Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Preoxygenation with the NasOral((R)) system or the standard face mask?].
Adequate preoxygenation of patients before onset of apnea for orotracheal intubation is of major importance in general anaesthesia. Various preoxygenation techniques are available but a face mask providing an oxygen supply via the circle absorber system of a mechanical respirator is most frequently used. Recently, a new device for preoxygenation - the NasOral((R)) system - has become available. The aim of the present study was to compare the efficacy of intrapulmonary oxygen storage with either the NasOral((R)) device or the standard face mask. ⋯ Both the NasOral((R)) system and the face mask are effective for intrapulmonary oxygen storage. In both systems the O(2) flow has to be adequately high and the masks have to be held tightly in order to avoid any contamination of the inhaled oxygen with nitrogen. Due to its unidirectional flow, the NasOral((R)) system additionally requires the patient to be cooperative. As the NasOral((R)) system is more expensive and has no clinical advantages without apneic oxygenation, we prefer the standard face mask for patient preoxygenation.
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We have developed a modern strategy for the anaesthetic management of the pediatric airway using anaesthetic drugs such as sevoflurane, propofol, mivacurium and remifentanil, together with new techniques including the laryngeal mask. This strategy provides optimal conditions for the examiner and maximum safety for the pediatric patient. ⋯ Important indications include acute and chronic stridor, chronic obstructive airway disease, mucoviscidosis and foreign body aspiration. The best and safest techniques are outlined depending on the clinical situation, and the most frequent complications are discussed, e.g. hypoxaemia, respiratory arrest, laryngospasm, bronchial obstruction, pneumothorax and overdosing of local anaesthetic agents.
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Catecholamines are currently the most often used vasopressor agents in the treatment of vasodilatory shock. However, progressive catecholamine resistance is a feared complication. Recent studies have shown that arginine vasopressin, an endogenous hormone of the neurohypophysis, may be a potent vasopressor when used in combination with catecholamines. ⋯ In the guidelines of both the "American Heart Association" and the "International Liaison Committee on Resuscitation" from the year 2000, arginine vasopressin is recommended as a possibly helpful agent in therapy refractory vasodilatory septic shock. There is currently limited data on possible side effects of a continuous arginine vasopressin therapy in vasodilatory shock. Therefore, arginine vasopressin should be restricted to patients where adequate stabilization of hemodynamic function cannot be achieved by conventional vasopressor therapy alone.
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Comparative Study Clinical Trial
[Partial CO(2) rebreathing technique versus thermodilution: measurement of cardiac output before and after operations with extracorporeal circulation].
The NICO(2) monitor determines "pulmonary capillary blood flow" (Qpc) and cardiac output (Qt) using the "partial CO(2) rebreathing technique". The agreement between NICO(2) and thermodilution (TD) cardiac output was compared before and after cardiac surgery with cardiopulmonary bypass (CBP). In addition, the possibility of calculating the intrapulmonary shunt fraction (Qs/Qt) by combining data from the NICO(2) monitor and the TD was investigated. ⋯ Cardiac output measurement by the NICO(2) monitor agree well with TD under steady-state conditions but after CBP the agreement was too small. Combining Qpc(NICO(2)) and Qt(TD) does not offer a reliable possibility for calculating intrapulmonary shunt.
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A case report is presented in which post-operatively a distinct macroglossia including an additional swelling running up to the trachea developed within the framework of a neurosurgical intervention in a seated position. Pathomechanisms and possible therapeutic methods are described and discussed with the help of a review of the literature.