Zusammenfassung
In der vorliegenden Studie werden Methohexital und Thiopental als intravenöses Narkotikum
per Dauerinfusion bei operativen Eingriffen unter der Verwendung der Jetventilation
mit reinem Sauerstoff verglichen. 40 Patienten wurden randomisiert auf die Methohexital-
(n = 20) und die Thiopentalgruppe (n = 20) verteilt. Am Abend vor der Operation wurden
psychometrische Tests durchgeführt und die Patienten erhielten eine standardisierte
Prämedikation. Die Narkose wurde mit 2 mg Alcuronium, 1 mg Alfentanil, 1,4 mg/kg KG
Methohexital beziehungsweise 5 mg/kg KG Thiopental sowie 1,4 mg/kg KG Succinylcholin
eingeleitet. Direkt vor Beginn der Laryngoskopie erhielten die Patienten 2-4 mg Alfentanil.
Die Muskelrelaxation wurde durch eine Succinylinfusion unter relaxometrischer Kontrolle
aufrechterhalten. Methohexital beziehungsweise Thiopental wurden nach klinischen Gesichtspunkten
als Infusion weitergegeben.
Summary
For the direct laryngoscopy and microscopic examination of the larynx with exploratory
excision and polpectomy using low frequency jet-ventilation with 100 % oxygen we used
total intravenous anaesthesia with a strong acting opioid and a barbiturate. Because
the achievement of sufficient reflexes and a high degree of vigilance postoperatively
are to be aimed, Methohexitone (M) and Thiopentone (T) were investigated in the regard
of the suppression of vigilance in the postoperative period. 40 patients were randomly
assigned to the group M (n = 20) or T (n = 20). The evening before operation, an intelligence
test and a syndrom-short-test (SST) were performed for the measurement of attention
and memory (functional psychosis). The patients received 2 mg Flunitrazepam orally
and transdermal Scopolamin. On the day of operation the patients received 1 mg Lormetazepam
orally for premedication. Anaesthesia was induced with 2 mg Alcuronium, 1 mg Alfentanil,
1.4 mg/kg Body-weight M respectively 5 mg/kg Bodyweight T and 1.4mg/kg Bodyweight
Succinylcholin. Immediately before laryngoscopy the patients received 2-4 mg Alfentanil.
Muscle relaxation was achieved by an infusion with Succinylcholin using relaxometry.
Methohexitone respectively Thiopentone were administered by infusion depending on
clinical signs indicating insufficient anaesthesia. The following parameters were
measured: Blood pressure, heart rate, duration of operation and anaesthesia, parameters
of vigilance 30, 60 and 120 minutes after operation (SST) and the ability of performance.
The groups were comparable with respect to all data except the parameters of vigilance.
The patients receiving M were significantly more vigilant 30 min., 60 min. (SST) and
120 min (SST) after the end of anaesthesia than patients receiving T (p = 0,01). The
results show that both methods can be used for direct laryngoscopy using total intravenous
anaesthesia and jet-ventilation. Methohexitone should be prefered to Thiopentone because
the patients achieve a high degree of vigilance significantly earlier than the patients
receiving Thiopentone. The reason for these results are the better hepatic extraction
rate and the shorter half life time of Methohexitone.
