Der Anaesthesist
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Randomized Controlled Trial Comparative Study
[Nasojejunal enteral feeding tubes in critically ill patients. Successful placement without technical assistance].
Critically ill patients with early enteral feeding seem to profit from post-pyloric administration. Two feeding tubes were studied that, due to their construction, are able to move into the duodenum without the necessity of technical support. The duration until successful positioning, time until total enteral feeding and possible complications were compared. ⋯ In comparison to the Bengmark tube the Tiger tube has a higher success rate in terms of positioning in intensive care patients with impaired abdominal motility.
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Classical adult type rapid sequence induction (RSI) intubation is not always appropriate in children. In newborns, infants and small children, limited cooperation during pre-oxygenation, reduced respiratory oxygen reserves, increased oxygen demand and a tendency for airway collapse, easily lead to hypoxaemia after induction of anaesthesia. Gentle mask ventilation with pressures not exceeding 10-12 degrees cm H(2)O allows oxygenation without the risk of gastric inflation and aspiration. ⋯ Application of cricoid pressure does not reliably prevent pulmonary aspiration. In children cricoid pressure clearly interferes with smooth induction of anaesthesia, results in difficult mask ventilation and intubation as well as provokes bucking and straining and, therefore, should not be routinely used. Key features of RSI intubation for children are effective induction of deep anaesthesia followed by profound muscle paralysis, careful mask ventilation and gentle tracheal intubation under optimised conditions.
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Historical Article
[Premedication, preoperative and postoperative visits. Importance as reflected in anaesthesiology textbooks].
Proceeding from German and English language textbooks on anaesthesia as sources, this article asks what concepts of preoperative and postoperative visits have dominated since 1880 and what types of premedication have been preferred. The idea of obligatory premedication became widespread in the first third of the twentieth century. ⋯ Much less attention was devoted to the postoperative visit. The current emphasis on the postoperative visit in the framework of perioperative anaesthesia is barely dealt with at all in the textbooks that were consulted.