Der Anaesthesist
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Pharmacokinetic models can be differentiated into two groups: physiological-based models and empirical models. Traditionally the pharmacokinetics of volatile anaesthetics are described using physiological-based models together with the respective tissue-blood distribution coefficients. The compartments of the empirical model have no anatomical equivalents and are merely the product of the mathematical procedure for parameter estimation. ⋯ In clinical practice volatile anaesthetics are normally combined with N(2)O and/or opioids. This results in an additive interaction between volatile anaesthetics and N(2)O but a synergistic interaction of volatile anaesthetics with opioids. However, there are relatively few investigations on the interactions between the clinically widely used combination of volatile anaesthetics, N(2)O and opioids.
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Introduction of the laryngeal mask airway (LMA) has been a revolutionary development in airway management over the last decades. It was first used clinically in 1981 by A. ⋯ Originally intended as a substitute for conventional mask respiration for short periods of general anaesthesia, the laryngeal mask is in the meantime used in many areas as an alternative to elective endotracheal intubation as well as an option for controlling difficult airways. This contribution provides an overview of the basics as well as practical aspects of LMA use, and discusses the possibilities and limitations of the laryngeal mask in daily practice.
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Review
[High-frequency oscillatory ventilation. Ventilation procedure for adults with acute lung failure].
The concept of lung protective ventilation strategies is based on the limitation of the inspiratory pressure and the reduction of the tidal volume, in order to minimize the extent of breathing cycle-dependent damaging mechanisms from mechanical ventilation. This concept is coupled with various procedures for optimization of the end-expiratory lung volume in acute lung failure in order to improve the compromized oxygenation. In this situation high-frequency oscillatory ventilation (HFOV) has achieved a renaissance. ⋯ Very little data exist with respect to the application of this procedure in adult patients. For the clinical use of HFOV as a secondary procedure in adult patients suffering from acute lung failure it could be demonstrated that it is a safe and effective method of treatment. The effect of HFVO on the morbidity and mortality outcome, however, still needs to be characterized.
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Patients with type 1 diabetes require continuous substitution of exogenous insulin due to their disability to produce insulin themselves. The insulin dosage required is individual-specific and may change dramatically during the perioperative period. ⋯ When planning the operation, an individual treatment regime should be drawn up and be made available to the medical team. In order to facilitate the challenging perioperative management of these patients, this article presents the current recommendations for the perioperative management of children and adolescents with type 1 diabetes mellitus (i.e. of the International Society for Pediatric and Adolescent Diabetes, ISPAD).
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In epidural anaesthesia, the anaesthetist injects one or more drugs into the epidural space bordering on the spinal dura mater to achieve a "central" and/or "neuraxial" block. It is one of the earliest techniques in anaesthesia, originally performed exclusively with local anaesthetic agents. ⋯ Continuous epidural analgesia is an important tool in postoperative pain management. More and more often, the increasing proportion of patients who have comorbidities or are permanently taking medication that modulates the clotting system demands that the anaesthesiologist balance the individual risks and benefits before inducing epidural anaesthesia.