Der Anaesthesist
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In this study we compared operating room (OR) efficiency of total intravenous anaesthesia (TIVA) with remifentanil and propofol and balanced anaesthesia (BAL) with fentanyl and isoflurane in cataract surgery using computersimulation. We simulated patient flow for one OR and for three ORs. Time intervals of patient flow were randomly generated from the results of a prospective, randomized trial. ⋯ Overtime in the PACU was less after TIVA. With a workload of 13 or 15 operations per day in three ORs, monitoring equipment for an additional patient in the PACU was required when BAL was used. TIVA with remifentanil and propofol was associated with more OR efficiency than balanced anaesthesia with fentanyl and isoflurane when given for cataract surgery.
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The last survey addressing postoperative pain management in Germany was published in 1987, special data concerning postoperative pain management in pediatric patients had not been presented previously. The goal of this survey is to present the standard of postoperative pain management in pediatric patients in Germany. A detailed questionnaire was mailed to all German anaesthesia departments and interdisciplinary intensive care units (n = 1,500) to determine the current management of postoperative pain management in pediatric patients. ⋯ The routine use of non-steroid antiinflammatory drugs (NSAIDs) and spasmolytics as well as the application of regional anaesthesia techniques is uncommon in pediatric postoperative pain management. Compared to other European countries, patient- or parent-controlled analgesia is more popular in Germany. Despite modern concepts of organization and a great variety of drugs available today, 71.1% of the responding anesthesiologists in this survey still believe that pediatric postoperative pain management needs to be improved.
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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.