Prämedikationsqualität und Patientenzufriedenheit nach Prämedikation mit Midazolam, Clonidin oder Placebo: Randomisierte Doppelblindstudie mit altersangepasster Dosierung

Zusammenfassung: Hintergrund: Die Prämedikation hat u.a. zum Ziel, Angstgefühle und innere Unruhe vor einem chirurgischen Eingriff zu lindern und gleichzeitig möglichst wenig unerwünschte Wirkungen zu verursachen. Es gibt bisher keine Untersuchungen, die die Wirkungen und Nebenwirkungen von Clonidin (Catapresan®), Midazolam (Dormicum®) und Placebo in altersabhängig unterschiedlicher Dosierung verglichen und deren Akzeptanz beim Patienten untersucht haben. Patienten und Methoden: In dieser randomisierten, placebokontrollierten Studie wurden 139 erwachsene Patienten untersucht und 60min vor der Narkoseeinleitung mit Clonidin, Midazolam oder Placebo prämediziert. Angst, Sedierungstiefe und Nebenwirkungen wurden an 6 aufeinanderfolgenden Zeitpunkten erfasst. Ergebnisse: Midazolam zeigte eine stärkere anxiolytische und sedative Wirkung als Clonidin. Die Prämedikation mit Midazolam verminderte die Sauerstoffsättigung. Es gab keine klinisch relevanten Veränderungen in der Hämodynamik in allen Gruppen. Midazolam und Clonidin verminderten das Risiko für "postoperative nausea and vomiting" (PONV). Midazolam zeigte die geringsten Nebenwirkungen. Placebo wurde von den Patienten weitaus am schlechtesten beurteilt, im Gegensatz zu Clonidin und Midazolam, das am besten beurteilt wurde. Schlussfolgerung: Die sedierende und anxiolytische Wirkung von Midazolam ist stärker als diejenige von Clonidin. Midazolam wurde von den Patienten besser angenommen als Clonidin, Clonidin siginfikant besser als Placebo. Die meisten Patienten würden Midazolam wieder wähle

Prämedikationsqualität und Patientenzufriedenheit nach Prämedikation mit Midazolam, Clonidin oder Placebo: Randomisierte Doppelblindstudie mit altersangepasster Dosierung

BACKGROUND: Premedication aims at alleviating preoperative anxiety and nervousness and also at minimizing adverse effects. To our knowledge there is no study comparing efficacy and patient satisfaction of different premedications in age-adjusted dosage. METHODS: In 139 patients anxiety, sedation and adverse effects were measured at 6 consecutive perioperative time points after administration of midazolam, clonidine or a placebo. RESULTS: Midazolam showed the strongest sedative and anxiolytic effects, clonidine less and placebo none. Clonidine and midazolam reduced the risk of postoperative nausea and vomiting (PONV). Midazolam showed minimal adverse effects and the best patient satisfaction. CONCLUSION: Midazolam was the most anxiolytic, sedative and favored premedication with the least adverse effects. Most patients would choose midazolam next time

Late oesophageal perforation after intraoperative transoesophageal echocardiography

Serious haemodynamic instability occurred during emergency surgery for a perforated duodenal ulcer in a 72-year-old man with acute myocardial infarction. Intraoperative transoesophageal echocardiography was crucial for diagnosis of the location of myocardial infarction in the right ventricle and the subsequent haemodynamic management. Postoperatively, a thrombus in the right coronary artery was removed by coronary angiography. The patient's trachea was extubated on the fourth postoperative day. Another 4 days later a leak in the lower oesophagus was suspected because of pleural empyema, and verified. The patient's trachea had to be re-intubated and an oesophageal stent was inserted. The patient was discharged, fully recovered, 2 months after the operation

Effect of rofecoxib on platelet aggregation and blood loss in gynaecological and breast surgery compared with diclofenac

BACKGROUND: Non-selective cyclooxygenase (COX) inhibitors or non-steroidal anti- inflammatory drugs (NSAIDs) are frequently omitted for perioperative pain relief because of potential side-effects. COX-2-selective inhibitors may have a more favourable side-effect profile. This study tested the hypothesis that the COX-2-selective inhibitor rofecoxib has less influence on platelet function than the NSAID diclofenac in gynaecological surgery. In addition, analgesic efficacy and side-effects of the two drugs were compared. METHODS: In this single-centre, prospective, double-blind, active controlled study, women undergoing vaginal hysterectomy (n=25) or breast surgery (n=25) under general anaesthesia received preoperatively 50 mg of rofecoxib p.o. followed 8 and 16 h later by two doses of placebo or three doses of diclofenac 50 mg p.o. at the same time points. We assessed arachidonic acid-stimulated platelet aggregation before and 4 h after the first dose of study medication, estimated intraoperative blood loss, and haemoglobin loss until the first morning after surgery. Analgesic efficacy, use of rescue analgesics, and side-effects were also recorded. RESULTS: In the rofecoxib group, stimulated platelet aggregation was disturbed less (P=0.02), and estimated intraoperative blood loss (P=0.01) and the decrease in haemoglobin were lower (P=0.01). At similar pain ratings, the use of anti-emetic drugs was less in the rofecoxib group (P=0.03). CONCLUSION: Besides having a smaller effect on platelet aggregation, one oral dose of rofecoxib 50 mg given before surgery provided postoperative analgesia similar to that given by three doses of diclofenac 50 mg and was associated with less use of anti-emetics and less surgical blood loss in gynaecological surgery compared with diclofenac

Isolated reduction of haematocrit does not compromise in vitro blood coagulation

Low haematocrit values are generally well tolerated in terms of oxygen transport but a low haematocrit might interfere with blood coagulation. We thus sampled 60 ml of blood in 30 healthy volunteers. The blood was centrifuged for 30 min at 2000 g and separated into plasma, which contained the platelet fraction, and packed red blood cells. The blood was subsequently reconstituted by combining the entire plasma fraction with a mixture of packed red blood cells, 0.9% saline, so that the final haematocrit was either 40, 30, 20, or 10%. Blood coagulation was assessed by computerized Thrombelastograph analysis. Data were compared using repeated measures analysis of variance and post-hoc paired t-tests with Bonferroni correction. Decreasing the haematocrit from 40 to 10% resulted in a shortening of reaction time (r) and coagulation time (k), and an increase in angle alpha, maximum amplitude (MA) and clot strength (G) (all P<0.02). This pattern represents acceleration of blood coagulation with low haematocrit values. The isolated reduction in haematocrit, therefore, does not compromise in vitro blood coagulation