Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 2003
Review[Management of pediatric airway--anatomy, physiology and new developments in clinical practice].
Due to the special features of paediatric anatomy and physiology, the expected and unexpected difficult paediatric airway is one of the major challenges to every anaesthesiologist, paediatrician and emergency physician. During the last years, some new devices have been made available to improve airway management in children and infants, and several studies have advanced our understanding of the risks and benefits of our clinical practice. ⋯ Recent studies have also demonstrated specific problems with the LMA in infants, as well as possible advantages of a new prototype LMA for children, similar to the ProSeal. Furthermore, the following review presents data about the use of the Cuffed Oropharyngeal Airway (COPA) and the Laryngeal Tube (LT) in paediatric patients.
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A tracheal tear requires fast and proper treatment. A 55-year-old man working in a sewage pipe slipped and hit his neck on the edge of a concrete ring. The patient showed the following symptoms: cervical bruising, neck emphysema and increasing dyspnea. ⋯ Due to an injury to both laryngeal nerves, the patient suffered from dysphagea, whispered speech and dyspnea on minimal exertion as long-term side-effects. A lateralization of the vocal cord was made eight months later. Because of the quick assessment of the situation and proper treatment of the patient at the site of the accident, the patient was able to survive the injury.
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Anaesthesiol Reanim · Jan 2003
Historical Article[Relations of German anesthesiology to east European societies of anesthesiology].
On the occasion of the 50th anniversary of the foundation of the "German Society of Anaesthesiology" (DGA)--later called "German Society of Anaesthesiology and Intensive Care Medicine" (DGAI)--which was founded on 10 April 1953, and in memory of the foundation of the "Section of Anaesthesiology", which was founded in East-Berlin ten years later on 25 October 1963 and later called "Society of Anaesthesiology and Intensive Therapy of the GDR" (GAIT), the development of relations between German anaesthetists and anaesthesiological societies in East Europe are described. The limited economic base of the medical-technical and pharmaceutical industries, a chronic lack of hard currencies and economic and political restrictions on travel activities by East German and East European anaesthetists to West European countries resulted in improved contacts between East German and East European anaesthesiological societies. This, in turn, led to the holding of "International Anaesthesiological Congresses" of the so-called socialist countries and "Bilateral Symposia of the Anaesthesiological Societies of Czechoslovakia and the GDR" and also bilateral meetings of nurses of anaesthesiology and intensive therapy from both countries. ⋯ The German members of this association, in particular its Secretary-General, Prof. Dr. Reinhard Purschke/Dortmund, organize postgraduate courses including theoretical lectures and practical work not only in Russia but also in Armenia and Usbekistan.
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Elements of the "open lung concept" are being increasingly included in clinical ventilatory strategies. Despite encouraging experimental investigations to date, relatively few studies exist that examine the clinical application of the complete concept. The aim of this study was to prove that with effective recruitment maneuvers and titrated PEEP levels this concept is applicable in clinical settings. ⋯ Due to elevated liver enzymes within the first 48 hours, titrated PEEP had to be decreased in three patients. The clinical application of the "open lung concept" demonstrated a quick and effective improvement in oxygenation in many patients. Side-effects in some patients limited the use of high PEEP levels.
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Delirium is mental dysfunctions occurring as impaired attentional and memory systems with disturbances of consciousness, affectivity, psychomotor activity and sleep patterns. Numerous factors and underlying diseases may be responsible for these non-specific symptoms. Therefore, a thorough evaluation of preadmission history and current clinical status, supplemented by laboratory and extended technical diagnostic procedures, are always required. ⋯ Personal care should be intensified and include help from family members. Most problems arise from agitated, non-cooperative patients. Treatment with clonidine, gamma-hydroxybutyric acid or neuroleptic drugs like perazin and haloperidol may be required to reduce agitation and the activation of sympathetic influence.