachea using a combined dye-thermal dilution method. Changing from mechanical ventilation to T-piece breathing did not show any significant differences in EVLW between the three groups, but a significant increase in PBVI from 155±5 ml/m2 to 170±4 ml/m2 could be observed in all groups (p〈0.05). After extubation of the trachea and treatment with BiPAP, PBVI decreased significantly to 134±6 ml/m2 (p〈0.05). After treatment with CPAP or BiPAP, EVLW did not change significantly in these groups (5.5±0.3 ml/kg vs 5.0±0.4 ml/kg and 5.1±0.4 ml/kg vs 5.7±0.4 ml/kg). In the RCP-treated group, however, EVLW increased significantly from 5.8±0.3 ml/kg to 7.1±0.4 ml/kg (p〈0.05). Sixty and 90 min after extubation, EVLW stayed at a significantly higher level in the RCP-treated group (7.5±0.5 ml/kg and 7.4±0.5 ml/kg) than in the CPAP-(5.6±0.3 ml/kg and 5.9±0.4 ml/kg). No significant differences in CI could be observed within the three groups during the time period from mechanical ventilation to 90 min after extubation of the trachea. Conclusions Mask CPAP and nasal BiPAP after extubation of the trachea prevent the increase in extravascular lung water during weaning from mechanical ventilation. This effect is seen for at least 1 h after the discontinuation of CPAP or BiPAP treatment. Fuether studies have to evaluate the clinical relavance of this phenomenon.
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  • 5
    ISSN: 1432-1238
    Keywords: Key words Thermodilution cardiac output ; Continuous monitoring ; Postoperative intensive care ; Extubation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Commercially available semi-continuous cardiac output (SCCO) monitoring systems are based on the pulsed warm thermodilution technique. There is evidence that SCCO fails to correlate with standard intermittent bolus cardiac output (ICO) in clinical situations with thermal instability in the pulmonary artery. Furthermore, ventilation may potentially influence thermodilution measurements by enhanced respiratory variations in pulmonary artery blood temperature and by cyclic changes in venous return. Therefore, we evaluated the correlation, accuracy and precision of SCCO versus ICO measurements before and after extubation. Design: Prospective cohort study. Setting: Intensive care unit (ICU) of a university hospital. Patients and participants: 22 cardiac surgical ICU patients. Interventions: None. Measurements and results: SCCO and ICO data were obtained at nine postoperative time points while the patients were on controlled mechanical ventilation. Further sets of measurements were taken during the weaning phase 20 min before extubation, and 5 min, 20 min and 1 h after extubation. SCCO and ICO measurements yielded 286 data pairs with a range of 1.8–9.9 l/min for SCCO and 1.9–9.8 l/min for ICO. The correlation between SCCO and ICO was highly significant (r=0.92; p〈0.01), accompanied by a bias of –0.052 l/min and a precision of 0.56 l/min. Correlation, accuracy and precision were not influenced by the mode of respiration. Conclusions: Our results demonstrate excellent correlation, accuracy and precision between SCCO and ICO measurements in postoperative cardiac surgical ICU patients. We conclude that SCCO monitoring offers a reliable clinical method of cardiac output monitoring in ICU patients following cardiac surgery.
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  • 6
    ISSN: 1432-1238
    Keywords: Key words Central venous catheter ; Bacterial colonization ; Antimicrobial coating ; Teicoplanin ; Catheter-related infection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Antibiotic-coated intravascular catheters may be an effective means of decreasing bacterial colonization and subsequent catheter-related infection. The present study was designed to investigate the retention of the antibiotic teicoplanin on a hydromer-coated intravenous catheter and the effect of this antibiotic coating on catheter bacterial colonization. Design: A prospective, randomized pilot study. Setting: Operating rooms (ORs) and an intensive care unit (ICU) at a university hospital. Patients: A consecutive group of 20 male patients undergoing major abdominal surgery. Interventions: Control (C, n=10) or teicoplanin-coated (T; n=10) single-lumen central venous catheters were inserted before surgery in the OR. Catheters were withdrawn at the discretion of the physicians in the ICU after various periods. Measurements: The teicoplanin content of the catheter material was assessed using a bioassay with Bacillus subtilis after complete elution of the antibiotic from the catheter. Bacterial colonization was measured using a quanitative culture technique after the catheter lumen had been flushed and the catheter segments sonicated. Main results: Nearly three-quarters of the initial teicoplanin coating (374±103 μg; mean±SD) were released during the first day of catheterization, and after 36 h of intravenous catheterization, no antibiotic was retained on the catheter. No significant difference could be found either in the incidence of bacterial colonization between test (n=3) and control (n=4) catheters or in the number of colony-forming units (CFU) on the catheter segments (T, 263±104 CFU/cm; C, 372±294 CFU/cm; mean±SEM). Conclusion: The retention of teicoplanin antibiotic coating on hydromer catheters is only short term if catheters are inserted intravenously. This may limit clinical antibacterial efficacy.
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  • 7
    ISSN: 1432-1238
    Keywords: Thermodilution cardiac output ; Continuous monitoring ; Postoperative intensive care ; Extubation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective Commercially available semi-continuous cardiac output (SCCO) monitoring systems are based on the pulsed warm thermodilution technique. There is evidence that SCCO fails to correlate with standard intermittent bolus cardiac output (ICO) in clinical situations with thermal instability in the pulmonary artery. Furthermore, ventilation may potentially influence thermodilution measurements by enhanced respiratory variations in pulmonary artery blood temperature and by cyclic changes in venous return. Therefore, we evaluated the correlation, accuracy and precision of SCCO versus ICO measurements before and after extubation. Design Prospective cohort study. Setting Intensive care unit (ICU) of a university hospital. Patients and participants 22 cardiac surgical ICU patients. Interventions None. Measurements and results SCCO and ICO data were obtained at nine postoperative time points while the patients were on controlled mechanical ventilation. Further sets of measurements were taken during the weaning phase 20 min before extubation, and 5 min, 20 min and 1 h after extubation. SCCO and ICO measurements yielded 286 data pairs with a range of 1.8–9.9 l/min for SCCO and 1.9–9.8 l/min for ICO. The correlation between SCCO and ICO was highly significant (r=0.92;p〈0.01), accompanied by a bias of −0.052 l/min and a precision of 0.56 l/min. Correlation, accuracy and precision were not influenced by the mode of respiration. Conclusions Our results demonstrate excellent correlation, accuracy and precision between SCCO and ICO measurements in postoperative cardiac surgical ICU patients. We conclude that SCCO monitoring offers a reliable clinical method of cardiac ouput monitoring in ICU patients following cardiac surgery.
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  • 8
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 9
    ISSN: 1432-055X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 10
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Inhalationsanästhesie ; Sevofluran ; Kosten-Effektivitätsanalyse ; Kostenkontrolle ; Key words Anaesthetics ; Inhalation ; Sevoflurane ; Cost-effectiveness ; Cost control
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The economic impact of the new German health care laws requires an awareness of cost-effectiveness when using newer drugs. The main goal in patient care, i.e., effective treatment, must be achieved by the rational use of restricted resources at a maximum degree of effectiveness. Economic aspects of the new inhalational anaesthetics such as sevoflurane are discussed in this article. The cost of inhalational anaesthetic agents accounts for up to 5% of all the running expenses of an anaesthesia department. The consumption and cost of an inhalational agent depend on fresh gas flow, vapour setting, and duration of anaesthesia. Comparing the cost for 1 MAC-h of anaesthesia, desflurane is more expensive at current market prices than sevoflurane and isoflurane. However, at low or minimal fresh-gas flows, the price for one MAC-h is almost the same for these volatile anaesthetics. Total intravenous anaesthesia using propofol is even more expensive, partly due to wastage, i.e., opened ampoules with a remainder of propofol that has to be discarded after each case. When choosing an anaesthetic agent, the price of 1 ml liquid anaesthetic is an important factor. However, the overall cost-effectiveness analysis must balance the cost of the agent with its pharmacodynamic advantages such as more rapid recovery from anaesthesia. Furthermore, the indirect costs of side effects have to be taken into account. For example, nausea and vomiting lead to a prolonged stay in the recovery room after anaesthesia for outpatient surgery, which in turn incurs additional costs for antiemetic drugs and the extra time for nursing care. Therefore, a lower incidence of nausea and vomiting and a more rapid recovery from anaesthesia leading to earlier discharge from the recovery room may compensate for the higher price. Volatile agents account for up to 1% of the total intraoperative costs. In analysing the costs of 1 h of anaesthesia, other products such as plasma substitutes and blood products account for a much higher proportion than anaesthetic agents, and reductions or increases in costs pertaining to these products have a bigger impact on overall costs than do volatile anaesthetics. We conclude that volatile anaesthetics account for only a minor portion of the anaesthesia department budget and the cost of anaesthesia delivery. The higher market price of the new agents may be compensated for by the economic impact of fewer side effects and a shorter post-anaesthesia stay in the hospital. In analysing data for sevoflurane, this agent may be cost-effective, for example, for outpatient anaesthesia.
    Notes: Zusammenfassung Die veränderten ökonomischen Bedingungen aufgrund des Gesundheitsstrukturgesetztes machen Kosten-Effektivitätsanalysen bei der Einführung neuer Medikamente erforderlich. Das Hauptziel der Patientenversorgung, nämlich die effektivste Behandlung, muß unter maximaler Effizienzsteigerung angesichts der beschränkten Ressourcen erreicht werden. Am Beispiel der modernen Inhalationsanästhetika, insbesondere des Sevofluran, werden die für den Anästhesisten ökonomisch relevanten Aspekte dargestellt. Inhalationsanästhetika verursachen nur ca. 5% der Sachkosten einer Anästhesieabteilung. Die Kosten für eine einzelne Inhalationsanästhesie hängen neben den Einkaufskosten für diese Substanzen im wesentlichen von dem Frischgasfluß, der Vaporeinstellung und der Anästhesiedauer ab. Beim Vergleich einer MAC-Stunde ist bei den aktuellen Preisen die Inhalationsanästhesie mit Desfluran teurer als die mit Sevofluran oder Isofluran, wobei sich jedoch unter low- und minimal-flow Bedingungen die Kosten annähern. Die Kosten für das Inhalationsanästhetikum betragen bis zu 1% der intraoperativen Kosten einer Fallpauschale. Andere Faktoren wie z.B. die Personalkosten oder die Sachkosten für Plasmasubstitute oder Blutprodukte sind für höhere Kostenanteile verantwortlich, so daß sich Einsparungen oder Mehrkosten in diesen Bereichen wesentlich stärker auswirken als bei dem Kostenfaktor Inhalationsanästhetikum. Eine Kosten-Effektivitätsanalyse am Beispiel der Inhalationsanästhetika muß nicht nur den Einkaufspreis der jeweiligen Substanz, sondern die Gesamtkosten mit einschließen, die durch unterschiedliche Nebenwirkungen oder differente postnarkostisch notwendige Überwachungszeiten bedingt sind. Am Beispiel des Sevofluran kann nach den bisherigen Daten für einige Einsatzgebiete wie z.B. die ambulante Tageschirurgie errechnet werden, daß dieses Inhalationsanästhetikum aufgrund der kürzeren notwendigen Betreuung im Aufwachraum trotz des höheren Einkaufspreises kosteneffektiv ist.
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