Der Anaesthesist
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A paper published in various US journals on Emergency Medicine in 1997, has raised considerable concerns. The authors question if it is justified to continue to recommend initial ventilation as part of basic CPR when performed by lay-bystanders. A few aspects need to be discussed and some questions have to be answered before any changes in the current recommendations may even be considered: e.g. 1. ⋯ Ad 2: Pepe's argument regarding the efficacy of endotracheal intubation (ETI) in VF-patients has not been scientifically proven and lacks conclusive evidence. ETI serves to protect the airways and lungs against aspiration of regurgitated material and to facilitate artificial ventilation including PEEP, both under anaesthesia and resuscitation. The efficacy of ETI in the OR has long b
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Paradoxical air embolism may occur with any venous air embolism. Air may either enter the systemic circulation through a patent foramen ovale or through transpulmonary passage of air. ⋯ This is especially true, since paradoxical air embolism may not become obvious under general anesthesia. More specific therapeutic regiments, such as hyperbaric oxygenation and the infusion of perfluorocarbons, are still in an experimental stage.
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There is still controversy on the usefulness of spinal anesthesia for operations performed in the prone or jackknife position. There is about the risk of inadvertent increase of the sensomotory blockade with the patient in the prone position and the difficulty of managing consecutive cardiorespiratory complications or inducing general anesthesia in case of failures. This article reviews the current literature in terms of safety and effectiveness of spinal anesthesia for such operations. ⋯ Substantial knowledge about the onset time, fixation time, duration of sensomotory block and baricity of the applied local anesthetic is crucial in this setting. Obese patients are at risk for sudden extension of the block when turned into the prone position. Additional narcotics and sedatives should be avoided and continuous monitoring of hemodynamic and respiratory parameters, of the level of the blockade and vigilance of the patient is mandatory.
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Tracheostomy is one of the oldest surgical procedures and in the past decades has become the method of choice in the management of patients requiring long-term mechanical ventilation. At present, several alternatives exist to conventional surgical tracheostomy, such as the percutaneous dilatational techniques according to Ciaglia (PDT), Griggs (GWDF), and Schachner (Rapitrach). In particular, PDT according to Ciaglia which was introduced in 1985, has been recognized as an equally safe, but less expensive procedure than conventional tracheostomy. ⋯ Nonetheless, we believe that percutaneous procedures should only be performed by experienced physicians who are well-trained in both endotracheal intubation and mask ventilation. Furthermore, the capacity to perform surgical tracheostomy immediately in case of complications should be given. Only if the contraindications are carefully observed, will these new procedures retain their value and benefit in airway management of long-term ventilated patients.