Der Anaesthesist
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The current increase in the cost of health care must be considered as a severe threat to the prehospital emergency services system. Two examples have been selected--the patient with polytrauma and the patient in cardiac arrest--to demonstrate the dilemma between a need for objective data and the requirements of emergency patients. Study results obtained in trauma patients indicating that total prehospital time, including scene time, is correlated to patient outcome have led to the conclusion that at the scene treatment by emergency physicians may be dispensable. ⋯ Politicians require an improvement in the quality of the validation of emergency measures, although the instruments available for the investigation of these measures are known to be obsolete (experimental models, experimental design). Additionally, the financial support of research in emergency medicine suffers from being accourded low priority by public research funds such as the German Research Fund. However, in view of the rapid application of experimental results to daily practice it should be emphasized that patients also support research in emergency medicine via their direct financial contributions to the health insurance companies.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Sevoflurane or halothane in inhalational anesthesia induction in childhood. Anesthesia quality and fluoride level].
Due to its low blood:gas partition coefficient (0.69) and its neutral odor, sevoflurane (S) is suitable for inhalational induction of anaesthesia. At the moment halothane (H) is preferentially used for this purpose due to its non-irritating odor and the smoothness of anaesthetic action. However, experience is limited with the use of S in children, and concern exists about potential renal toxicity of its metabolite, i.e. fluoride. Therefore, we compared S and H in an open, randomized phase III trial. ⋯ Sevoflurane is an alternative to halothane in pediatric inhalational anaesthesia, with a comparable, low incidence of airway irritation and smoothness of induction. Because of the significantly faster induction and recovery it seems superior to halothane. With the fluoride levels measured, an impairment of renal function is unlikely.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Neuromuscular blockade after atracurium and alcuronium with propofol and thiopental].
Does propofol or thiopentone enhance the effect of nondepolarizing muscle relaxants? We evaluated the effects of propofol and thiopentone on the pharmacodynamics of atracurium and alcuronium in 43 surgical patients (ASA I and II) under general anaesthesia. ⋯ Propofol and thiopentone have no potentiating influence on the time course of action and the magnitude of relaxation with alcuronium and atracurium. Pharmacodynamics of nondepolarizing muscle relaxants do not seem to be influenced by these two hypnotics.
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Portofemoro-axillary bypass systems are commonly used to treat adverse haemodynamic effects during the anhepatic phase of orthotopic liver transplantation (OLT). However, low shunt flows may reduce the efficacy of these bypass systems. In order to improve veno-venous bypass management, a percutaneous cannulation technique (PCT) was used to insert large-bore catheters (21 F) into the left femoral and subclavian veins. This study prospectively addresses the complications of the PCT in 195 adult patients undergoing 203 OLTs. ⋯ The portofemoro-subclavian bypass can be performed by percutaneous cannulation without additional complications in patients undergoing OLT. Although haemorrhagic complications following central venous catheterisation are reported to occur in patients with haemostatic defects, none of them was observed in this study. Two events of air embolism and one cardiac arrest could not be related to the PCT. In conclusion, femoro-subclavian percutaneous cannulation is a simple, rapid, and safe alternative to commonly used veno-venous bypass systems.
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The standard procedure when difficulties are anticipated with intubation, e.g. following the clinical classification as per Mallampati, is the fibreoptic bronchoscopic method applied while the patient is awake. In the case of unexpected difficulties encountered during intubation while the patient is anaesthetized, a scenario that cannot be absolutely ruled out, e.g. in an emergency resection when there is no longer a simple method of returning the patient to the waking condition, and when problems are accentuated by seriously hampered mask respiration, aspiration risk, danger of hypoxia, and visual obstruction by secretions and blood, the fibrebronchoscope is no longer the instrument of choice. A larynx mask or a combination tube is probably a better option. ⋯ The BL is routinely deployed, as an alternative to the Macintosh instrument, for practice purposes by all our colleagues in the department. It has proved to be remarkably effective: to date it has led to the target quickly and without complications in every case. As examples three case histories selected from a series of cases in which the BL was used have been highlighted.