Der Anaesthesist
-
Randomized Controlled Trial Comparative Study
[Topical anesthesia before vascular access in children. Comparison of a warmth-producing lidocaine-tetracaine patch with a lidocaine-prilocaine patch].
Venepuncture is one of the most stressful situations for children during induction of general anesthesia. Therefore, many clinicians use a local anesthesia patch (EMLA) containing a mixture of lidocaine and prilocaine in order to reduce the stress for pediatric patients. This study compared the effect of a new heated topical anesthesia delivery system containing lidocaine and tetracaine (Rapydan) with the lidocaine/prilocaine patch EMLA. ⋯ After a contact time of 35 min the Rapydan patch led to superior analgesia during venous puncture than the EMLA patch. With regard to visibility of the veins and success rate of the punctures, differences between the two patches were not observed.
-
Extraglottic airway devices (EGA) are not only used in routine anaesthesia practice, they also have a distinct value for in-hospital and out-of-hospital difficult airway management. In the environment of the intensive care unit (ICU) EGA are not used on a regular basis. ⋯ This review presents the potential indications for EGA on the ICU for the management of difficult airway situations as well as during percutaneous tracheotomy. Furthermore, the possible advantages of EGA during postoperative recovery from anaesthesia as well as termination of controlled ventilation for intensive care patients are discussed.
-
Accurate scheduling of operations is essential for an efficiently used OR. The aim of this investigation was to describe the quality of OR scheduling in the analyzed OR. Furthermore suggestions for avoiding underutilization or overutilization through optimized OR planning should be addressed if possible. ⋯ Prognosis of operations with longer planned duration (>150 min) should be improved in the OR area analyzed. Scheduling of these operations at the beginning of the OR list or with a sufficient time interval towards the end of the appointed OR block time within the OR list can avoid or at least minimize underutilization and overutilization of the OR.
-
In cases of unclear depression of conciousness, arrhythmia and symptoms of cardiac insufficiency inadvertent carbon monoxide intoxication should always be taken into consideration. Rapid diagnosis of acute carbon monoxide intoxication with mostly unspecific symptoms requires an immediate supply of high dose oxygen which enables a distinct reduction of mortality and long-term morbidity. ⋯ There is no sufficient coherence between carboxyhemoglobin blood levels and clinical symptoms. Increased carboxyhemoglobin concentrations help to diagnose acute carbon monoxide intoxication but do not allow conclusions to be drawn about possible long-term neuropsychiatric or cardiac consequences.
-
Intoxication due to local anaesthetic drugs poses a rare but potentially life-threatening complication. In particular long-acting local anaesthetics can cause refractory cardiac arrest due to their lipophilic properties. This is often preceded by neurological symptoms such as confusion, vertigo and tonic-clonic seizures. ⋯ In case of cardiac arrest standard protocols for cardiopulmonary resuscitation have to be implemented immediately. The use of lipid emulsion can then be initiated as a supplement to standard resuscitation. It is recommended that lipid emulsions are instantly accessible in all facilities where local anaesthetics are administered.