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1.
Anasthesiol Intensivmed Notfallmed Schmerzther ; 50(6): 426-33; quiz 434, 2015 Jun.
Article in German | MEDLINE | ID: mdl-26147414

ABSTRACT

As a result of the demographic change, the proportions of elderly patients undergoing operations and anesthesia are increasingly important. The consumption of benzodiazepines evidently rises with increasing age. Associated with the increasing consumption in the elderly is the risk of cognitive impairment, delirium, falls and fractures. Also long-term benzodiazepine use in low-dose may induce perioperative withdrawal syndrome. The following article will present characteristics and complications accompanied by critical benzodiazepine use especially in the elderly patients.


Subject(s)
Anesthetics, General/adverse effects , Benzodiazepines/adverse effects , Postoperative Complications/chemically induced , Postoperative Complications/prevention & control , Substance-Related Disorders/diagnosis , Substance-Related Disorders/therapy , Antidepressive Agents/adverse effects , Humans , Substance Abuse Detection/methods , Substance-Related Disorders/complications
2.
Urol Int ; 93(2): 193-201, 2014.
Article in English | MEDLINE | ID: mdl-24851943

ABSTRACT

INTRODUCTION: Radical retropubic prostatectomy (RRP) is associated with an increased risk of intraoperative blood loss and the necessity of transfusions. This prospective randomised clinical study evaluates the influence of thoracic epidural analgesia (TEA) on blood loss in RRP. MATERIALS AND METHODS: 235 patients were randomised: TEA in group 1 (n = 116; general anaesthesia + TEA) comprised continuous administration of 0.25% bupivacaine, while group 2 (n = 119; general anaesthesia alone) received intravenous analgesia with fentanyl (intubation: 2 µg/kg; maintenance: 0.1-0.3 mg). A restrictive infusion regimen (<1,000 ml until specimen removal) was administered in both groups. Blood loss, infusion rates and anaesthesiological parameters were recorded and analysed using regression models and analyses of variance. RESULTS: Haemoglobin difference between the pre- and the first postoperative day (group 1: 3.35 ± 1.16 g/dl; group 2: 3.56 ± 1.42 g/dl; p = 0.19), overall blood loss (group 1: 665 ± 431.5 ml; group 2: 705 ± 881 ml; p = 0.73) and transfusion rates (0.4% intraoperatively; 2.55% postoperatively; p = 1.0) did not show group differences. In regression analysis blood loss was influenced by preoperative haemoglobin levels (p < 0.0001), patients' weight (p = 0.018) and duration of the operation (p = 0.017). CONCLUSIONS: This study did not demonstrate a direct impact of TEA on intraoperative blood loss and transfusion rates in RRP. Further randomised clinical trials are needed to evaluate an impact of the different anaesthetic procedures presented alone or in combination on blood loss.


Subject(s)
Analgesia, Epidural/methods , Anesthetics, Local/administration & dosage , Blood Loss, Surgical/prevention & control , Blood Transfusion , Bupivacaine/administration & dosage , Prostatectomy/adverse effects , Prostatic Neoplasms/surgery , Administration, Intravenous , Aged , Analgesics, Opioid/administration & dosage , Anesthesia, General , Biomarkers/blood , Body Weight , Fentanyl/administration & dosage , Germany , Hemoglobins/metabolism , Humans , Male , Middle Aged , Operative Time , Prospective Studies , Prostatic Neoplasms/pathology , Risk Factors , Time Factors , Treatment Outcome
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