[Levosimendan. Clinical indications of a new vasoactive substance]. / Levosimendan. Klinische Indikationen einer neuen vasoaktiven Substanz.

Levosimendan is a recently developed drug which is not yet approved for clinical routine use in Germany. The clinical use is limited to a few selected cases and it has been used as a salvage therapy in patients with severe heart insufficiency. As a potent inodilator it has been given to patients with severe heart failure, when all other therapeutic options have failed. However, in some European countries levosimendan is used in clinical routine situations and the European Society of Cardiologists has included the drug in their guidelines for treatment of acute heart failure. The following article describes the main pharmacological characteristics of levosimendan and summarises the indications for this new drug for physicians working in the field of anaesthesia or intensive care.

Downward movement of syringe pumps reduces syringe output.

We studied how lowering a syringe pump and changing the outflow pressure could affect syringe pump output. We experimentally reduced the height of three different syringe pump systems by 80 cm (adult setting) or 130 cm (neonatal setting), as can happen clinically, using five flow rates. We measured the time of backward flow, no flow and the total time without flow. An exponential negative correlation was present between infusion rate and time without flow (r2=0.809 to 0.972, P<0.01). Minimum flow rates of 4.4 and 2.6 ml h(-1) respectively were calculated to give 60 and 120 s without infusion. The compliance of the different syringe pumps and their infusion systems was linearly correlated with the effective time without infusion (r2=0.863, P<0.05). We conclude that the height of the syringe pumps should not be changed during transportation. If vertical movement of the syringe pump is necessary, the drugs should be diluted so that the flow rate is at least 5 ml h(-1).

A randomized controlled double-blind trial comparing piritramide and morphine for analgesia after hysterectomy.

BACKGROUND AND OBJECTIVE: Efficacy and side-effects of piritramide (pirinitramide) and morphine, given intravenously for postoperative analgesia after hysterectomy, were compared in a randomized controlled double-blind trial in 92 ASA class I-III patients. METHODS: Administration was investigator-controlled during the first 90 min and subsequently via a patient-controlled device. Visual analogue scales for pain intensity and verbal rating scales for side-effects were taken repeatedly. RESULTS: Median visual analogue scores for pain intensity on a 100-mm scale 4, 8 and 24 h after surgery were 10, 8.5 and 5 mm in the piritramide group and 18, 10 and 8.5 mm in the morphine group. These differences are neither statistically nor clinically significant. Median values for nausea on a verbal rating scale from 0 to 3 were zero for both groups at all times with similar ranges. There was no difference in number of episodes of vomiting and retching and usage of antiemetics. The mean amount of piritramide used for initial titration was 15.2 mg; the respective amount of morphine was 15.4 mg. CONCLUSIONS: In this setting the two agents are equally effective and show a similar profile of side-effects.

Prilocaine 3% is superior to a mixture of bupivacaine and lignocaine for peribulbar anaesthesia.

We have compared motor block of the extraocular muscles produced by injections of 3% prilocaine and a mixture of equal parts of 2% lignocaine and 0.75% bupivacaine into the medial compartment of the orbit. A volume of 8 ml was used initially, and a vasoconstrictor and hyaluronidase were added to both solutions. Ninety patients undergoing cataract surgery were allocated randomly to one of two groups in double-blind study. Eight minutes after block insertion, the median ocular movement score in the prilocaine group was 1 and in the lignocaine-bupivacaine group 3. This difference was statistically significant (P = 0.016). Twenty of the patients who received prilocaine and 29 of the patients who received the lignocaine-bupivacaine mixture required an additional inferotemporal injection. This difference was not statistically significant (P = 0.094).