Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Application of the laryngeal mask for elective percutaneous dilatation tracheotomy].
Percutaneous dilatational tracheostomy is an increasingly accepted procedure for bed-side tracheostomy. The exact positioning of the endotracheal tube, the localization of the point for puncturing the trachea and damage to the endotracheal tube and the cuff as well as to the bronchoscope due to the puncturing process are technical problems which can endanger the course of the operation. In a prospective randomized study, we examined whether use of the laryngeal mask airway (LMA) is a real alternative to the endotracheal tube during tracheostomy. ⋯ An increase in PetCO2 and a decrease in minute ventilation volume were observed in both groups. Regarding technical complications, the LMA is a safe alternative to the endotracheal tube. The choice of method should depend on the basic disease and the patient's ventilation requirements at the time of tracheostomy, while there is still a call for safe instruments guaranteeing sufficient sealing of the respiratory tract during the dilatational tracheostomy and simultaneous avoidance of technical problems during puncturing of the trachea and widening of the point of puncturing.
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Anaesthesiol Reanim · Jan 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Is the laryngeal mask a viable alternative to endotracheal intubation in adenoidectomies in children?].
Based on our results and experiences, we consider the laryngeal mask anaesthesia a recommendable alternative to endotracheal intubation anaesthesia for adenotomies in children. Prerequisites with regard to the highest possible safety for the patient are specialist's knowledge, close anaesthesiological-otolaryngological cooperation and continuous clinical and apparative monitoring in order to detect possible accidental dislocations of the laryngeal mask without any delay. Using the laryngeal mask, disadvantages of endotracheal intubation, such as lesions of the vocal cords and damages to the tracheal mucous membrane can be avoided and the total time of narcosis can be reduced on average by about five minutes, particularly by shortening the recovery time of anaesthesia.
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Since the beginning of this century, a few biopolymers have been used as basic materials for volume substitution. Aside from gelatin and dextran, modified starch (hydroxyethyl starch, HES) is currently the first-choice means. Due to special manufacturing processes, different hydroxyethyl starches are now available. ⋯ The molecular parameters of HES also influence other effects, such as cumulation in various organs and hemostasis. Critical reading of current HES literature shows that many questions still have to be answered. At the same time ways and means of optimizing differential volume substitution therapy and hemodilution therapy are emerging.
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Anaesthesiol Reanim · Jan 1998
Review[Introduction of patient-controlled analgesia--an interim report].
In spite of improved therapeutic methods, the number of patients who suffer from moderate or severe postoperative pain remains high at 30 to 70%. It is accepted that improvement of the organization of postoperative pain therapy is a necessary precondition for changing this situation. Therefore, patient-controlled analgesia (PCA) using pain-pumps should be recognized and the effect on the whole postoperative pain therapy of a university clinic observed. ⋯ Because of these fundamental changes, the frequency of the application of pain-pumps increased six-fold within one year. Additionally, rapid pain treatment based on patients' needs increased clearly from 9.2 to 30.8%. The standardized introduction of PCA had an extremely favourable effect on the whole postoperative pain therapy and can thus be wholeheartedly recommended.
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Anaesthesiol Reanim · Jan 1998
Randomized Controlled Trial Clinical Trial[Changes in blood coagulation in treatment with hydroxyethyl starch].
The aim of the study was to investigate the influence on coagulation and platelet function of two 6% medium molecular weight hydroxyethylstarch solutions (HES, MW 200,000, DS 0.5) made of potato (K) and corn (M) starch. Twenty patients undergoing elective vertebral disc surgery were randomly assigned to one of the groups. Haemoglobin, haematocrit, protein concentration, fibrinogen, antithrombin III, factor VIII:C, von-Willebrand-factor, prothrombin time, activated partial thromboplastin time and platelet maximum aggregation and maximum gradient of aggregation (inductors: ADP, epinephrine, collagen and ristocetin) were measured before infusion and 30, 240 minutes and one day after infusion. ⋯ The infusion of a medium molecular weight solution is an effective and cost-saving method in volume therapy. Despite the physicochemical differences of the two HES solutions, there were no clinically apparent effects on coagulation and platelet function. Both preparations of HES up to a volume of 1,000 ml can be used equally in the clinical setting.