Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 2005
Review[Infection control measures in anaesthesia].
Several reasons such as ignorance, convenience, or economical considerations might lead to disobeying basic hygiene measures in anaesthesia. The most important recommendations are for: 1. General anaesthesia: bacterial filters prevent breathing circuit contamination from patient's expiratory secretions. ⋯ One-way-valves do not securely prevent retrograde contamination of the infusion system. Do not use multi dose vials unless declared by manufacturer. Alcoholic hand disinfection is the most important measure in order to avoid nosocomial pathogen transmission and infection.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 2005
Review Historical Article[Development and current status of combined spinal epidural anaesthesia].
Combined spinal and epidural anaesthesia/analgesia is a method whereby drugs are applied intrathecally as a single dose and epidurally either continuously or intermittently via an epidural catheter. More than 50 years ago, first attempts were made to introduce this method into clinical practice but they found little general acceptance. ⋯ This review describes the main and most important developmental steps and offers practical examples for its use in day-case surgery of the lower limb, in the "walking epidural" in obstetrics and in caesarean section. The method has become a valuable new tool in the armamentarium of the anaesthetist and part of daily routine in many clinics.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 2005
Comparative Study Clinical Trial[The applicability of the ProSeal laryngeal mask airway for laparotomies].
The ProSeal laryngeal mask airway (PLMA) has some design features, which in contrast to the classic LMA allow separation of the respiration from the gastrointestinal canal, a higher leak pressure and a better position assessment. It can be debated if these instrumental improvements justify the application of the PLMA for elective abdominal surgery in cases without aspiration risk. Insertion of airway instruments and gastric tube with regard to insertion time and difficulties and frequency of side effects were to be compared for the tracheal tube and the PLMA. The pharyngolaryngeal morbidity for both methods was also of interest. It was approached with direct and indirect postoperative interview techniques. ⋯ In this investigation the PLMA could be successfully applied for elective laparotomies in cases without the risk of aspiration. Proper patient selection and a deep level of anaesthesia are important. The advantage for patients receiving the PLMA is a smooth recovery without cough, but not so much a reduced amount of pharyngolaryngeal morbidity. From this observation it might be concluded that the invasiveness of the surgical intervention might also influence the tolerance for the airway instrument. The disadvantage in this study was the more difficult insertion of the PLMA compared with the oral intubation. Further studies with a larger number of patients must show if these first results of the "Proseal"-LMA for lararotomies are to be confirmed.