Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1993
Review[The laryngeal mask--an overview 1983-1993].
The laryngeal mask which was developed by Brain in 1981 and described for the first time in 1983 has been employed worldwide a million times since 1989. Traditionally, all anaesthesiologists are oriented towards the techniques of conventional mask anaesthesia or endotracheal intubation. This new alternative, however, amazes by its easy handling and its concept: insertion of the mask directly onto the larynx without irritating it and sealing the pharynx at the same time thus allowing sufficient ventilation. ⋯ However, cases of difficult intubation may be greatly facilitated. All users appreciate the reliability of the laryngeal mask in daily routine even though some fear that more difficult and safer techniques of anaesthesia might be forgotten. The indications of the laryngeal mask expand rapidly at the moment and the fast trend in its spread might continue if this method is not discredited by violations of its contraindications: full stomach, extreme obesity and low compliance of the lungs.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1993
Case Reports Comparative Study[The laryngeal mask versus intubation in difficult intubation conditions in the Franceschetti-Zwahlen-Klein syndrome (Treacher-Collins syndrome)].
A twenty-nine-year-old man suffering from Franceschetti syndrome requiring a retinal detachment operation was successfully anaesthetised using the laryngeal mask airway. The laryngeal mask has many advantages compared to endotracheal intubation in patients suffering from craniofacial abnormalities i.e. hypoplasia of the mandibular bone and ventral position of the larynx. ⋯ However, the facilities of fibreoptic bronchoscopy should be readily available. The physician should have gained confidence in using a laryngeal mask before employing this device in cases of difficult intubation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1993
[The laryngeal mask with > 1900 general anesthesias--report of experiences].
Since November 1990 until January 1993, the laryngeal mask airway was employed for 1925 general anaesthesias, i.e. 19.6% of all general anaesthesias in our hospital. On the basis of the protocols the age distribution of the patients, the practice of anaesthesia (premedication with oral benzodiazepines, induction with thiopental, anaesthesia sustained with enflurane/nitrous oxide/oxygen) and the complications are reported. ⋯ One aspiration was recorded, but could not be attributed to the laryngeal mask. Complications with major influence on the postoperative course and hospital stay were not seen.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1993
Case Reports[An unconventional use of the laryngeal mask for the therapy of a postoperative atelectasis-induced respiratory insufficiency].
A 90-year-old cardiopulmonary high-risk patient had to undergo a laparatomy due to a perforated ulcus ventriculi. Postoperatively he developed pulmonary insufficiency due to an atelectasis of the upper right pulmonary region. The clinical situation deteriorated because of dyspnoea and exhaustion. ⋯ Reintubation involving the necessity of relaxation and anaesthesia could be avoided by this unconventional use of a LMA. This case report confirms the good tolerance and easy handling of the LMA. It demonstrates a further application of the LMA, which is not only a new device but a new idea of airway management.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1993
Randomized Controlled Trial Clinical Trial[Postoperative pain therapy following total endoprosthetic surgery on the hip using a continuous 3-in-1 blockade].
40 patients who had undergone total hip replacement were included in a randomised prospective study. Postoperative pain management was performed with a continuous 3-in-1 block combined with demand-adapted intravenous meperidine titration (3-in-1 catheter group; n = 20) or by demand-adapted intravenous meperidine titration alone (control group; n = 20). The 3-in-1 catheter was placed before the start of anesthesia, and the patients received 30 ml 0.5% bupivacaine via this catheter. ⋯ Placement of the 3-in-1 catheters was without complications. For the management of postoperative pain following total hip replacement a continuous 3-in-1 block alone was often insufficient but postoperative meperidine requirements were significantly reduced (p < 0.05). Toxic bupivacaine plasma concentrations were not measured.