Der Anaesthesist
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Tracheostomy is one of the oldest surgical procedures and in the past decades has become the method of choice in the management of patients requiring long-term mechanical ventilation. At present, several alternatives exist to conventional surgical tracheostomy, such as the percutaneous dilatational techniques according to Ciaglia (PDT), Griggs (GWDF), and Schachner (Rapitrach). In particular, PDT according to Ciaglia which was introduced in 1985, has been recognized as an equally safe, but less expensive procedure than conventional tracheostomy. ⋯ Nonetheless, we believe that percutaneous procedures should only be performed by experienced physicians who are well-trained in both endotracheal intubation and mask ventilation. Furthermore, the capacity to perform surgical tracheostomy immediately in case of complications should be given. Only if the contraindications are carefully observed, will these new procedures retain their value and benefit in airway management of long-term ventilated patients.
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Randomized Controlled Trial Clinical Trial
[Rocuronium for anesthesia induction in elective procedures. Time course of muscular blockade and intubation after administration of 2-compartment ED95 (0.6 mg/kg) and dose reduction (0.4 mg/kg)].
Rocuronium is a non-depolarising neuromuscular blocking agent structurally related to vecuronium. The compound has a rapid onset and an intermediate duration of action. The rapid onset is of importance in patients at risk for pulmonary aspiration, for elective induction of anaesthesia slower onset properties generally are accepted. In this context, we asked whether the induction dose of rocuronium may be reduced to doses smaller than 2 x ED95 in situations in which slower onset properties may be acceptable. ⋯ In the present study dose reduction from 0.6 mg/kg rocuronium to 0.4 mg/kg rocuronium led to a slower onset and reduced clinical duration. However, the intubating conditions, evaluated 3 min after injection of the muscle relaxant were comparable. This offers new possibilities for muscle relaxation for surgical or diagnostic procedures of short duration and may reduce costs.
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Clinical Trial
[Development of a new closed-loop system for controlling mivacurium-induced neuromuscular blockade].
There are many closed-loop control systems for muscle relaxants reported, but only a few could cope with the introduction of the latest shorter acting neuromuscular blocking drugs. These new muscle relaxants such as mivacurium require a fast adapting closed-loop system for controlling an adequate infusion. ⋯ A closed-loop system for control of a mivacurium infusion could be established. The system proofed to be reliable for a closed-loop infusion of mivacurium in order to maintain a predefined degree of neuromuscular blockade of 95% during routine surgery. The performance of the described controller is comparable to all recent attempts and could therefore be useful for scientific studies. It should be further validated and established for other muscle relaxants, as well.
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We report on a case of a lumbar epidural abscess with staphylococcus aureus following a catheter epidural anaesthesia in a previously healthy and not immunosuppressed 34-year-old female. The indication for the epidural anaesthesia was mobilization of the right knee following arthrotomy due to chronic synovitis. On postoperative day 7 the patient experienced lumbar pain, headache and meningism. ⋯ The patient was discharged from hospital on postoperative day 21 without any neurological sequelae. This is another addition to the published cases of epidural abscess following a epidural technique. It underlines the need for a proper aseptic technique, to abandon frequent changes of bacterial filters, daily examination of the entry site of the catheter and strategies for close and continuous monitoring of patients following epidural anaesthesia.