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[Qualitative comparison of modified neurolept-, balanced and intravenous anesthesia. 2. Results of a clinical study, 1992]. / Qualitätsvergleich von modifizierter Neurolept-, balancierter und intravenöser Anästhesie. Teil 2. Ergebnisse der Krefelder Studie 1992.
Harke, H; Schmidt, K; Gretenkort, P; Hommerich, P; Deutschmann, S; Eckes, C; Hense, W; Kleemann, A; Rehorn, W; Stöcker, H.
Afiliação
  • Harke H; Institut für Anaesthesie, Städtischen Krankenanstalten Krefeld.
Anaesthesist ; 44(10): 687-94, 1995 Oct.
Article em De | MEDLINE | ID: mdl-8533868
ABSTRACT
The safety and tolerance of neuroleptanaesthesia (NLA), balanced anaesthesia (BAL), and intravenous anaesthesia with propofol (IVA) were analysed for the first time in a prospective, randomised clinical trial. METHODS. In all, 1318 surgical patients received either NLA, BAL, or IVA. Patients who had regional anaesthesia, were aged under 18 years, or were non-cooperative or vitally threatened (ASA class i.v. to V) did not participate in the study. Premedication and anaesthetic course were set up at a standard of 30% oxygen and 70% nitrous oxide. Incidents, events, and complications due to anaesthesia were obtained (IEC key of the German Society of Anaesthesia and Critical Care Medicine, DGAI). Furthermore, postanaesthetic alertness based on specific recovery tests and the quality of anaesthesia from the patient's viewpoint, rated by patient questionnaires from the DGAI were evaluated. All parameters were calculated and checked for statistical significance using the chi-square test. RESULTS AND DISCUSSION. The groups were broadly comparable with respect to age (P = 0.91), ASA class (P = 0.42), preoperative blood pressure (P = 0.36), and length of anaesthesia (P = 0.82). The anaesthesia, which averaged 103 min, comprised the following regimens (1) NLA 7.1 mg droperidol and 0.008 mg/kg body weight fentanyl, (2) IVA 493.4 mg propofol and 0.004 mg/kg body weight fentanyl, and (3) BAL 2.6 mg droperidol and 0.004 mg/kg body weight fentanyl with 0.4 vol.% isoflurane. With respect to anaesthetic risk, the following reactions were observed the use of NLA led to a high incidence of tachycardia (P = 0.001), arrhythmias (P = 0.05), and hypertensive reactions (P = 0.001), whereas in the IVA group only hypotension (P = 0.0001) occurred. However, after the use of BAL none of the aforementioned complications were detectable to any considerable degree. Similarly, patients who had cardiac disease showed greater IEC changes after the use of NLA than after BAL or IVA (P = 0.02) (Tables 1 and 2). The heart rates and blood pressures during BAL and IVA were extremely stable, and therefore, vasoactive therapy was required considerably less in comparison to NLA (P = 0.001) (Table 4). Recovery after the use of IVA was strikingly rapid the patient's responsiveness, orientation, and ability to concentrate was significantly better than after the other anaesthetic regimen (P = 0.01) (Table 5). With regard to the typical discomforts after anaesthesia, IVA was highly superior to BAL and NLA nausea (P = 0.0003) and retching (P = 0.03) hardly ever occurred (Table 6). Due to the tolerable manner of waking up and rapid return of orientation and the ability to concentrate, IVA was highly favoured by the patients (P = < 0.01) (Table 7). CONCLUSION. The present results show clear clinical advantages of BAL and IVA in contrast to neuroleptanaesthesia. Due to the very low incidence of side effects such as nausea and vomiting IVA was highly recommended by the patients, at least in part because of the rapid recovery time.
Assuntos
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Propofol / Anestésicos Intravenosos / Anestesia Intravenosa / Neuroleptanalgesia Tipo de estudo: Clinical_trials / Observational_studies / Qualitative_research / Risk_factors_studies Limite: Adult / Humans / Middle aged Idioma: De Revista: Anaesthesist Ano de publicação: 1995 Tipo de documento: Article
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Propofol / Anestésicos Intravenosos / Anestesia Intravenosa / Neuroleptanalgesia Tipo de estudo: Clinical_trials / Observational_studies / Qualitative_research / Risk_factors_studies Limite: Adult / Humans / Middle aged Idioma: De Revista: Anaesthesist Ano de publicação: 1995 Tipo de documento: Article