Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1997
Comparative Study[Comparison between continuous and intermittent thermodilution measurement of cardiac output during coronary artery bypass operation].
Continuous recording of cardiovascular parameters ranks high in cardioanaesthesia. Various methods to measure the cardiac output have been developed within a period of a few years. We compared the bolus thermodilution method (COI), which has been internationally adopted as "gold standard" method, with the continuous thermodilution method (CCO) for measuring the cardiac output by means of the CCO Vigilance Monitor. Our aim was to find out whether cardiac output can be determined with valid results during coronary artery bypass surgery when using CCO. ⋯ Literature references show that the continuous thermodilution method is not only valid for intensive-care long-term measurement of cardiac output with approximately stationary haemodynamics, but also-as our results prove-valid if haemodynamics are not usually stationary, such as during coronary artery bypass surgery. The pros of the continuous thermodilution method are that no additional equipment is required apart from the standard equipment used in intensive-care medicine and cardio-anaesthesiology: that there is no stress caused by volume; and that manipulation is safe because no calibration routine is needed and also because measurement and analysis techniques are fully automated. Hence, we are of the opinion that the intraoperative use of this cardiac output measurement technique during open heart surgery is clinically indicated.
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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.