Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 1997
Randomized Controlled Trial Comparative Study Clinical Trial[Use of the laryngeal mask in adenoidectomy in childhood--a comparison with endotracheal intubation].
Anaesthesia for adenoidectomy is possible during infancy without succinylcholine. One possibility is intubation with vecuronium bromide, whereas another possibility is the use of the laryngeal mask (LMN). The conditions for intubation as well as further details during anaesthesia are listed and compared. ⋯ LMN takes time to get used to, and places greater demands on the anaesthetist. Success of LMN depends on the cooperation and collaboration to the surgeon to lower the risk of complications. Once specific improvements in the LMN have been made, it may become the standard method for adenoidectomy in future. It is already used by us and in some outpatient departments, as well as in England and America. Our suggestions are as follows: Aims at convincing the surgeons and improving their co-operation; No routine fixation of the laryngeal mask. The laryngeal mask should be kept slightly taut before opening--preferably slowly--the mouth clamp; possible technical modifications of the mouth clamp itself, which produce a wider gap, could be adapted to the new conditions of the wider LM; reaching the necessary depth of anaesthesia through higher doses of propofol or possibly by total intravenous anaesthesia; routine wearing of the LM in the recovery room until it is no longer tolerated by the child.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 1997
[Fiber optic intubation using a modified laryngeal mask. Report of experiences with use in 105 patients].
This study was made to investigate the suitability of a modified laryngeal mask airway as an aid for fibreoptic endotracheal intubation in patients with a difficult airway. We used a laryngeal mask airway split lengthwise on its convex site, the incision going from a point corresponding to the teeth down to the base of the cuff. The cuff remains uncut. By this modification it is possible to ventilate an anaesthetised patient and to pass down a fibreoptic bronchoscope via splitting of the laryngeal mask airway into the trachea at the same time. An endotracheal tube of any diameter already mounted over the bronchoscope is then guided into the trachea. The feasibility of this technique was tested and haemodynamic reactions and changes of the parameters of respiration were recorded. ⋯ It could be demonstrated that a fibreoptic intubation is possible in cases of a difficult airway using the technique described here. There is no haemodynamic strain on the patient. This method can be carried out without pressure of time and without to endanger the patient by hypoxia as the patient can be ventilated during the fibreoptic intubation. In cases of impossible intubation and insufficient mask ventilation it can be tried to establish ventilation and to avoid a emergency surgical airway or transtracheal jet ventilation by using this technique.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 1997
Case Reports[Severe aspiration pneumonia with the laryngeal mask].
The anaesthesia management of a 10-year old girl with a fracture to her distal arm is presented, using inhalational anaesthesia with a laryngeal mask and a supplementary axillary plexus block. Due to light anaesthesia the patient vomited during the course of surgery resulting in a severe pulmonary aspiration necessitating four days of mechanical ventilation in the ICU. The safety of the laryngeal mask airway for emergency surgery is discussed.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 1997
[Experiences with use of the laryngeal mask with flexible, wire reinforced tube for ENT interventions in childhood].
This is a report on experiences regarding the use of the reinforced laryngeal mask airway for 121 minor operations in paediatric otolaryngology. By far the most interventions were adeno-tonsillectomies (104), which until now were performed under general anaesthesia with tracheal intubation. ⋯ The use of the reinforced laryngeal mask airway during paediatric otolaryngological operations in the hand of an experienced anaesthetist appears to be a promising alternative to tracheal intubation and merits more widespread use.