Der Anaesthesist
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PEEP has become a widely used ventilatory technique. The beneficial effects of PEEP were first described in asphyctic neonates, and it was later used in the treatment of cardiogenic pulmonary edema. Since the 1970s PEEP has been well established for the treatment of ARDS; the technique is also used for scoring the degree of severity of ARDS. ⋯ PEEP should be used in cardiogenic pulmonary edema as well as in ARDS; there are few contraindications. To choose the individual level of PEEP, PEEP should be titrated in 3- to 5-cm increments and its effects on haemodynamic function, pulmonary gas exchange and respiratory mechanics taken into account. In this article the effects of PEEP, its use and abuse are reviewed from a practical point of view.
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Verification of the correct position of the endotracheal tube is a daily routine task of every anaesthesiologist. Accidental intubation of the oesophagus is a very rare complication in absolute terms but still the most frequent preventable anaesthetic mishap with fatal outcome. Even the most experienced anaesthetist is not immune to this complication. ⋯ Visualization of the endotracheal tube between the vocal cords and a typical CO2 excretion waveform are two of the best practical signs. After every change of position of the patient, especially after flexion or extension of the head, the position of the tube must be checked again. The old aphorism is still valid: When in doubt, take it out.
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Review Randomized Controlled Trial Clinical Trial
[Intraoperative awareness in balanced anesthesia. A literature review based on a randomized double blind study using fentanyl, pentazocine and ketamine].
Since the first case report by Winter-bottom [106], the problem of intraoperative awareness or recall has received increasing attention from patients, anaesthesiologists and, more recently, even law courts [4, 20, 21, 78]. Our own interest in awareness derives from a study with the opiate agonist tramadol as a supplement to balanced anaesthesia, which revealed an unexpectedly high incidence of about 65% of patients who could recall intraoperative music [55]. It was the aim of the present randomized double-blind study to evaluate, under identical experimental conditions, what the incidence would be with other analgesic supplements to balanced anaesthesia (fentanyl, pentazocine and ketamine). ⋯ Recovery was fastest with F, followed by P, and slowest with K. Retrospective judgement of the quality of anaesthesia by the anaesthesiologist did not differ significantly between the treatment groups. Most (93%) of the patients were satisfied with their anaesthesia; 2 patients each who received P and K were dis
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Of 434 cases of epidural, subdural, and intracranial haematomas published in the last 2-3 decades, 61 had developed following spinal, epidural or caudal anaesthetic procedures; 29 haematomas were around the spinal cord and 32, within the cranium. The most frequent secondary cause of this complication was pre-, intra-, or postoperative administration of drugs influencing blood coagulation. Simultaneous traumatic and haemorrhagic punctures may favour the development of a haematoma. ⋯ Postoperative results of laminectomies for lumbothoracic haematomas has been found to on the time interval between the first symptoms and the start of surgery. If surgery is performed within 8 h after the onset of paraplegia the prognosis is relatively good. Compared with the frequency of spinal, epidural, and caudal anaesthetic procedures throughout the world, haematomas of the lumbothoracic or cranial region are extremely rare complications.