Der Anaesthesist
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Review
[Residual neuromuscular blockades. Clinical consequences, frequency and avoidance strategies].
Even after administration in routine clinical dosages, muscle relaxants can lead to long-lasting residual blockades which increase the risk of severe postoperative pulmonary complications. Even without the additional effects from analgetics, sedatives or anaesthetics, a partial neuromuscular blockade, which cannot reliably be avoided either by the anaesthetist alone or by the additional use of nerve stimulators (train-of-four [TOF] ratio 0.5-0.9), can cause reductions in the vital capacity and the hypoxic breathing response, as well as obstruction of the upper airway and disruption of pharangeal function. ⋯ If the course of a neuromuscular blockade is continually monitored during the whole anaesthetic procedure using the TOF ratio and not only occasionally at the end, a TOF ratio of 1 measured with an acceleromyograph (e.g. TOF-watch) promises an adequate neuromuscular recovery from the effects of muscle relaxants.
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Review Case Reports
[Mask ventilation as an exit strategy of endotracheal intubation].
The goal of ventilation in an unprotected airway is to optimize oxygenation and carbon dioxide elimination of the patient. This can be achieved with techniques such as mouth-to-mouth ventilation, but preferably with bag-valve-mask ventilation. Securing the airway with an endotracheal tube is the gold standard, but excellent success in emergency airway management depends on initial training, retraining, and actual frequency of a given procedure in the routine. "Patients do not die from failure to intubate; they die from failure to stop trying to intubate or from undiagnosed oesophageal intubation" (Scott 1986). ⋯ During ventilation of an unprotected airway, stomach inflation and subsequent severe complications may result. Careful ventilation can be performed with low inspiratory pressure and flow, and subsequently with a low tidal volume at a high inspiratory fraction of oxygen. This could be a strategy to achieve more patient safety.