Der Anaesthesist
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The use of endotracheal tubes with a cuff is controversial in infants and small children. Often anaesthetists advocate extreme opinions and whereas some propagate the use of cuffed tubes in all cases without restriction, others condemn their use in infants and small children under all circumstances. In this article, the discussion concerning the use of cuffed endotracheal tubes in infants and small children is based on current data and arguments. ⋯ However, acquired subglottic stenosis might represent a severe long-lasting complication. Regardless as to whether tubes with or without cuffs are used, a disproportion between the outer diameter of the tube and the inner diameter of the nonexpandable cricoid ring is the main reason for the genesis of this lesion. A continuous monitoring of the cuff pressure is recommended when using cuffed endotracheal tubes in this age group.
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Randomized Controlled Trial Clinical Trial
[Prevention of "post-sevoflurane delirium" with midazolam].
In a randomized double-blind placebo-controlled trial in children 2-7 years of age, we investigated the effect of a single prophylactic midazolam bolus (0.1 mg/kg b.w.) prior to the termination of anaesthesia, on the incidence and severity of agitation occurring after sevoflurane administration. Compared to the placebo group, midazolam prophylaxis significantly decreased the incidence of postanaesthetic delirium. However, the incidence of severe agitation requiring treatment was not different between the groups (placebo: n = 6; midazolam: n = 4). ⋯ All patients were discharged from the recovery room after the 2 h observation period. From our study we conclude that a small prophylactic midazolam bolus is able to reduce the incidence and severity of agitation after sevoflurane anesthesia in some patients but is insufficiently effective in patients with severe agitation. Thus, the prophylactic administration of midazolam extenuates but does not solve the problem of post-sevoflurane agitation.
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Randomized Controlled Trial Clinical Trial
[Urapidil for treatment of postanesthetic shivering following general anesthesia. A placebo controlled pilot study].
Postanaesthetic shivering is common during recovery from general anaesthesia. Therefore we studied whether urapidil suppresses postanaesthetic shivering. ⋯ In a placebo controlled trial, it was demonstrated that postanaesthetic shivering can be successfully treated by urapidil in 70% of the patients.
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Cytokines are a heterogeneous group of polypeptides that were originally described to mediate activation of the immune system and inflammatory responses. Most of them have meanwhile been shown to be also produced by and act on the peripheral and central nervous system. There is ample evidence from experimental studies that proinflammatory cytokines induce or increase neuropathic pain as well as inflammatory pain. ⋯ Studies with cytokine knock-out animals often lead to different results from the pharmacological studies. This is in part due to compensatory mechanisms in the animals combined with the high redundancy of the cytokine system. Preliminary data from human studies are encouraging insofar as in the future, cytokine inhibition may add to the panel of treatment modalities for neuropathic pain.
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Review Comparative Study
[Crystalloid versus colloid. A never ending story?].