Der Anaesthesist
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Case Reports
[Transtracheal oxygenation in respiratory tract obstruction from a hypopharyngeal tumor].
A 42-year-old male with a history of chronic alcoholism was admitted to the department of otolaryngology with acute respiratory insufficiency and generalised cyanosis due to a respiratory obstruction by a large tumour of the hypopharynx. Because of the size and location of the tumour and the risk of bleeding, orotracheal intubation by direct laryngoscopy was considered almost impossible. ⋯ Awake fiberoptic nasotracheal intubation was performed under topical anaesthesia, then general anaesthesia was induced and controlled ventilation was started. After surgical tracheotomy the patient was transferred to an intensive care unit and 12 h later the patient was discharged from the ICU.
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Patients undergoing non-cardiac surgical procedures who carry coronary artery stents have to be classified as high risk patients. Perioperative myocardial infarction and severe bleeding are possible. ⋯ The urgency of the surgical procedure, perioperative risk and an antiplatelet regimen have to be discussed with the patient and the surgeon in advance. In the case of cardiac complications, rapid therapy by an interventional cardiologist must be available.
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Comparative Study Clinical Trial
The Narcotrend--a new EEG monitor designed to measure the depth of anaesthesia. A comparison with bispectral index monitoring during propofol-remifentanil-anaesthesia.
The Narcotrend is a new EEG monitor designed to measure the depth of anaesthesia based on a 6-letter classification from A (awake) to F (general anaesthesia with increasing burst suppression) and divided into 14 substages (A, B0-2, C0-2, D0-2, E0,1, F0,1). This study was designed to investigate the assessment of the depth of anaesthesia as measured by the Narcotrend in comparison with bispectral index monitoring (BIS). ⋯ We could demonstrate that an increase of the hypnotic component of anaesthesia as indicated by BIS is accompanied by corresponding effects as displayed by the Narcotrend during propofol-remifentanil anaesthesia. The Narcotrend stages D or E are assumed equivalent to BIS values between 64 and 40 indicating general anaesthesia.