Der Anaesthesist
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Clinical Trial
[Influence of rocuronium dose on the effectiveness of mask ventilation : A prospective, randomized clinical trial].
Mask ventilation could improve after administration of muscle relaxants if there is a functional obstruction of the airway, such as laryngospasm, vocal cord closure or opioid-induced muscle rigidity. On the other hand, muscle relaxants could worsen mask ventilation because they induce upper airway collapse; however, clinical studies showed that rocuronium (Roc) improved mask ventilation or it remained unchanged. In most cases Roc 0.06 mg/kgBW was used. ⋯ The efficacy of mask ventilation was equal or improved after administration of Roc but did not become worse. Patients who were ventilated with a Guedel tube had higher TV/ppeak ratios after Roc03 and Roc06 compared to saline. Higher dosages (>Roc06), however, had no advantages concerning quality of mask ventilation. In obese patients who had to be ventilated with a Guedel tube, Roc also improved the efficacy of mask ventilation. We conclude that administration of Roc is effective in improving mask ventilation and this effect was seen after 30-60 s even after Roc03.
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The Federal Institute for Drugs and Medical Devices (BfArM) was notified of an event in which it was not possible to sufficiently ventilate a patient suffering a severe asthma attack. It turned out that the ventilation pressures used by the device for pressure-controlled ventilation were below the values set by the user, which the user was not aware of. The ventilation pressures chosen by the user exceeded the preset alarm limits of the ventilator. This pressure and alarm management significantly differed from that of other ventilators used in the hospital. This and similar incident reports suggest that safely operating medical devices for anesthesia and intensive care may be impaired when different models of a device are used within a hospital. If different models are used, more device information needs to be stored in memory. Existing knowledge on human memory suggests that the more individual memory items (e. g. different operating rules) are stored, the greater the risk of memory interference and hence of impaired retrieval, particularly if the different items are associated with overlapping retrieval cues. This is the case when different devices are used for a single functional purpose under identical or similar circumstances. ⋯ Using different device models for anesthesia and intensive care seems to be common in many German hospitals, particularly for ventilators. An association between device diversity and problems operating a device is plausible, given the functioning of human memory. This topic should be investigated by future studies in order to identify factors that may contribute to such problems and possible solutions for clinical settings. Likewise, the potential benefits of having different device models at one's disposal should be evaluated. To pinpoint the measures that will be most effective given the specific settings of the individual hospital, all underlying clinical and economic considerations must be carefully balanced against the associated potential risks.
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Review Meta Analysis
[Correct positioning of central venous catheters in pediatrics : Are current formulae really useful?]
Correct positioning of a central venous catheter (CVC) tip in pediatric patients is very important. Malpositioning may lead to direct complications, such as arrhythmia and increase the risk of thrombosis, infections, valve failures or pericardial tamponade. ⋯ The benefit of a formula for daily practice is very limited due to the problem of choosing the right insertion point. The recommended insertion depth should be considered as an indicator and a verification of the CVC tip position should be done using an imaging technique.
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The prevalence of malignant hyperthermia (MH) in Germany is 1:2000-1:3000 and therefore more common than previously assumed, so that anesthesia personnel will more often be confronted with susceptible patients in the clinical setting. After the initial treatment with 2.5 mg/kg body weight dantrolene, further therapy using up to 10 mg/body weight dantrolene can be indicated for 24 h. ⋯ For outpatient anesthesia a stockage of dantrolene is not necessary as long as the use of MH trigger substances in general is strictly avoided. The introduction of Ryanodex® (Eagle Pharmaceuticals, Woodcliff Lake, NJ, USA), a preparation of dantrolene with clearly improved pharmacological properties, in the clinical practice has not yet been realized in Germany.