Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[Movement of the temporomandibular joint during tracheal intubation].
Laryngoscopy causes temporary postoperative dysfunction of the temporomandibular joint (TMJ): during iatrogenic TMJ manipulation in anaesthetised patients, the TMJs have lost the protection afforded by the tone of the surrounding muscles. Thus far, the exact type and extent of TMJ movements have not been known. The purpose of this study was to develop a method to visualise and assess TMJ movements during intubation by means of electronic axiography, a diagnostic monitor of TMJ movements used in dentistry: registration of the hinge axis (HA) as an equivalent of the condylar paths on extra-oral sagittaly mounted, parallel plates. ⋯ MOTs and EITs were recorded and analysed with the system described and typical EIT patterns were identified: bland, clinically uneventful intubations (n = 7), massive distraction and laterotrusion of the EIT compared to the MOT (n = 24), and blocked or limited TMJ movements resulting in intubation problems (n = 1). With the method presented, TMJ movements could be visualised during endotracheal intubation for the first time. It can be used to assess techniques, routes, and instruments for intubation as well as to evaluate potential traumatising movements during endotracheal intubation.
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Trauma and associated major blood losses in Germany represent the leading cause of mortality in patients up to 45 years of age. The endpoints of prehospital fluid resuscitation in traumatic-hemorrhagic shock are the restitution of intravascular volume und cardiac preload, in order to increase cardiac output and thus provide adequate oxygen delivery to the tissues. The key therapeutic factor to prevent the development of multiple organ failure complicating trauma and shock, however, is the normalization not only of macrohemodynamics (systemic blood pressure. cardiac output), but the restitution of the disturbed microvascular perfusion. ⋯ A new concept consists of i.v. bolus infusion of a small volume (4 ml/kg body weight) of a hyperosmolar (7.2-7.5%) NaCl/colloid solution, which is termed "Small-volume Resuscitation". Recently presented data from a cohort analysis of 8 preclinical studies show an increase in survival rate by about 5% when compared to standard of care. In addition, artificial oxygen carrying solutions are currently investigated. by which-through an increase of O2-blood content-oxygen delivery to the tissues might be augmented.
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Comparative Study
[Accuracy of measurement and overestimation of CO2 of two capnometers intended for potential use in emergency medicine].
Capnometry, the noninvasive measurement of end-expiratory CO2 concentration (cCO2, vol%) or calculation of its respective partial pressure (pCO2; mmHg) is an established method. However, for prehospital settings, capnometry is still used very restrictively, mainly owing to the respective devices used. The prerequisite for their use is sufficient accuracy (+/-2 mmHg) and easy handling. Two special capnometers (STAT CAP. Nellcor: mainstream, semiquantitative estimation; Capnocheck 8200, BCI: sidestream, quantitative measurement, numeric display), developed recently for potential use in emergency medicine, are said to fit these criteria. Therefore, the objective of the present investigation was to assess the accuracy and precision of both devices, comparing methods under standardized in vitro (reference gases) and in vivo (intubated and ventilated patients) conditions. ⋯ Evaluation of the accuracy of capnometers must focus on the necessary pH2O correction and the possible effects exercised by O2 (and N2O) as well as the possible dependence on barometric pressure (if pCO2, mmHg, is the desired value). The "Capnocheck" showed an accuracy of more than 2 mmHg in dry gas mixtures as well as in humidified air. Concerning the practical use during constant artificial ventilation, the digital display and accuracy of the sidestream capnometer allow for reliable conclusions on patients' ventilation and circulation (CO2 elimination). The 90% accuracy of the segment bar display of Nellcor's "STAT CAP", per se covering only a rather broad range of 20 mmHg, obviously does not provide more than a rough overview. Therefore, the STAT CAP cannot be recommended for prehospital capnometry in the field. However, both the accuracy of the BCI capnometer (Capnocheck) and its numeric display and easy handling strongly recommend this device also for clinical use.