Levobupivacain zur postoperativen Schmerztherapie bei Patienten mit Kniegelenksersatz - ein Vergleich mit Ropivacain

In der vorliegenden Arbeit wurde die postoperative analgetische Potenz von Levobupivacain mit derjenigen von Ropivacain nach Kniegelenkersatz an 60 Patienten (30 Patienten pro Gruppe) verglichen. Nach N. femoralis Katheteranlage und Einleitung einer Allgemeinanästhesie wurden die Patienten einer Kniegelenkersatzoperation unterzogen. Postoperativ erhielten die Patienten über eine PCA Pumpe für insgesamt 72 Stunden eine kontinuierliche Zufuhr des entsprechenden Lokalanästhetikums (5ml/h Levobupivacain 0,125% oder Ropivacain 0,2%), zusätzlich konnten über die PCA Pumpe Boli zu je 5ml des entsprechenden Lokalanästhetikums mit einer Sperrzeit von 30 Minuten angefordert werden. Der Lokalanästhetikaverbrauch sowie die Schmerzintensität (nach NRS) wurden bei Verlassen des Aufwachraumes sowie 24, 48 und 72 Stunden danach erfasst. Hinsichtlich der Anzahl der erhaltenen bzw. angeforderten Boli und des Gesamtvolumens in Millilitern zeigte sich kein statistisch signifikanter Unterschied. Auch die postoperative Schmerzintensität sowie der Opioidbedarf waren vergleichbar. Um diese vergleichbare Analgesie zu erreichen, benötigten Patienten der Ropivacain Gruppe, bezogen auf den Gesamtverbrauch in Milligramm, beinahe 70% mehr Lokalanästhetikum als Patienten der Levobupivacain Gruppe. Unter den Bedingungen dieser Studie ergab sich demnach für Ropivacain im Vergleich zu Levobupivacain eine deutlich geringere analgetische Potenz. Vor diesem Hintergrund relativieren sich generelle Aussagen hinsichtlich eines günstigeren Wirkprofils des Ropivacains.

Total OH reactivity measurements at the biosphere-atmosphere interface

The biosphere emits copiously volatile organic compounds (VOCs) into the atmosphere, which are removed again depending on the oxidative capacity of the atmosphere and physical processes such as mixing, transport and deposition. Biogenic VOCs react with the primary oxidant of the atmosphere, the hydroxyl radical (OH), and potentially lead to the formation tropospheric ozone and aerosol, which impact regional climate and air quality. The rate of OH decay in the atmosphere, the total OH reactivity is a function of the atmospheric, reactive compound's concentration and reaction velocity with OH. One way to measure the total OH reactivity, the total OH sink, is with the Comparative Reactivity Method - CRM. Basically, the reaction of OH with a reagent (here pyrrole) in clean air and in the presence of atmospheric, reactive molecules is compared. This thesis presents measurements of the total OH reactivity at the biosphere-atmosphere interface to analyze various influences and driving forces. For measurements in natural environment the instrument was automated and a direct, undisturbed sampling method developed. Additionally, an alternative detection system was tested and compared to the originally used detector (Proton Transfer Reaction-Mass Spectrometer, PTR-MS). The GC-PID (Gas Chromatographic Photo-Ionization Detector) was found as a smaller, less expensive, and robust alternative for total OH reactivity measurements. The HUMPPA-COPEC 2010 measurement campaign in the Finish forest was impacted by normal boreal forest emissions as well as prolonged heat and biomass burning emissions. The measurement of total OH reactivity was compared with a comprehensive set of monitored individual species ambient concentration levels. A significant discrepancy between those individually measured OH sinks and the total OH reactivity was observed, which was characterized in detail by the comparison of within and above the forest canopy detected OH reactivity. Direct impact of biogenic emissions on total OH reactivity was examined on Kleiner Feldberg, Germany, 2011. Trans-seasonal measurements of an enclosed Norway spruce branch were conducted via PTR-MS, for individual compound's emission rates, and CRM, for total OH reactivity emission fluxes. Especially during summertime, the individually monitored OH sink terms could not account for the measured total OH reactivity. A controlled oxidation experiment in a low NOx environment was conducted in the EUPHORE reaction chamber (CHEERS, Spain 2011). The concentration levels of the reactant isoprene and its major products were monitored and compared to total OH reactivity measurements as well as to the results of two models. The individually measured compounds could account for the total OH reactivity during this experiment as well as the traditional model-degradation scheme for isoprene (MCM 3.2). Due to previous observations of high OH levels in the isoprene-rich environment of the tropics, a novel isoprene mechanism was recently suggested. In this mechanism (MIME v4) additional OH is generated during isoprene oxidation, which could not be verified in the conditions of the CHEERS experiment.