Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1993
Review[The laryngeal mask--an overview 1983-1993].
The laryngeal mask which was developed by Brain in 1981 and described for the first time in 1983 has been employed worldwide a million times since 1989. Traditionally, all anaesthesiologists are oriented towards the techniques of conventional mask anaesthesia or endotracheal intubation. This new alternative, however, amazes by its easy handling and its concept: insertion of the mask directly onto the larynx without irritating it and sealing the pharynx at the same time thus allowing sufficient ventilation. ⋯ However, cases of difficult intubation may be greatly facilitated. All users appreciate the reliability of the laryngeal mask in daily routine even though some fear that more difficult and safer techniques of anaesthesia might be forgotten. The indications of the laryngeal mask expand rapidly at the moment and the fast trend in its spread might continue if this method is not discredited by violations of its contraindications: full stomach, extreme obesity and low compliance of the lungs.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1993
[The laryngeal mask with > 1900 general anesthesias--report of experiences].
Since November 1990 until January 1993, the laryngeal mask airway was employed for 1925 general anaesthesias, i.e. 19.6% of all general anaesthesias in our hospital. On the basis of the protocols the age distribution of the patients, the practice of anaesthesia (premedication with oral benzodiazepines, induction with thiopental, anaesthesia sustained with enflurane/nitrous oxide/oxygen) and the complications are reported. ⋯ One aspiration was recorded, but could not be attributed to the laryngeal mask. Complications with major influence on the postoperative course and hospital stay were not seen.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1993
Case Reports[An unconventional use of the laryngeal mask for the therapy of a postoperative atelectasis-induced respiratory insufficiency].
A 90-year-old cardiopulmonary high-risk patient had to undergo a laparatomy due to a perforated ulcus ventriculi. Postoperatively he developed pulmonary insufficiency due to an atelectasis of the upper right pulmonary region. The clinical situation deteriorated because of dyspnoea and exhaustion. ⋯ Reintubation involving the necessity of relaxation and anaesthesia could be avoided by this unconventional use of a LMA. This case report confirms the good tolerance and easy handling of the LMA. It demonstrates a further application of the LMA, which is not only a new device but a new idea of airway management.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1993
[The effect of intermittent prone position on pulmonary gas exchange in acute lung failure].
In a clinical trial, the influence of repeated intermittent prone position on pulmonary gas exchange was investigated in 6 patients with severe ARDS. Despite various intra- and interindividual differences, oxygenation index (calculated by the paO2:FiO2 ratio) was improved significantly by change from supine to prone position in the first two days of treatment, whereas paCO2 remained unchanged. Later on, a significant improvement of oxygenation could not be verified. In patients with proven or presumed densities of dorsal lung regions, body position changes from supine to prone position in the early phase of treatment may improve arterial oxygenation and may be regarded as a therapeutic principle in conventional ARDS treatment.