Der Anaesthesist
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Randomized Controlled Trial Comparative Study
Different anesthesia methods for laparoscopic cholecystectomy.
The aim of the study was to compare the possibility of performing laparoscopic cholecystectomy using two different anesthesia procedures (spinal anesthesia versus general anesthesia). ⋯ Laparoscopic cholecystectomy with low pressure pneumoperitoneum with CO(2) can be safely performed under spinal anesthesia. Spinal anesthesia was associated with an extremely low level of postoperative pain, better recovery and lower cost than general anesthesia.
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Perioperative anxiety and the resulting lack of cooperation during induction of anesthesia is a common problem in pediatric anesthesia. The extent of anxiety depends on a variety of factors concerning the child, the parents, the anesthesia team and the hospital's friendly atmosphere and infrastructure. Apart from premedication there are a number of non-pharmacological means to improve the child's cooperation and thereby facilitate the induction of anesthesia. If the child is still uncooperative despite an optimal preparation, the anesthetist has to decide whether to postpone the operation or to perform induction of anesthesia under physical restraint in consideration of various criteria.
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Since 2007 interhospital transport of intensive care patients in Lower Saxony appertains to the performance requirements of emergency medical services. Against this background the Working Group for Evaluation of Intensive Care Transport (Arbeitsgemeinschaft Evaluation Intensivverlegung) was established. This group formulated standardized definitions for the requirements of intensive care transport vehicles and a federal statewide monitoring of intensive care transport was implemented to analyze if simultaneously on-call intensive care transport systems (intensive care helicopter and ground based mobile intensive care units) can be deployed need-based and efficiently. ⋯ Interhospital transfer of intensive care patients can be carried out need-based with a limited number of intensive care transport vehicles if the missions are deployed effectively by standardized disposition in accordance with performance requirements.
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In contrast to the adult population scientific data on ProSeal™-LMA (PLMA) usage in infants, children, and adolescents are rather limited. Most data have been generated by expert users in studies on small numbers of patients. The aim of this study was to gather comprehensive data about the characteristics, efficacy and safety of its routine use in children at a teaching institution. ⋯ This survey demonstrates that the PLMA can be used effectively in infants, children and adolescents in the routine university clinical practice setting. However, this study does not confirm the extremely high success and low complication rates reported in controlled studies. The results support the assumption that with the PLMA regurgitated gastric fluid can be drained away from the larynx through the drain tube.
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This case history deals with an 85-year-old patient who underwent surgery to treat rhinoliquorrhea. The patient aspirated a lutescent fluid shortly after anesthesia was administered. ⋯ The CSF had been stained with fluorescein prior to surgery in order to help localize the CSF fistula. This case of top down aspiration is discussed and preventive measures which can be employed in order to avoid similar complications in patients with rhinoliquorrhea are presented.