Der Anaesthesist
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Awake craniotomy in tumor and epilepsy surgery or for the implantation of electrodes for deep brain stimulation requires specific anesthesiological strategies. Propofol allows for quick emergence and has little effect on the respiratory function of the usually spontaneously breathing patient. ⋯ The airway may be secured by an ordinary Magill tube placed transnasally with its tip underneath the epiglottis. To protect the patient against vomiting an adequate antiemetic prophylaxis is required.
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Comparative Study
[Videolaryngoscopy versus direct laryngoscopy for elective endotracheal intubation].
We compared the ease of viewing the glottis under direct vision during conventional laryngoscopy with the quality of indirectly viewing on a monitor during laryngoscopy with a Macintosh videolaryngoscope in a multicenter study. ⋯ Videolaryngoscopy can lead to better viewing conditions but in rare cases it may result in worse viewing conditions.
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The purpose of this study was to investigate whether there is a risk of epidural catheter damage during the advancement of the spinal needle through an epidural needle in clinical use. ⋯ The CSE technique with either pencil-point type or Quincke-type spinal needles for subarachnoidal punctures was safe and showed no relevant epidural catheter damage.
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The Schwartz-Jampel syndrome, also known as myotonia chondrodystrophica, is a rare autosomal recessive disorder characterized by bone dysplasia, growth retardation and generalized myotonia. Laryngoscopy and intubation may be difficult because of micrognathia and limited mouth opening due to myotonia of the masseter muscles. ⋯ We report on a 5-year-old girl who underwent osteotomy of both hips and received intraoperative and postoperative analgesia via a caudal catheter. Excellent analgesia without myoclonic episodes could be achieved by continuous infusion of ropivacaine.
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The Intubating LMA was designed to facilitate blind intubation and to provide ventilation between two intubation attempts. However, blind intubation can be associated with a risk of oesophageal penetration, therefore, a flexible bronchoscope is frequently used to assist tracheal intubation. This leads to increased burdens on materials and personal resources and prolongs intubation times. Hence the LMA CTrach laryngeal mask airway (CTrach) was developed with an integrated fibreoptic system which can be connected to a monitor for visualisation of the larynx during intubation. ⋯ In this small sample of patients with difficult-to-manage airways, the CTrach yielded high success rates for both ventilation and tracheal intubation. Adjusting manoeuvres can improve the laryngeal view further.