Der Anaesthesist
-
Coordination of respiratory care with protection of the brain is critical in neurosurgical intensive care. Therefore, in addition to hyperventilation, adequate sedation and muscle relaxation are applied to mitigate the difficulties with control of intracranial pressure (ICP) during routine tracheobronchial suctioning (TBS). Although hypnotics have been shown to be effective in mitigating increases in ICP in response to endotracheal suctioning in paralyzed patients, brisk bucking and coughing with further increases in ICP may occur without muscle relaxation. ⋯ Despite the postulated faster onset of nm blockade in the diaphragm, suppression of thumb-twitch response to TOF stimulation does not necessarily predict absence of diaphragmatic movement elicited by excessive tracheal stimulation. As demonstrated, intense nm blockade quantified by a PTC of 5 is necessary to rule out any bucking and coughing, i.e., to ensure total diaphragmatic paralysis in response to tracheal stimulation. On-line neurological evaluation, one of the essentials in the approach to the neurosurgical patient, will not be prevented by the intermittent bolus regime utilized in this study.
-
A computerized database for use in pediatric anesthesia and in the perioperative care of patients with malformation syndromes and rare diseases is presented. A total of 2200 syndromes are listed, and the database contains helpful data, experience, guidelines and literature references relevant to about 500 rare diseases. The access to the databank, its structure and the probable benefits of the system are explained and discussed.