Der Anaesthesist
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Randomized Controlled Trial Comparative Study
[Comparison of two different laryngeal mask models for airway management in patients with immobilization of the cervical spine].
Reduced cervical spine mobility can impair laryngoscopy and tracheal intubation. Supraglottic airway devices can be important alternatives for oxygenation under these circumstances. The Ambu laryngeal mask (ALM) and the LMA-Classic (LMA) are compared in patients with immobilization of the cervical spine. ⋯ LMA-Classic and Ambu laryngeal masks are suitable for rapid and reliable airway management in patients with cervical immobilization.
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Comparative Study
[Psychological traits, course of surgery and recovery following hernia repair in patients preferring general or local anaesthesia].
This study addresses two questions concerning open inguinal hernia repair patients: (1) are there differences in psychological traits between patients opting for local vs. general anaesthesia and (2) assuming comparable operations, are there any differences between the two groups during surgery and postoperative recovery? ⋯ Psychological traits do not have a significant impact on the choice of either local or general anaesthesia. However, highly extraverted patients prefer local anaesthesia while extreme introverts prefer general anaesthesia. Our findings suggest that local anaesthesia will become more widely adopted for the repair of groin hernia. Future studies should focus on optimising the perioperative care for patients who choose local anaesthesia.
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Case Reports
Vasopressin as adjunct vasopressor for vasodilatory shock due to non-occlusive mesenteric ischemia.
We present the case of an 83-year-old patient who underwent cardiac surgery and developed postoperative non-occlusive mesenteric ischemia (NOMI), which was treated with a local intra-arterial papaverine and prostaglandin E1 infusion. After successful mesenteric reperfusion, a multiple organ dysfunction syndrome with severe cardiovascular failure developed. ⋯ AVP stabilized vasodilatory shock, ensured adequate gut perfusion pressure and had no adverse clinical or angiographic effects on restitution of gut integrity. In conclusion, after reperfusion of NOMI in this patient, adjunct AVP therapy combined with local vasodilator infusion was beneficial as a potentially life-saving vasopressor.
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The aim of this study was to demonstrate differences in structure and severity of pediatric emergencies treated by aeromedical (air rescue) or ground ambulances services. Conclusions for the training of emergency physicians are discussed. ⋯ Training of emergency physicians should include pediatric life support and specific information about frequent pediatric emergency situations. For emergency physicians in aeromedical services, an intensive training in pediatric trauma life support is also necessary.
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The treatment of acutely ill patients who presumably lack the insight or judgement to determine their need for medical treatment, is a difficult challenge for emergency physicians. We have carried out a study to assess the frequency and relevance of involuntary treatment and procedures in medical emergency services. ⋯ Involuntary inpatient commitment by emergency physicians was only necessary in relatively few cases. Nevertheless, in order to be able to correctly consider treatment and management options, emergency physicians should be aware of the basic conditions for treatment without a patient's consent.