Der Anaesthesist
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Case Reports
[Endotracheal intubation of patients with Pierre-Robin sequence. Successful use of video intubation laryngoscope].
Patients with Pierre Robin sequence are a classic model for patients with a difficult airway. In these patients tracheal intubation may be facilitated using the lateral approach. In a 3-day-old newborn with Pierre Robin sequence, scheduled for anaesthesia to take a mould of the cleft palate, we used a video-intubation laryngoscope to give a video-display of the lateral approach intubation technique to the junior colleagues. ⋯ In addition, video-transmission of the laryngoscope picture enabled the attendant anaesthetist to quickly recognise the need for suctioning the hypopharynx and to coordinate the direction and extent of laryngeal pressure according the video-laryngoscopic findings. Of special value for the intuboscopist was the improved view of the cords provided by the video-display compared with direct laryngoscopy. This facilitated a non-traumatic insertion of the tube into the trachea and allowed reliable confirmation of the intubation depth by the tube marking between the vocal cords.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Cisatracurium in coronary bypass operations--a comparison with pancuronium. Hemodynamic and neuromuscular effects in patients under chronic beta blocker treatment].
The aim of the study was to compare haemodynamic and neuromuscular effects of cisatracurium and pancuronium in patients undergoing coronary artery bypass grafting (ASA III, good or moderately impaired LV function) who were chronically medicated with beta-adrenergic blocking agents. ⋯ Under high-dose opioid induction, bradycardia must be considered if cisatracurium is administered to cardiac surgery patients.
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Anemia is a frequent finding, particularly in the elderly population, and usually indicative of a serious disease. The main causes of preoperative anemia are acute or chronic hemorrhage, iron deficiency, renal insufficiency, inflammatory and neoplastic diseases. A preexisting mild anemia may be enhanced or unmasked by surgically induced bleeding or repeated diagnostic phlebotomies, and by a postoperative erythropoietic dysfunction caused by the surgical trauma, irrespective of any hemorrhage. ⋯ Time permitting, the patient's cardiovascular and pulmonary status should be optimized preoperatively. Furthermore, iron should be substituted to treat and prevent deficiency. Recombinant human erythropoietin has successfully been used to treat anemia of chronic renal failure and chronic disease, as well as in the perioperative and intensive care setting, and to support the efficiency of autologous programs.
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Clinical Trial
[Ultrasonography and peridural anesthesia. Technical possibilities and limitations of ultrasonic examination of the epidural space].
Epidural anaesthesia (EA) is the most important analgesia technique in obstetrics for delivery. In pregnancy, hormonal adjustments lead to an alteration of tissue consistency, which often causes an early, untimely loss of resistance. Apart from mere inspection and palpation, no useful diagnostic method prior to EA performance has been established yet. ⋯ Ultrasonography offers the possibility to determine site and direction of epidural puncture and distance of the epidural space to the skin even before the puncture attempt. The ultrasound controlled EA for delivery can easily be inserted into the clinical routine. Ultrasonography can fill an important diagnostic gap in regional anaesthesia.