Der Anaesthesist
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The aim of this follow-up study was to find out if severely injured patients with multiple organ failure (MOF) show any organotopic sequelae in the late course. Additionally the occupational rehabilitation result as well as the reasons for a poor occupational result were investigated. ⋯ Severely injured patients who survive MOF during their intensive care treatment, show no sequelae of organ failure. The occupational rehabilitation results were excellent with a "return to work rate" of 64% which was dependent on the severity of head injury, a decreased range of motion of the hip joint and general physical fitness.
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Fiberoptic intubation for the management of the difficult airway is usually achieved with the patient under light sedation. The goal of the present study was to evaluate the combination of propofol and remifentanil for sedation during fiberoptic intubation. ⋯ Our combination of remifentanil and propofol was shown to be a safe sedation regimen for fiberoptic intubation. Monitoring ventilation via nasal capnography and arterial oxygen saturation via pulse oximetry provided sufficient patient safety.
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The robot device "da Vinci" represents the latest stage in laparoendoscopic surgery. We report the first two cases worldwide of endoscopic Nissen fundoplication with a telemanipulatory robot system in two children, aged 10 and 12 years. In addition to standard monitoring, we used invasive blood pressure monitoring during the 300 min periods of general anesthesia. ⋯ Robot-assisted techniques may possibly add significant progress and improvement to laparoendoscopic surgery. Nonetheless, we conclude that, despite our first encouraging results, potential risks of robot-assisted surgery have not yet been definitively defined. Therefore, patients are in need for intensive and even invasive monitoring, unless a larger number of patients has been studied.
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Case Reports
[Transesophageal echocardiography as intraoperative monitoring for the resection of an intra-atrial tumor].
Fibrolamellar hepatocellular carcinomas (FLHCC) can grow into the inferior vena cava and the right atrium thus rendering it impossible to insert a pulmonary artery catheter or increasing the risk of tumor embolisation. We report of a young patient with intraatrial growth of a FLHCC where intraoperative transesophageal echocardiography (TEE) instead of a pulmonary artery catheter for continuous monitoring of hemodynamics was used. Hemodynamic parameters as well as the surgical result could easily be assessed.