Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2004
[The unexpectedly difficult airway -- a plea for the oxford-non-kinking-tube].
The skill to safely manage the unexpectedly difficult airway is expected from every anaesthetist. The strategies to safely overcome this severe problem have to be adapted to the given equipment and the individual aptitude and skills of the respective colleague. The algorithms for management of the difficult airway should be as simple as possible, and one cannot assume that devices for fibre-optic intubation are available at every site. ⋯ This paper is especially devoted to recalling the Oxford non-kinking tube and its specific way of handling, as a lot of cases of unexpectedly difficult airway can be safely managed with this tool. Alternatives to safeguarding the difficult airway are the intubation laryngeal mask airway or the esophago-tracheal combitube. For managing the worst case, the "cannot ventilate - cannot intubate" disaster, instruments for percutaneous punction of the trachea and devices for oxygen insufflation must be readily available in every theatre.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2004
Randomized Controlled Trial Comparative Study Clinical TrialSedation for fiberoptic bronchoscopy: fewer adverse cardiovascular effects with propofol than with midazolam.
To study the influence of the sedatives propofol and midazolam on cardiovascular parameters in patients undergoing fiberoptic bronchoscopy (FOB). ⋯ Propofol, when used as a sedative for FOB, is associated with lower hemodynamic side effects than in patients undergoing FOB with midazolam. In addition, it is well-tolerated by patients with pre-existing pulmonary disease. Even patients without a history of heart disease should be monitored for cardiac arrhythmia while undergoing FOB for pulmonary disease, especially patients with a FEV (1) of less than 50 % of the predicted value.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2004
[Outcome quality in terms of product safety in preoperative autologous blood donation].
The most common form of autologous blood transfusion is where blood is donated in anticipation of elective surgery. The aim of this study is to critically evaluate the product safety of autologous blood units. ⋯ Autologous blood components are prepared individually, and an established system of quality assurance with controls of processes and products is particularly important to meet quality standards. The red cell content of autologous units cannot be standardized as in allogeneic components. Due to the differences between the laboratory screening programmes for patients and donors, the risk of transmission of virus infections is different from that of allogeneic blood components. The quality of stored autologous red cells is comparable to that of allogeneic products. Results of systematic sterility monitoring lead to the conclusion that under the conditions practised the risk of transfusion-associated sepsis is not higher to that of allogeneic products. Soluble biological response modifiers which accumulate during storage, are assumed to be the cause of reactions that occur in one of 4,500 autologous transfusions. Incorrect allocation and handling errors continue to be a serious problem in autologous transfusions.