Der Anaesthesist
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Comparative Study
[Long-term results after surgical tracheotomy and percutaneous dilatation tracheostomy. A comparative retrospective analysis].
Besides surgical tracheostoma for treatment of long-term intubation, percutaneous dilatational tracheostomy (PDT) has become available during the last few years. Long-term results of the PDT are rare in the medical literature. This paper reports a retrospective analysis comparing the results after PDT with those after surgical tracheostomy. ⋯ The endoscopic examination showed minor stenosis of the trachea in both groups that were not functionally relevant. The average stenosis of 14% for the PDT was similar to that observed after surgical tracheostomy which was 19%. The choice of the best technique should be made in close cooperation between head- and neck surgeons and anesthesiologists.
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One of the factors that can alter the response to drugs is the concurrent administration of other drugs. There are several mechanisms by which drugs may interact, but most can be categorised as pharmacokinetic (absorption, distribution, metabolism, excretion), pharmacodynamic, or combined toxicity. Knowledge of the mechanism by which a given drug interaction occurs is often clinically useful and may help to avoid serious adverse events and perioperative morbidity. ⋯ This article reviews the basic principles of drug metabolism and the role of cytochrome P450 in this scenario. Drugs frequently used in anaesthesia and critical care medicine such as benzodiazepines, opioid analgesics, antihypertensive and antiarrhythmic agents, antibiotics and antifungal drugs, antiemetics, histamine-receptor-antagonists, theopylline and paracetamol will be considered. The development of methods and tools which are practical and also economic, are of utmost importance since drug interaction is predictable if the metabolic pathway and the activity (genetic polymorphism) of the enzyme is known.
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The aim of this prospective study was to evaluate the vertical infraclavicular approach to the brachial plexus for the insertion of a catheter to achieve continuous analgesia in postoperative patients and patients with chronic upper limb pain. ⋯ The placement of an infraclavicular plexus catheter is a suitable method for pain management in the upper limb. This approach may have advantages in patients with severe injuries who cannot abduct the arm. Our results are encouraging in terms of catheterisation time, patient comfort and incidence of complications.