Der Anaesthesist
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Clinical Trial
[Laryngeal surgery with a 3-D technique. Early results with the jet-laryngoscope in superimposed high-frequency jet ventilation].
Surgery by three-dimensional (3D) endoscopy is being used routinely in abdominal surgery and, in special cases, in thoracic surgery; however, it has not been reported as being used in microlaryngeal surgery. METHODS. We inserted a 3-D endoscope into a jet laryngoscope and studied the pressure properties at the tip of the laryngoscope as well as intrapulmonary pressures while applying superimposed high-frequency jet ventilation. ⋯ In the clinical application of 3-D endoscopy via a jet laryngoscope, it was possible to achieve sufficient ventilation, inspection of the surgical field, and performance of the surgical procedure. A CO2 laser was used without changing the ventilation regime. Although technical alterations would be desirable for its application to microlaryngeal surgery, it is presently possible to safely use the 3-D endoscope via the jet laryngoscope for microlaryngeal surgery, presenting the surgeon with new possibilities in voice-improving microsurgery of the larynx.
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We report two cases of compartment syndrome of the lower leg that occurred in male patients aged 62 and 57 years, respectively, after 10 and 12-h urological surgery in the lithotomy position. During sedation and mechanical ventilation creatine kinase (CK) activity of more than 8,000 U/l was found in both patients. After extubation, clinical symptoms of the compartment syndrome were found. ⋯ The deep veins of the legs should be checked by phlebography. In cases of verified compartment syndrome, early fasciotomy is the best choice of therapy, because neuromuscular defects are known to be irreversible after 12 to 24 h. Enforced diuresis is recommended in order to avoid renal complications.