Der Anaesthesist
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Comparative Study Clinical Trial
[Intraoperative transesophageal versus preoperative transthoracic contrast echocardiography. A method for detection of patent foramen ovale in neurosurgical patients].
Preoperative detection of a patent foramen ovale (PFO) may be achieved employing either transthoracic echocardiography (TTE) with the Valsalva manoeuvre in the awake patient or trans-oesophageal echocardiography (TEE) in the anaesthesised patient. Our study was undertaken to validate these methods with regard to their efficacy in identifying patients at risk for paradoxical air embolism (PAE). METHODS. ⋯ The reason for the lower incidence of PFO detected by TEE during airway pressure 20 cm H2O may have been an insufficient increase of pressure in the right atrium with a negative right-to-left atrial pressure gradient. A standardised ventilation manoeuvre with supra-atmospheric airway pressure of 20 cm H2O is not sufficient. Bulging of the intra-atrial septum from right to left during airway pressure is a possible indication of the efficacy of the manoeuvre, regardless of the influence of the breathing pattern.
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Case Reports Clinical Trial
[A guidewire as a reintubation aid. Translaryngeal fiberoptic insertion of a guidewire into the trachea to assist fiberoptic reintubation in patients difficult to intubate].
Securing the airway following surgery can be a problem in certain patients. Preparation, therefore, should include a plan for safe reintubation, if necessary. ⋯ In addition, one of the patients suffered from an acute abdomen and ileus. We used a guidewire placed into the trachea via a fiberscope to facilitate fiberoptic reintubation.