[Comparative study of propofol emulsions for anesthesia in varicose vein operations]. / Vergleichende Untersuchung zweier Propofol-Emulsionen zur Anästhesie bei Varizenoperationen.

PURPOSE: It is commonly known that propofol-based anaesthesia is easily controlled and well tolerated. These advantages of propofol are partly offset by the comparably high costs of the anaesthetic. The present prospective randomised double-blind cross-over study compared two propofol emulsions with regard to their efficacy and drug safety. METHODS: 30 patients were included in this study. All patients underwent two propofol-based anaesthesias for leg vein surgery on both legs within 2-4 days. The patients were randomised in two treatment groups where Group A (n = 15) received the investigational drug for the 2nd anaesthesia and the control drug for the 1st anaesthesia. The order of drug application was reversed for Group B (n = 15). The propofol induction doses, the maintenance doses, and the side effect profiles were evaluated for the purpose of comparing the two propofol emulsions. RESULTS: The study showed no differences in the efficacy of the two propofol emulsions. Furthermore, the side effect profiles were almost identical and did not reveal any unknown side effects of propofol. CONCLUSIONS: The results clearly demonstrate that both propofol emulsions are comparably well suited for vascular surgery anaesthesia. This study demonstrates a methodological clinical approach to compare the same medication supplied by different manufacturers.

[Myoglobin release and renal function in polytraumatized patients in intensive care]. / Myoglobinfreisetzung und Nierenfunktion bei polytraumatisierten Intensivpatienten.

The excessive release of myoglobin following extensive skeletal muscle trauma, burns, and myopathies may result in renal dysfunction. Due to its molecular size, myoglobin is filtered through the glomerulus and is in part reabsorbed by the tubular system. intraluminal deposition of myoglobin following renal hypoperfusion and the impact of endogenous mediators on cell function contribute to the pathogenesis of acute renal failure. The present study was aimed to investigate the relation between myoglobin and renal function in polytraumatized patients. Thirty-four patients with an Injury Severity Score (ISS) of 28 +/- 3.1 (SEM) and a mean age of 39.5 years (range 18-70) were studied prospectively. Myoglobin, sodium, and creatinine concentrations in plasma and urine were determined 8-hourly. Myoglobin excretion, fractional myoglobin excretion, myoglobin clearance, creatinine clearance, and fractional excretion of sodium were calculated. The mean concentration of plasma myoglobin on the 1st day post-trauma was 3087 ng/ml. A continuous decrease in plasma myoglobin concentration could be observed, with a mean value of 497 ng/ml on day 7. The myoglobin concentration in urine showed marked fluctuations: the mean values were 3.37-4.12 mg/ml on day 1 and 0.78-1.34 mg/ml on day 7. There was no correlation between plasma and urine myoglobin concentrations. The myoglobin concentration increased during the period of observation, but there was no correlation with the creatinine clearance. The fractional excretion of myoglobin was in the range of 1% to 14%. There was no correlation between the fractional excretions of myoglobin and sodium.(ABSTRACT TRUNCATED AT 250 WORDS)

[Infusion or repetitive bolus injection? A clinical study of midazolam/fentanyl and diazepam/fentanyl combination anesthesia in neurosurgical operations]. / Infusion oder repetitive Bolusinjektion? Eine klinische Untersuchung von Midazolam/Fentanyl- und Diazepam/Fentanyl-Kombinationsanästhesien bei neurochirurgischen Eingriffen.

The objectives of this study were to compare two narcotic/benzodiazepine combinations given either as continuous infusion or intermittent bolus injections in neurosurgical patients. 24 patients scheduled for elective craniotomy were investigated. They were assigned randomly to four different groups for treatment. Groups 1 and 2 received a combination of midazolam and fentanyl, groups 3 and 4 a combination of diazepam and fentanyl. Anaesthesia was maintained either by continuous infusion (groups 1 and 3) or intermittent bolus injections (groups 2 and 4). At six key intervals cardiovascular variables were compared. Furthermore, total drug dosage requirements were measured and compared. Except for measurement 3 (skin incision), cardiovascular dynamics were not markedly different between bolus and infusion groups. Haemodynamic response to skin incision was less in both bolus groups. Furthermore, the bolus technique revealed a non-significant reduction in total drug dosage requirements in the bolus groups. Our data indicate that for neurosurgical anaesthesia conventional bolus injection of intravenous anaesthetics is superior to continuous infusion with respect to intraoperative haemodynamics. The typically reduced level of pain with short peaks only, characteristic for neurosurgical operations, is one of the factors contributing to these surprising results. Furthermore, the simple method of infusion chosen influences the results decisively. Certain advantages might be achieved by the use of sophisticated pharmacokinetic infusion models. Total drug dosage requirements were reduced in the bolus groups mainly because of the typical anaesthetic requirements of craniotomy, disposing it for bolus technique.