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At least 145 records · Page 8Linked to original sources

[Midazolam in combination with piritramid versus Thalamonal in premedication in ambulatory ENT interventions in childhood].

70 children aged between 15 months and 8 years who had to undergo outpatient surgery (adenotomy) were divided into two groups and given different premedication. Group A received Midazolam (0.15 mg/kg) combined with Piritramid (0.1 mg/kg), group B Thalamonal (0.04 ml/kg). Based on vigilance schemes, the degree of sedation and the mood tone were rated during initiation of anaesthesia, in the awakening phase and on discharge of the patient. Cooperation during initiation (via a mask) was definitely higher in group A (72%) than in group B (44%). During the awakening phase the children in group A showed a more balanced mood tone combined with improved vigilance. For example, 3 hours postoperatively 65% of the children in group A had got up and participated in getting dressed, whereas in group B only 11% of the children did so. Intramuscular premedication with Midazolam/Piritramid must be considered as especially advantageous in outpatient ENT treatment requiring a large number of small surgical interventions in children in respect of effective preparation and with a minimum of problems regarding postoperative follow-up.

Adenoidectomy↗

[Extracorporeal shockwave lithotripsy in sedation-analgesia].

The aim of the present study was to examine the effects of combined sedation and analgesia during extracorporeal shockwave lithotripsy using the Dornier lithotriptor HM III. We used a combination of a benzodiazepin derivatives with an opioid. We tested the dosage of drugs needed in relation to the length of treatment, the size of the stone and the overall energy output of the lithotriptor. In addition, continuous records were made of the patient's blood pressure and the oxygen saturation in the blood, with and without oxygen insufflation. Our results show that sedation combined with analgesia is a reasonable and useable alternative to general or regional anaesthesia for extracorporeal lithotripsy.

Anesthesia, Conduction↗

The use of midazolam and diazepam for sedation following aorto-coronary bypass surgery.

The new water-soluble benzodiazepine midazolam was compared in a randomized study to diazepam for postoperative sedation in fifty patients following aortocoronary bypass surgery with a sufentanil-anesthesia. Midazolam and diazepam were administered intravenously in repeated doses in conjunction with an opioid infusion (piritramide) from the end of surgery during a twelve-hour study period, patients being artificially ventilated. Midazolam scored better than diazepam for quality of sedation and cardiovascular stability during the period of mechanical ventilation and for respiration during the weaning period and after extubation, although no difference was found in weaning time from artificial ventilation and time of extubation. Hemodynamic tolerance for both drugs was good. The administration of a loading dose of midazolam 5 mg caused a slight, transient decrease in mean arterial pressure. Midazolam appeared to be a more effective sedative agent than diazepam for short-term administration during mechanical ventilation. No evidence of cumulation and prolonged recovery was seen.

Adult↗

[High-dose piritramide basal anesthesia in experimental anesthesia and surgery].

On the basis of investigations of three groups of dogs (7 in each) the effects of high dosage piritramide anesthesia were analyzed. Using a standardized technique no significant changes in hemodynamics and microcirculation were found during 4 h. So variations in the "steady-state" must be attributed to additional medication or therapeutic intervention. High dosage piritramide anesthesia has been applied in more than 250 animal experiments.

Anesthesia↗

[Methodological variants of neuroleptanalgesia (author's transl)].

A survey is presented of the variations of neuroleptanalgesia. Modification of the injection technique, the hypnotic, the analgesic or the neuroleptic partial effect of the drug combinations produces four variations. The principles of the classical type of neuroleptanalgesia, namely the ability to selectively influence the single components of anaesthesia and the predominant use of a strong analgesic must remain unaltered in the definition of a variant. The use of clear nomenclature is used in an attempt to overcome the confusion which still exists in this field.

Acupuncture Therapy↗

Termination of anaesthesia--do we pay enough attention to its consequences? Haemodynamic studies following the use of piritramide, flunitrazepam and nitrous oxide anaesthesia for open heart surgery.

After completion of coronary or valve replacement surgery the haemodynamic changes due to cessation of nitrous oxide were measured. Seventy-four patients received piritramide-nitrous oxide anaesthesia. In 20 patients nitrous oxide was continued after operation and no marked haemodynamic changes occurred. However, when nitrous oxide was discontinued immediately after the operation (n=30) a significant rise in systolic arterial pressure (108+/-15 to 153+/-30 mm Hg), systolic pulmonary artery pressure (35+/-9 to 40+/-16 mm Hg), systemic vascular resistance (111 +/-26 to 148+/-44 MN.s.m-5) and rate pressure product (9,600+/-1,600 to 14,300+/-4,000) occurred. Heart rate (89+/-11 min-1), left artrial pressure (13+/---4 mm Hg) CO2 minute production (125+/-19 ml. min-1.m-2) and cardiac index (2.5+/-0.61.min-1.m-2) rose only moderately. When additional flunisternal closure to 24 patients, marked haemodynamic changes were still noted after N2O withdrawal, even though anaesthesia was prolonged. The sudden rise of arterial pressure and vascular resistance implies risks to patients with myoicardial or coronary insufficiency, therefore close monitoring is necessary, when nitrous oxide has to be stopped, to enable undelayed antihypertensive therapy.

Adult↗