Der Anaesthesist
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Comparative Study
[Comparison between the laryngeal tubus S and endotracheal intubation. Simulation of securing the airway in an emergency situation].
The value of the laryngeal tube S (LTS) for emergency airway management was evaluated in comparison to endotracheal intubation (ETI). ⋯ The LTS represents a fast and reliable method to secure the airway and to achieve ventilation in the mannequin model described. The success rate, the time until successful ventilation and the rating by the participants indicates that the LTS is an important alternative to ETI. The LTS offers special benefits for the less experienced users.
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In unconscious, spontaneously breathing and anaesthetised children, a high incidence of partial or complete airway obstruction jeopardizes sufficient oxygenation. In this situation, the most important and efficient manoeuvre is to open up the upper airway. Chin lift, jaw thrust and continuous positive airway pressure (CPAP) are proven and effective methods for opening an obstructed upper airway. In addition to these simple airway manoeuvres, different techniques of body positioning (e.g., lateral positioning or supine position in combination with the "sniffing position") are effective to improve and maintain upper airway patency.
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Review
[New perspectives for simulator-based training in paediatric anaesthesia and emergency medicine].
Anaesthesia and emergency medical care for infants and toddlers is often associated with high clinical demands and specific challenges. Nevertheless, a significant proportion of interventions is performed by anaesthetists and emergency physicians with no specialised paediatric training and little experience in the management of anaesthetic incidents and emergencies specific to these age groups. ⋯ Recently, high-fidelity infant simulators have become available, which permit authentic exposure to a large spectrum of scenarios in paediatric anaesthesia and emergency medicine. A multimodular concept of training, including such simulator-based techniques, may relieve the widespread shortage in clinical experience, and hence greatly facilitate improvement of quality of care and patient safety.
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Randomized Controlled Trial Comparative Study
[Use of the size 3 ProSeal laryngeal mask airway in children. Results of a randomized crossover investigation with the Classic laryngeal mask airway].
The low-pressure airway seal of the Classic laryngeal mask airway (CLMA) can be inadequate for positive pressure ventilation (PPV) in children. The ProSeal laryngeal mask airway (PLMA) forms a more effective seal of the airway than the CLMA and facilitates gastric tube placement in adults. The size 3 PLMA can be used in adults and children. ⋯ The high reliability of g-tube placement and the significantly increased airway leak pressure seem to make the size 3 PLMA a more suitable device for PPV in children than the same size CLMA.
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During the last decades anesthesia has developed into a wide ranging specialty in western countries, whereas in most developing and newly industrializing nations it still focuses on its core discipline, the perioperative care of the surgical patient. Poor socioeconomic status and inadequate financing of health systems result in a high burden of disease, a high rate of self-financing of healthcare costs by the patients, as well as insufficient personnel, infra-structural and material equipment of most healthcare facilities. Important limiting factors for anesthesia are low educational standards and a widespread lack of oxygen and medical gas supplies, as well as locally serviceable medical equipment. Studies evaluating the status of anesthesia in developing and newly industrializing nations in detail are urgently needed in order to provide aid on national and international as well as institutional and private levels for the development of anesthesia in poor countries.