Advancements in the medical field with regard to the development of new techniques, reassessment and analyses of the old and unsatisfactory techniques and the expansion and improvement of acceptable techniques have led to an increase in the use of regional anaesthetic nerve blocks in paediatric patients. However, several regional anaesthetic procedures are currently not being performed by anaesthetists due to the high number of complications and difficulties experienced. Some medical practitioners are under the impression that they lack the knowledge and confidence to perform these regional nerve blocks, especially on neonatal and infant patients. In order to assist these doctors in refining their anatomical knowledge and increasing their confidence in performing these nerve blocks, the procedures which are experienced as problematic need to be identified and evaluated. The aim of this study was therefore: (1) to establish the most efficient method of blocking the maxillary nerve within the pterygopalatine fossa; (2) to investigate which head and neck regional nerve blocks are performed most frequently on paediatric patients and identify problem procedures that are performed by practicing anaesthesiologist in South Africa; (3) to develop a clinical anatomy information base for the selected procedures. Three methods / techniques for maxillary nerve blocks were simulated and compared on 24 dry paediatric skulls and 30 dissected paediatric cadavers. The depth and angles at which the needle travels to block the maxillary nerve in the pterygopalatine fossa, after existing the skull through the foramen rotundum, was measured and compared. The method using the supra-zygomatic approach (method B), from the frontozygomatic angle towards the pterygopalatine fossa, exhibited no statistical significance (p > 0.05) when comparing the measurements in the skulls and cadavers. Method A, a supra-zygomatic approach from the midpoint on the lateral border of the orbit, as well as method C, an infra-zygomatic approach with an entry at the site of a vertical line extending along the lateral orbit wall, showed statistical significance when comparing measurements in the skulls and cadavers. It can therefore be concluded that method B produces the most consistent data and should be tested in a clinical setting. Seventeen commonly performed paediatric regional nerve blocks were identified. A detailed questionnaire was completed by 111 respondents, either electronically or from others attending either the Pain Interventions and Regional Anaesthesia Conference or the South African Society of Anaesthesiologists Conference. Difficulties in performing the regional anaesthetic nerve blocks, and complications encountered, were the main areas of focus, when selecting the four problem procedures. The problem procedures selected are the following: supra-orbital and supra-trochlear nerve blocks, infra-orbital nerve block (Extra-oral approach), superior laryngeal and recurrent laryngeal nerve blocks. A detailed anatomical information base was developed through an extensive literature review. This will aid in educating and facilitating doctors in performing paediatric regional nerve blocks, thereby enabling them to successfully practice medicine. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Anatomy / unrestricted

Dental decay remains a global issue but, in the UK, has become concentrated within the most vulnerable section of society, namely young children and the most deprived. When dental decay and subsequent infection become too severe, teeth may need to be extracted under General Anaesthetic. The aim of this work was to develop a greater understanding of the population of young children referred for a Dental General Anaesthetic (DGA) in the North West of England and to explore possible interventions that may positively impact on this group reducing the high number of children undergoing this procedure. A mixed methods approach was utilised, combining a broad scoping review, quantitative data collection and qualitative interviews. Individually these methods were used to develop a greater understanding of the issue and of the services, processes and patients involved in DGA. The methods were subsequently combined using triangulation to address potential preventative interventions that would be appropriate and acceptable to this group. Differences were observed between hospitals in treatment experiences of children across the North West of England. These included variations in the environment, hospital setting and time from referral to treatment, all of which were shown to impact on the child. The number of children experiencing a repeat DGA was also high and noted as an area that required further intervention. While DGA could be a distressing experience it was considered necessary and resulted in a positive outcome both in terms of oral health and a child’s quality of life. Improving oral health in young children who experience severe decay is a complex and challenging area. A number of interventions were identified that could reduce the need for extraction under DGA. These ranged from targeted interventions, linked to information provision and enablement to support those who are more at risk, to policy change with regard to excessive sugar in food and beverages that could have a broader impact across the population. In addition, DGA service re-designs are discussed including increased provision of prevention that may benefit children referred along this pathway and thereby reduce repeat DGA rates in the future.

Objective: To compare the effects of thiopental, propofol and alfaxalone on arytenoid cartilage motion and establish dose rates to achieve a consistent oral laryngoscopy examination. Study design: Prospective, randomised, blinded crossover study. Animals: Six healthy adult beagle dogs. Methods: Each dog was administered three induction agents in a random order with a one week washout period between treatments. No premedication was used prior to induction of anaesthesia. Thiopental, propofol or alfaxalone were administered at 7.5 mg/kg, 3 mg/kg and 1.5 mg/kg, over 1 minute to effect, for induction of anaesthesia, respectively. If the dog was deemed inadequately anaesthetised then top-up boluses of 1.8 mg/kg, 0.75 mg/kg and 0.4 mg/kg, respectively, were administered over 10 seconds, repeated every 20 seconds, until an adequate anaesthetic plane had been reached. Continual examination of the larynx, using a laryngoscope, commenced once an adequate anaesthetic depth had been reached until recovery from anaesthesia. The number of arytenoid motions and deep inspiratory efforts (vital breaths) were counted within three time periods and compared over time among treatments. Data were analysed using Friedman test, Mann-Whitney U test, Spearman's rho, linear mixed model with post-hoc pairwise comparison with Tukey correction. Results interpreted at a 5% level of significance. Results: The median (range) induction time was 2.8 (2.0, 3.0), 2.7 (2.0, 3.3) and 2.5 (1.7, 3.3) minutes for thiopental, propofol and alfaxalone, respectively (p = 0.727). The median (range) dose rate required to achieve an adequate depth of anaesthesia was 6.3 (6.0, 6.6), 2.4 (2.4, 2.4) and 1.2 (1.2, 1.2) mg/kg/minute for thiopental, propofol and alfaxalone, respectively. Therefore, the median (range) total dose administered over the induction time was 17.8 (13.2, 18.8), 6.8 (5.3, 8.3) and 3.2 (2.3, 4.1) mg/kg for thiopental, propofol and alfaxalone, respectively. There was no significant difference for the total number of arytenoid motions (p =0.662) or vital breaths (p = 0.789) among induction agents. The median (range) examination times were 14.1 (8.0, 41.8), 5.4 (3.3, 14.8) and 8.5 (3.8, 31.6) minutes for thiopental, propofol and alfaxalone, respectively (p=0.016). Conclusion and clinical relevance: There was no significant difference in the total number of arytenoid motions among the induction agents. However, at the dose rates used in this study, propofol provided adequate conditions for evaluation of the larynx within a shorter examination time which may be advantageous during laryngoscopy in dogs. / Mini Dissertation (MMedVet)--University of Pretoria, 2016. / Companion Animal Clinical Studies / MMedVet / Unrestricted

<p>The aim of the study was to describe how anaesthetic nurses, within both advanced beginner and expert levels, experience their professional role as they perform a general anaesthetic.</p><p>The study had a descriptive design with a qualitative approach in which ten advanced beginners- and ten expert anaesthetic nurses from an operating theatre and an ambulatory surgical ward at a hospital located in the middle of Sweden, participated. All data was collected in an interview with semi-structured questions which focused on how the anaesthetic nurses experience their work. The data were analysed with qualitative content analysis. The results are presented in categories and themes. The themes were formed from the categories. Themes for the advanced beginners were: <em>support develops self confidence that gives the feeling of satisfaction</em> and <em>lack of support impedes further development of independency and gives the feeling of insecurity</em>. Themes for the experts were: <em>experience and new challenges in a supported environment give satisfaction</em> and <em>lack of support and own insecurity give dissatisfaction</em>. The advanced beginners described their experiences in a more descriptive way, while the experts had more difficult to describe what they experienced. The advanced beginners wanted more support from their colleagues while the experts wanted to be more independent and were also more confident in their professional role.</p> / <p>Syftet med studien var att beskriva hur anestesisjuksköterskor på avancerad nybörjarnivå respektive expertnivå upplever sin yrkesroll vid generell anestesi. Studien hade en deskriptiv design med kvalitativ ansats där tio avancerade nybörjare respektive tio expert anestesisjuksköterskor, från en allmän operations avdelning och en dagkirurgisk avdelning vid ett Mellansvenskt sjukhus, deltog i studien. Data samlades in via halvstrukturerade intervjufrågor som inriktade sig på anestesisjuksköterskors upplevelser av sitt arbete. Data analyserades med kvalitativ innehållsanalys. Resultatet redovisas utifrån kategorier som bildade olika teman. Teman som för avancerade nybörjare var <em>stöd utvecklar självförtroende som ger en känsla av tillfredställelse</em> samt <em>brist på stöd hindrar utvecklingen av självständighet och ger känsla av osäkerhet</em>. Teman för experterna var <em>erfarenhet och nya utmaningar i en stödjande miljö ger tillfredställelse</em> samt <em>bristande stöd och egen osäkerhet ger otillfredsställelse</em>. Avancerade nybörjarna beskrev sina upplevelser på ett mer beskrivande sätt medan experterna hade svårare att beskriva vad de upplevde. Avancerade nybörjarna ville ha mer stöd medan experterna ville vara mer självständiga och var mer trygg i sin yrkesroll.</p>

The aim of the study was to describe how anaesthetic nurses, within both advanced beginner and expert levels, experience their professional role as they perform a general anaesthetic. The study had a descriptive design with a qualitative approach in which ten advanced beginners- and ten expert anaesthetic nurses from an operating theatre and an ambulatory surgical ward at a hospital located in the middle of Sweden, participated. All data was collected in an interview with semi-structured questions which focused on how the anaesthetic nurses experience their work. The data were analysed with qualitative content analysis. The results are presented in categories and themes. The themes were formed from the categories. Themes for the advanced beginners were: support develops self confidence that gives the feeling of satisfaction and lack of support impedes further development of independency and gives the feeling of insecurity. Themes for the experts were: experience and new challenges in a supported environment give satisfaction and lack of support and own insecurity give dissatisfaction. The advanced beginners described their experiences in a more descriptive way, while the experts had more difficult to describe what they experienced. The advanced beginners wanted more support from their colleagues while the experts wanted to be more independent and were also more confident in their professional role. / Syftet med studien var att beskriva hur anestesisjuksköterskor på avancerad nybörjarnivå respektive expertnivå upplever sin yrkesroll vid generell anestesi. Studien hade en deskriptiv design med kvalitativ ansats där tio avancerade nybörjare respektive tio expert anestesisjuksköterskor, från en allmän operations avdelning och en dagkirurgisk avdelning vid ett Mellansvenskt sjukhus, deltog i studien. Data samlades in via halvstrukturerade intervjufrågor som inriktade sig på anestesisjuksköterskors upplevelser av sitt arbete. Data analyserades med kvalitativ innehållsanalys. Resultatet redovisas utifrån kategorier som bildade olika teman. Teman som för avancerade nybörjare var stöd utvecklar självförtroende som ger en känsla av tillfredställelse samt brist på stöd hindrar utvecklingen av självständighet och ger känsla av osäkerhet. Teman för experterna var erfarenhet och nya utmaningar i en stödjande miljö ger tillfredställelse samt bristande stöd och egen osäkerhet ger otillfredsställelse. Avancerade nybörjarna beskrev sina upplevelser på ett mer beskrivande sätt medan experterna hade svårare att beskriva vad de upplevde. Avancerade nybörjarna ville ha mer stöd medan experterna ville vara mer självständiga och var mer trygg i sin yrkesroll.

Syftet med studien var att beskriva anestesisjuksköterskors strategier kring omvårdnaden av patienter med missbruksproblem inom anestesiologisk omvårdnad.Bakgrund Anestesisjuksköterskan möter dagligen patienter med olika bakgrund, förutsättningar och behov. Personer med missbruksproblem har ofta andra fysiologiska och psykologiska faktorer som påverkar anestesin och den anestesiologiska omvårdnaden än personer utan liknade problem. Faktorer som spelar in är t.ex. ökad tolerans mot läkemedel, försämrad förmåga att bryta ner läkemedel i kroppen, ökad blödningsbenägenhet samt stress och oro hos patienterna. Anestesisjuksköterskans kunskap och förståelse för nämnda faktorer är av högsta vikt för att kunna utföra god och optimal anestesiologisk omvårdnad.Design Studien genomfördes med kvalitativ design med semistrukturerade intervjuer.Metod Deltagarna valdes ut med ändamålsenligt urval. Datainsamlingen bestod av semistrukturerade intervjuer med anestesisjuksköterskor på fem sjukhus i mellersta och norra Sverige. Intervjuerna skrevs ut och analyserades med kvalitativ innehållsanalys.Resultat Tolv intervjuer genomfördes under hösten 2016. Analysen av materialet resulterade i tre kategorier med titlarna "Att ha handlingsberedskap", "Att kommunicera med patienten" och "Att vara säkerhetsmedveten". Kategorierna utgjordes av åtta subkategorier som fick benämningarna "Att vara beredd att anpassa doserna", "Att välja rätt läkemedel", "Att hantera blödningsrisk", "Att hantera sticksvårigheter", "Att etablera förtroende", "Att vara tydlig", "Att se till personalens säkerhet" och "Att se till patientens säkerhet".Slutsats Anestesisjuksköterskor är medvetna om de fysiologiska och psykologiska faktorer som påverkar anestesin hos patienter med missbruksproblem. De har en uttänkt strategi för planering av anestesin och för att förhindra att problem uppstår. Läkemedelsrelaterade åtgärder som dosanpassning och läkemedelsval var övervägande. Det var olika åsikter huruvida ett PM eller en generell rutin skulle öka säkerheten eller förbättra handläggandet av personer med missbruksproblemNyckelord: Anestesisjuksköterska; M / Purpose The aim of this study was to describe anaesthetic nurses' strategies for the nursing of patients with misuse dependency within anaesthetic care.Background Anaesthetic nurses daily meet patients with different backgrounds, conditions and needs. There are often different physiological and psychological factors that affect the anaesthesia and the anaesthetic care for persons with misuse problems than for persons without similar problems. These factors could be for example increased tolerance for drugs, impaired ability to digest drugs, increased bleeding tendency, stress and anxiety. The anaesthetic nurses' knowledge and understanding for earlier mentioned factors are of utmost importance for them to be able to perform a good and optimum anaesthetic care.Design The study was made with qualitative research design with semi-structured interviews.Methods The participants were chosen on a representative basis. The data collection consisted of semi-structured interviews with anaesthetic nurses in five hospitals in Sweden. The interviews were written down and analyzed using a qualitative content method.Results Twelve interviews were made during the autumn 2016. The analysis of the material resulted in three categories titled ”Having preparedness for action”, ”Communicating with the patient” and ”Being security conscious”. The categories consisted of eight subcategories that were titled ”Being prepared to adjust the doses”, ”Choosing the adequate medicine”, ”Managing bleeding tendency”, ”Handling difficulties with giving injections”, ”Establishing trust”, ”Being explicit”, ”Ensuring safety for the staff” and ”Ensuring safety for the patient”.Conclusion Anaesthetic nurses are aware of the physiological and psychological factors that affect the anaesthesia of patients with misuse dependency. They have conceived strategies for planning the anaesthesia and for preventing the emerging of problems. The predominant strategies contain drug related measures such as dose adjustment and selection of drugs. There are different opinions whether a PM or a general routine would increase the safety and improve the handling of patients with misuse dependency.Keywords: Anaesthetic nurse; Misuse; Strategies; Experiences

Ces dernières décennies, de nouvelles techniques d’anesthésie-analgésie locorégionales ont permis d’améliorer la prise en charge post-opératoire. Cependant, les anesthésiques locaux (AL) exposent les patients à un risque de toxicité systémique potentiellement fatale. La première étude est une étude rétrospective ayant inclus des cas potentiels de toxicité systémique aux AL. Cette étude a montré que, face à l’importante variabilité pharmacocinétique des AL observée, l’interprétation des concentrations est difficile. Sa contribution au diagnostic clinique est limitée aux prélèvements précoces après les signes de toxicité.La deuxième étude porte sur la pharmacocinétique de la lidocaine administrée en anesthésie locale tumescente. Il s’agit de la première description de sa pharmacocinétique dans cette indication. Les concentrations restent faibles pendant la durée de suivi. La modélisation par approche de population a permis de décrire le processus d’absorption systémique de la lidocaine après l’injection d’une solution tumescente. La troisième étude porte sur 10 patientes ayant reçu une infusion cicatricielle de ropivacaine de 40 heures. Il s’agit de la première description pharmacocinétique de l’infusion cicatricielle de ropivacaine dans cette indication. La modélisation a montré que l’absorption systémique de la ropivacaine est retardée et la concentration maximale est atteinte 2 heures après la fin de la perfusion. Les études rapportées dans cette thèse ont exploré les propriétés pharmacocinétiques des AL. L’objectif de ces travaux est de contribuer à une meilleure connaissance des thérapeutiques et de contribuer à une meilleure prise en charge des patients. / New locoregional anaesthetic techniques have permitted an improvement of care. However, local anaesthetics (LA) expose patients to systemic toxicity risks. It is essential to set guidelines for the use of these techniques. A retrospective study includes cases of suspected LA systemic toxicity. Systemic toxicity of LA occur when a large amount of LA reaches the systemic circulation. This thesis shows that the interpretation of plasmatic concentrations remains difficult because of the significant pharmacokinetics variability in the different nervous blocks. The second study deals with the population PK of lidocaine administrated in tumescent local anaesthetic. It is the first description of lidocaine PK is performed in this indication. The lidocaine concentrations remain low during the whole time of the operation. The modelling approach has allowed to highlight the slow systemic absorption process of lidocaine after injection of a tumescent solution. The third study focuses on the PK of ropivacaine administrated via continuous wound infusion in 10 women. It is the first time that the PK of ropivacaine administered using wound infusion is described. The modelling approach shows that systemic absorption of ropivacaine delayed and the maximal serum concentration is reached 2 hours after the end of ropivacaine infusion. These studies explored the PK properties of LA used as an anaesthetic or analgesic drug. The objective of this work is to contribute to a better knowledge of therapeutics and a better handling of patients.

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Darbo tikslas - ištirti anestezijos slaugytojų pasitenkinimą darbu. Uždaviniai: 1. Ištirti slaugytojų pasitenkinimą profesija ir specializacija, bei įvertinti bendrą pasitenkinimą savo darbu tarp KMUK, VULSK ir VUGPL dirbančių anestezijos slaugytojų. 2. Įvertinti slaugytojų darbo sąlygas (tarpasmeniniai santykiai, stresas,profesinis savarankiškumas, darbo užmokestis)ir pasitenkinimą darbo aspektais tarp KMUK, VULSK ir VUGPL dirbančių slaugytojų. 3. Nustatyti slaugytojų, ketinančių palikti darbą ryšį su darbo sąlygomis. 4. Nustatyti, slaugytojas geriau dirbti skatinančius veiksnius. Hipotezė – KMUK, VULSK ir VUGPL dirbančių anestezijos slaugytojų pasitenkinimas darbu ir darbo aspektais yra vienodas. Tyrimo metodika: Tyrimo objektas – anestezijos slaugytojos, dirbančios Kauno medicinos universiteto klinikose, Vilniaus universiteto ligoninės Santariškų klinikose ir Vilniaus universitetinėje greitosios pagalbos ligoninėje. Tyrimo metodai – anketinė apklausa. Statistinė duomenų analizė buvo atliekama Microsoft Excel 2003 programa. Duomenų priklausomybei nustatyti naudota SPSS for Windows 11.0 programa. Tyrimo rezultatai ir išvados: Anestezistės darbu patenkintos 86% slaugytojų. Slaugos profesiją iš naujo pasirinktų 44% visų slaugytojų, nesirinktų 29% (p≤0,05).Bendras respondenčių pasitenkinimo darbu vidurkis yra aukštesnis nei vidutinis – 7,1balai. VULSK (7,3 balai) ir KMUK (7,2 balai) darbuotojos yra labiau patenkintos darbu nei VUGPL darbuotojos – 6,7... [toliau žr. visą tekstą] / The aim of the study – to investigate anesthetic nurse’s job satisfaction. The objectives of the study: 1. To investigate satisfaction with nursing profession and specialty, also evaluate general job satisfaction between anesthetic nurse’s, working at KUH, VUHSC, VUEH. 2. To evaluate nurse’s working conditions ( interpersonal relationships, stress, autonomy, salary) and satisfaction with job aspects between nurse’s, working at KUH, VUHSC, VUEH. 3. To identify nurse’s, which are intent to leave the job, connections with working conditions. 4. To identify factors, most motivating nurses to work better. Hypothesis – job satisfaction and satisfaction with job aspects between nurses, which are working at KUH, VUHSC, VUEH, is the same. Methodology: Investigative – anesthetic nurses, which are working at Kaunas University Hospital, Vilnius University Hospital Santariškių Clinics, Vilnius University Emergency Hospital. Investigation method – Questionnaire – based inquiry. Statistical analysis has been made by Microsoft Excel 2003 program. The obtained findings were processed using SPSS for windows 11.1 statistical software package. The results and conclusions of the study : 86% of nurses are satisfied with anesthetic nurse job. Nursing profession would choose again 44 % of nurses, would‘n choose 29% of nurses(p≤0,05). Average of general job satisfaction is higher than medium - 7,1 points. VUHSC (7,3) and KUH (7,2) nurses are more satisfied with job than... [to full text]

Störungen der Aufwachphase sind sowohl in der Human-, als auch Veterinäranästhesiologie von Bedeutung. So kann eine verlängerte, aber auch eine unruhige exzitatorische Aufwachphase zusätzlichen intensivmedizinischen, zeitlichen und finanziellen Aufwand bedeuten. Eine Vielzahl von metabolischen und neuropathologischen, aber auch pharmakologischen Insulten werden insbesondere beim Menschen als Ursachen derartiger Aufwachstörungen beschrieben. Unter anderem scheint auch ein zentraler Acetylcholinmangel mitverantwortlich zu sein. Dieser Mangel wird durch die Anwendung von Physostigmin als indirektes, zentral wirkendes Parasympathomimetikum behoben. Inhalt dieser Studie ist der Einsatz von Physostigmin in der Aufwachphase des Hundes nach zwei gängigen l-Methadon-Narkoseprotokollen. Zum einen sollten Wirkungen und Nebenwirkungen des Medikamentes untersucht werden. Zum anderen sollte geklärt werden, ob Physostigmin in der Lage ist, die Aufwachphase in beiden Narkoseregimen zu verkürzen und auftretende Aufwachstörungen beseitigen zu können. Daraus resultierend war zu klären, ob ein Teil der vorhandenen Aufwachstörungen als Folge einer zentral anticholinergen Blockade auftreten und dem Zentral Anticholinergischen Syndrom (ZAS) zugeordnet werden können. Methodik: Die Untersuchung wurde an 40 klinisch gesunden Hunden (ASA I, II) nach elektiven Eingriffen oder Verfahren bildgebender Diagnostik in der postoperativen Aufwachphase durchgeführt. Zwanzig Tiere erhielten zur Narkoseeinleitung Diazepam und Levomethadon (DLA-Gruppe), zwanzig weitere Acepromazin und Levomethadon (ALA-Gruppe). Im Blindversuch wurde jeweils zehn Tieren pro Narkosegruppe Physostigmin (0,04 mg/kg KM als intravenöse Kurzinfusion über 10 Minuten, Gruppen DLAVerum, ALAVerum) und den anderen zehn Tieren 0,9%-ige Kochsalzlösung (Gruppen DLAPlacebo, ALAPlacebo) verabreicht. Die Untersuchungen beinhalteten die Messungen der Vitalparameter (Herzfrequenz, -rhythmus, arterieller systolischer und diastolischer Blutdruck, kapilläre Rückfüllzeit, Schleimhautfarbe Zusammenfassung 94 und innere Körpertemperatur), des Sedations- und Algesiegrades sowie Laboruntersuchungen (arterielle Blutgasanalytik, Säure-Base-Status, Hämatologie und klinische Chemie) und klinische Nebenwirkungen des Physostigmins. Darüber hinaus wurde das Aufwachverhalten beurteilt und mit dem ebenfalls dokumentierten Einschlafverhalten verglichen. Die Daten wurden in der ersten Stunde nach Applikation der Prüfsubstanz im Abstand von 10 Minuten sowie 120 und 180 Minuten nach Applikation erfasst. Hämatologische und klinisch chemische Untersuchungen erfolgten als Ausgangswerte vor Applikation sowie nach 60 Minuten. Ergebnisse: DLAVerum-Tiere besitzen unter Physostigmingabe einen signifikant niedrigeren Sedationsgrad im Messintervall 10 bis 40 Minuten (p< 0,05). Diese Tiere sind bereits 15 Minuten nach Beginn der Untersuchung in der Lage den Kopf zu heben (DLAPlacebo 30 Minuten). Im ALA-Regime konnten hier keine Unterschiede beobachtet werden. Der Algesiegrad aller vier Gruppen ist annähernd gleich. Nur zu drei Messzeiten ist dieser in DLAVerum um 1-2 Grade über der DLAPlacebo (0-27 Punkte). Das Aufwachverhalten unterscheidet sich nicht signifikant zwischen den Physostigmin-behandelten und -unbehandelten Tieren der beiden Narkoseregime und auch nicht zum Einschlafverhalten. In DLAVerum steigt die Herzfrequenz (nach initialem Abfall) wie auch der systolische Blutdruck tendenziell an (nicht signifikant). DLAPlacebo und ALAPlacebo zeigen konstante Herzfrequenzen und Blutdrücke. Signifikante Unterschiede fehlen zwischen DLAVerum und DLAPlacebo. ALAVerum hat signifikant niedrigere Blutdrücke zum Zeitpunkt 10 bis 40 Minuten als ALAPlacebo (p< 0,05). Schleimhautfarbe, Pulsqualität und Körpertemperatur unterscheiden sich nicht zwischen Physostigmin-behandelten und -unbehandelten Tieren beider Anästhesiegruppen (p> 0,05), verbessern sich jedoch mit Zunahme der Untersuchungszeit. Alle Tiere besitzen eine ausgeprägte respiratorische Azidose zu Untersuchungsbeginn. Signifikante Unterschiede bestehen zwischen DLAVerum und DLAPlacebo. Der paCO2 und der pH-Wert sind nach Physostigmingabe signifikant näher am Referenzbereich. Unterschiede zwischen Verum und Placebo fehlen im ALA-Regime. Bei der angewendeten Dosis wurden als Nebenwirkungen Brady- und Tachykardien beobachtet. Zusammenfassend kann ein antisedativer Effekt nur im Diazepam-l-Methadon-Regime unter Physostigmingabe beobachtet werden. Physostigmin lindert die atemdepressive Wirkung des Opioids Levomethadon in der DLAVerum-Gruppe. Derartige Effekte fehlen in der Acepromazin- l-Methadon-Narkose. In dieser Narkose wird einzig die blutdrucksenkende Wirkung des Acepromazins deutlich verstärkt, was bei alten oder kreislauf-insuffizienten Tieren von Bedeutung sein könnte. Unruhezustände, Lautäußerungen und Muskelzuckungen sind mit und ohne Physostigmin in gleichem Maße vorhanden. Ein zentraler Acetylcholinmangel kann für die beobachteten Aufwachstörungen nicht verantwortlich gemacht werden, da in diesem Fall Physostigmin eine Wirkung zeigen müsste. Ein „Zentral Anticholinergisches Syndrom“ lag somit nicht vor. / Disorders of anaesthetic recovery are found in human but also in veterinary medicine. It is important to understand, that a prolonged or an excitatory stage of recovery causes an additional time in post anaesthesia care unit and financial effort. Animals with agitation represent a risk factor for anaesthesia staff. Many metabolic, neuropathological and pharmacological insults cause these disorders in humans. A lack of acetylcholine within the brain seems to be a cause of arousal disorders. The therapy of choice is the application of physostigmine, as an indirect parasympathomimetic drug. The purpose of this study was the examination of the application of physostigmine in anaesthetic recovery of two l-methadone-anaesthetic regimes. Effects and side effects of physostigmine application in dogs should be described. The following questions should be answered additionally: Is physostigmine able to reduce the time of anaesthetic recovery? Can physostigmine restore disorders of anaesthetic recovery? Is the central anticholinergic syndrome (CAS) a cause of these disorders of anaesthetic recovery? Methods: The investigations were carried out on 40 clinically healthy dogs (ASA I & II) undergoing anaesthesia for elective surgery or diagnostic imaging. Patients were allocated to two different induction protocols: DLA (diazepam-l-methadone) and ALA (acepromacine-lmethadone). In both groups (n=20) 10 dogs received blinded either Physostigmine (n=10; verum) or isotonic saline (n=10; placebo) intravenously in randomized fashion. Following parameters were measured in postoperative period: heart rate, systolic and diastolic blood pressure and respiratory rate, colour of mucous membranes, capillary filling time and rectal body temperature. Analysis of arterial blood gas values and acid base status were performed. A modified numeric rating scale was used for calculating the sedation depth and a Summary 96 cumulative scale for measuring the intensity of algesia. Furthermore a comparison between sleep behaviour and arousal behaviour had been drawn. All parameters were evaluated at time 0 (beginning of application of verum versus placebo), every 10 minutes within the first hour and after the second and third hour. Blood samples (haematological, clinical chemistry) were collected at time point 0 and 60. Side effects of medication were documented. Results: There was a significant lower degree of sedation in DLAVerum compared to DLAPlacebo (p< 0.05), but not in ALA. The degree of pain in DLAVerum is two points over DLAPlacebo. No significant difference among the four groups has been found in behaviour of arousal, vocalization and the incidence of tremor and seizures. Heart rate and blood pressure increase none significantly in DLAVerum in contrast to DLAPlacebo (constant values). A significant reduction in systolic and diastolic blood pressure in ALAVerum, but not in ALAPlacebo was noticeable. Blood pressure in DLAVerum and DLAPlacebo was significant higher than in ALAVerum and ALAPlacebo. There was no significant difference between physostigmine treated and placebo treated animals in pulse quality, rectal body temperature and colour of mucous membranes. A respiratory acidosis has been found in nearly all dogs at the beginning of the investigation. Physostigmine has significantly reduced this opioid induced respiratory depression in DLA but not in ALA. The influence of Physostigmine in reversal of sedation, respiratory depression and restoration of blood pressure was time dependant. Differences were seen in time point 10 to 40 (50) minutes. Side effects were bradycardia and tachycardia, but not nausea or vomiting in contrast to human literature. Conclusion: The antisedative effect has been found only in diazepam-l-methadone-group, while the pressure depressant influence only in acepromacine-l-methadone group became obvious. Physostigmine intensifies the pressure depressant effect of acepromacine. Changes in blood pressure occurred in physical limits only but should be considered in cardiac and circulation insufficient patients. In this study it could be demonstrated that physostigmine could not resolve arousal disorders like restlessness, vocalization, tremor and seizures in dogs. A central lack of acetylcholine (a central anticholinergic syndrome) can not be therefore the cause of these problems. Physostigmine should be limited to severe agitation and prolonged times of arousal cases. Other causes of arousal disorders should be excluded before treatment. After application of physostigmine the supervision with ecg and blood pressure monitoring seems to be necessary.