Der Anaesthesist
-
Mucopolysaccharidosis IVA (Morquio-Brailsford syndrome) results from an inborn deficiency of n-acetyl-galactosamine-6-sulphate sulphatase. Clinical features include skeletal deformities with hypoplasia or absence of the odontoid process of the axis. The resulting atlanto-axial subluxation compresses the spinal cord, resulting in cervical myelopathy. ⋯ Analgosedation with ketamine and midazolam allows sufficient spontaneous breathing and--to some extent--maintenance of protective laryngeal reflexes. In conclusion, anaesthetic management of patients with Morquio-Brailsford syndrome is a challenge that is further increased by extending indications for surgical intervention to include infants. With respect to protecting the airway, fiberoptic nasotracheal intubation of the spontaneously breathing child is our method of choice.
-
Randomized Controlled Trial Comparative Study Clinical Trial
[Fiberoptic intubation and stress].
Nasotracheal intubation of the trachea by means of fiberoptic endoscopy is an accepted approach to difficult airways. The associated avoidance of direct laryngoscopy may affect the stress response to nasotracheal intubation. We tested this hypothesis by means of a prospective, randomized, controlled clinical study. ⋯ Nasotracheal intubation does not provoke a major stress response, when performed in accordance with the protocol of this study. However, topical anaesthesia of the larynx, as well as the fiberendoscopic approach proved superior to control with respect to diastolic arterial pressure. We conclude that fiberoptic nasotracheal intubation, or laryngoscopy preceded by topical anaesthesia of the larynx may be useful in patients for whom an increase in rate pressure product would be undesirable.
-
Randomized Controlled Trial Clinical Trial
[The incidence of postoperative pain on general surgical wards. Results of different evaluation procedures].
Knowledge of the incidence and significance of postoperative pain is essential for the establishment of effective pain treatment programmes. Detailed investigations on the incidence, severity and quality of postoperative pain from the surgeon's perspective are scarce in German hospitals. It was the aim of our study to investigate postoperative pain in general surgery under routine conditions. ⋯ CONCLUSIONS. We conclude from our results that patients perceive significant postoperative pain under current standardized pain treatment in our department. Effective programmes for pain relief should take account of the different patterns of pain after different operations, as identified in this study.
-
Hereditary or acquired disorders of coagulation often lead to the question of whether it is permissible to perform regional anaesthetic techniques. Disorders of coagulation that cannot be treated are generally contraindications to regional anaesthesia. The history and clinical findings represent the most important measures before employing a regional anaesthetic technique. ⋯ In addition to coagulation studies, the use of regional anaesthetic techniques during simultaneous anticoagulant treatment requires a clear arrangement with the operative department in question. In most instances there will be a tendency to perform general anaesthesia, however, considering the fact that general anaesthesia is also associated with complications (intratracheal bleeding), regional anaesthesia represents an alternative method, especially in patients with significant concomitant disorders. In this situation the possibility of peripheral nerve blockade should be taken into consideration.
-
Randomized Controlled Trial Clinical Trial
[ST segment changes in the ECG. Anesthesia induction with propofol, etomidate or midazolam in patients with coronary heart disease].
Induction of anaesthesia with propofol and fentanyl can lead to marked reductions in mean arterial pressure (MAP) and heart rate (HR). Thus, the application of propofol in patients with severely reduced coronary artery perfusion is controversial. METHODS. ⋯ Despite marked reductions in MAP in the P group, the number of patients with ischaemic ECG changes was cut by half. Their number was unchanged or even raised in the other groups. After application of P, with an alleged reduction of coronary perfusion, a compensational reduction in myocardial oxygen consumption may occur.