Der Anaesthesist
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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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The aim of this investigation was to assess the extent of stress and demands in patients during preparation for general anesthesia for elective surgical procedures. ⋯ In future studies assessing the perioperative management of patients and quality of care, standardized testing questionnaires should be preferred, instead of vegetative parameters alone, to reliably evaluate perioperative demands and stress in surgical patients.
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The German health care system is currently in a constant state of flux owing to enhanced competition and to the increasing focus on economic aspects. Medical services, especially treatment processes, are being reorganised in an attempt to adapt them to the new economic challenges. Ideally, radical reorganisation and streamlining of medical therapy processes should be accompanied by controlling and quality management systems. The purpose of this is to monitor the intensity of any economic and any patient-related (side)-effects. Business management techniques are needed that allow online and long-term performance reviews of reorganisation measures once initiated. ⋯ Economic and patient-related key figures can be evaluated with SPC. It allows online assessment both before and during process optimisation, and especially in the long term afterprocess optimisation.
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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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Optimized training facilities are the key to efficient teaching of regional anesthesia. ⋯ The presented method is an optimized, strongly accepted teaching and training tool for teaching regional anesthesia.