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Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Are marginal notes marginal? Backed by a book from the private library of Emil von Behring the paper reflects whether annotations are peripheral sources or whether they can give some hints concerning biographical details. Behring's traces of reading are exposed and discussed by using the example of Otto Rot's Arzneimittel der heutigen Medicin (1877). The marginal notes demonstrate Behring's intensive work on hypnotics, sedativs, and analgetics which were possibly used for the therapy of others or himself. The findings will be compared to other sources of Behring's personal papers.

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of this paper is to show relevant aspects of dental treatment in pregnancy. Common medication used in dental offices should be highlighted in special regard to the pregnant patient during dental treatment. The reader should gain more security in the election of the proper drugs for local anesthesia and oral analgesics. Local anaesthetics such as articain with adrenalin in a dilution of 1 : 200 000 can be used for dental treatment at any time. Paracetamol should be used as first line oral analgesic. Elective dental procedures should be postponed after delivery and after lactation period.

Unlabelled: In this paper we describe the assessment and medical treatment of pain in children according to the concept of the Centre of Pediatrics and Adolescent Medicine at the university of Freiburg, Germany. Opiate therapy in children as well as novel data about the association of paracetamol (acetaminophen) and wheezing/asthma bronchiale in children are discussed. Special aspects of analgesia for painful procedures and a nitrous oxide/oxygen mixture which has been recently introduced in Germany are described. The second part of the paper presents results of our prospective study about continuous infusion of fentanyl and midazolam in a fixed combination in 19 critically ill patients with a median age of 46 months, 40% of these patients had an ARDS. The mortality rate was 21%. A median dose of fentanyl of 3.9 microg/kg/h (midazolam 0.26 mg/kg/h) was infused. The fentanyl serum level (median 4.2 ng/ml, range 1.7-17.8 ng/ml) correlated significantly with the administered dose while the midazolam serum levels (median 911 ng/ml, range 234-4 651 ng/ml) correlated neither with the administered dose nor with any of the analysed parameters., Conclusion: A standard protocol for the assessment and treatment of pain should be established in every pediatric hospital. The data about the association of asthma bronchiale and paracetamol cannot be interpreted conclusively, but show that even for well known substances clinical trials may lead to new awareness. The study data about continuous infusion of fentanyl and midazolam show a good correlation of the fentanyl application to serum levels, while midazolam appears to be not the optimal substance for continuous sedation in this setting.

Pain is a complex subjective phenomenon that so far cannot be objectively quantified by any standardized procedure. This fact renders it also difficult to measure the efficacy of analgesic drugs. In recent years the application of functional magnetic resonance imaging (fMRI) has significantly increased our current knowledge about the brain physiological correlates of pain in humans. The technique is non-invasive and detects the increased blood flow into neuronally active brain regions based on the so-called BOLD (blood oxygenation level dependent) effect of T2-weighted MRI. This paper gives an overview of the application of pharmacological fMRI (phfMRI) as an approach to evaluate the efficacy of analgesics. In contrast to EEG- and MEG-based methods phfMRI allows more flexibility in the design of experimental paradigms and stimulus protocols to account for the diversity of clinical pain types (inflammatory pain, tactile allodynia etc.) or their dependence upon psychological circumstances (anxiety, depression, stress) in which pain occurs. However, in order to specifically refer results from phfMRI to the neuronal processes underlying pain, future research needs to increase the understanding of the mechanisms underlying the neurovascular coupling reaction represented by the BOLD technique. The same applies for the influence of cerebrovascular diseases on the BOLD response.

Minimally invasive injection therapy is an effective approach for the treatment of sciatica with less complications. This therapy is a sufficient option in cases without absolute indications for operation.The paper describes in detail the different injection techniques like spinal nerve analgesia, epidural dorsal/perineural injections, vertebral joint infiltrations, and radiculographies.

The goal of therapy in patients with severe head injury is to avoid secondary brain damage. Analgesia and sedation are an essential part of the therapy, and several drugs are in current use. However, few controlled clinical trials have been performed so far, and none of these drugs has proved to be superior. Although in the past the therapy has been focused on controlling elevated intracranial pressure (ICP), many authors emphasize the role of cerebral ischaemia in the prognosis of patients. Therefore, cerebral perfusion pressure (CPP) i.e. the difference between ICP and mean arterial pressure (CPP = MAP-ICP), seems to be more important than ICP alone. Analgesics and sedatives reduce the cerebral metabolic rate (CMR), and the consequent decrease in cerebral oxygen uptake might prevent ischaemic damage in regions with low perfusion. Moreover, a decrease in CMR is often associated with a decrease of cerebral blood flow (CBF) in regions with normal perfusion and, as a result, ICP is also reduced. Basically, the cerebral effects (on ICP, CMR, and CBF) and the haemodynamic effects with respect to maintenance of a sufficient CPP are most important in the selection of drugs for analgosedation. In addition, the effects on general intensive care management must be considered (pulmonary function, immunreactivity bowel motility). The purpose of this paper is to describe drugs commonly used for analgosedation in severe head injury. Barbiturates bring about the most pronounced decrease of CMR and ICP. In the past these drugs were used routinely in high doses ("barbiturate coma"). However, no improvement in outcome was demonstrable, and vitally dangerous side effects, such as infection, pulmonary dysfunction, arterial hypotension, and renal failure often occurred. High-dose barbiturate therapy is therefore only indicated in exceptional cases, such as refractory increase in ICP with preserved CO2 response of cerebral vessels. The effect is dependent on CMR at the start of this therapy. Benzodiazepines are frequently used in patients with head injury. They cause only a moderate decrease of CMR and ICP. In general, side effects are negligible. However, a possible decrease of MAP by reduced central sympathetic drive has to be taken into account. Opioids are also frequently used in patients with head trauma. The observed cerebral effects are inconsistent. Some authors have described increases in ICP, CBF, and CMR, but in most studies no influence on these values, or a decrease, has been observed. In any case, cautious titration of these drugs and cerebral monitoring are therefore desirable. As with benzodiazepines, a decrease in MAP due to central effects is possible. In addition, opioids inhibit bowel motility. Ketamine is generally used because of its favourable circulatory effects, bronchodilatation and absence of inhibition of bowel motility. In patients with increased ICP, however, it is often considered contraindicated, since it can be associated with cerebral vasodilation and ICP increase. Other studies did not confirm an increase of ICP when controlled ventilation and additional sedation were applied. More recent studies have demonstrated the role of neuroexcitatory NMDA-receptors in ischaemic and traumatic brain damage. Since ketamine exerts an antagonistic effect on N-methyl-D-aspartate receptors (NMDA) and studies in animals have demonstrated a protective effect of ketamine against ischaemic and traumatic brain damage, controlled clinical studies in patients with head injury are desirable. Propofol results in a profound decrease of CMR and a significant decrease of ICP, but often also in haemodynamic depression. Few results obtained during long-term administration are available, but it seems to be beneficial. More clinical studies are warranted. Gamma-hydroxybutyrate (GHB) is a physiological substance, which has only sporadically been investigated for sedation in patients with head trauma. The few available studies show beneficial res

In this paper causes of pain and factors influencing sensitivity to pain in tumour patients are described. Changes and requests of outpatient therapy with non-opiates versus opiates are further analyzed. Results of pharmacological studies and clinical experiences show that most physicians have unjustified prejudice against prescription, effectiveness and side-effects of opiates. Some typical faults in outpatient therapy are a consequence of this kind of prejudice. An effective outpatient therapy using a phased plan in treatment with drugs could enable most tumour patients to become free of pain.

Despite numerous efforts to establish an adequate pain treatment, many patients still do not receive a proper pain therapy. This is unfortunate as it is estimated that between 5 and 7.6 Mi. people are suffering from chronic pain in Germany. This paper is demonstrating an adequate pain management for different diseases including an interdisciplinary approach. Further, we hope to reduce the fear of many physicians for the administration of opioid analgetics to realize a proper pain treatment where indicated.

For decades the adrenergic alpha2 agonist clonidine has been considered to be one of the classical, centrally acting antihypertensive agents. In addition to its antihypertensive and sympathicolytic effects, in recent studies clonidine has been demonstrated to be an effective sedative and analgesic and to reduce the amount of anaesthetic agents required. Therefore, a reconsideration of possible new indications for clonidine in clinical anaesthesiology seems to be justified. This paper presents the pharmacological basis for treatment with clonidine and reviews the extensive literature on its clinical indications in anaesthesia. Clonidine apparently produces its sedative and anaesthetic-sparing effects by stimulation of centrally located alpha2 adrenoceptors. Analgesia seems to be mediated mainly by activation of alpha2 adrenoceptors in the dorsal horn of the spinal cord. Considering its clinical indications, clonidine is often used as a supplement in the treatment of alcohol withdrawal syndromes. Future indications for clonidine may be the treatment of postoperative shivering and chronic pain management. Administration of clonidine in combination with a local anaesthetic prolongs analgesia and motor blockade. Its use in premedication and postoperative pain management may be limited by its principal effects of hypotension and bradycardia. In future, cardiovascular side effects may be minimized if all the subtypes of alpha2 adrenoceptors, their distribution within the central nervous system, and their specific action are clearly defined. This could result in a detailed therapeutic index of more selective and potent alpha2 agonists.

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Four standard analgetics were tested using the tail-flick and the hot-plate method, and by means of the Writhing syndrome. The frequency distributions of the data obtained from the control group were recorded first. The skewed distributions of the data yielded by the tail-flick and the hot-plate method were transformed into normal distributions. These normal distributions of data obtained form larger samples of control animals by the tail-flick and the hot-plate method permitted to develop alternative procedures of evaluation which led to dose-effect curves allowing to determine whether or not the effects of any single doses of the substances under study are significantly different. Testing the analgetics by means of the Writhing syndrome also yielded statistically interpretable dose-effect curves which resulted from a comparison with the frequency distributions of the data from control animals, all-or-not solutions being avoided. The evaluation procedures presented in this paper have the advantage that, in any case, the dose-related effects may be statistically interpreted due to the greater slopes of the dose-effect curves. Furthermore, these procedures improve the reproducibility of the dose-effect curves.

Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)