Der Anaesthesist
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Occupational exposure to volatile anaesthetics cannot be completely avoided even in modern operating theatres. In 1997, the staff exposure during balanced anaesthesia in our hospital was low (sevoflurane 0.49 ppm; N(2)O 11.5 ppm). In 1999, N(2)O was completely omitted at our hospital, therefore, exposure to volatile anaesthetics, namely sevoflurane, might have increased. ⋯ The occupational exposure to volatile anaesthetics is not higher using sevoflurane alone compared to the combination of sevoflurane and N(2)O. In addition, the data acquired from environmental and personal measurements showed similar results.
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Postoperative cognitive dysfunction is a severe and life-threatening complication after an operation. The mobilisation of the patient is difficult and, therefore, the stay of the patient in the hospital is extended and the resulting immobilisation is associated with further complications (e.g. decubitus, pneumonia, or thrombosis). ⋯ Preexisting diseases, like diabetes mellitus, heart failure, depression or alcohol excess are high risk factors as well as the use of anticholinergic drugs. A specific therapy for this cognitive dysfunction is unknown and, therefore, preventive measures should be used in patients with a preexisting high risk.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Influence of gender on propofol consumption and recovery times].
We investigated gender differences of drug consumption and recovery times for propofol-remifentanil anaesthesia. ⋯ With propofol-remifentanil anaesthesia, gender has impact on recovery times and propofol consumption. If the same amounts of propofol are applied, males awake later, with BIS or Narcotrend monitoring males receive less propofol for comparable EEG effects.
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Randomized Controlled Trial Clinical Trial
[Influence of blockades with local anesthetics on the stimulation ability of a nerve by peripheral nerve stimulation. Results of a randomized study].
In the present study we examined the influence of local anesthetics on the ability to stimulate a nerve by means of peripheral nerve stimulation. In 35 patients either 5 ml saline (group 1, n=18) or local anesthetics (group 2, n=17) were injected close to the sciatic nerve in a randomized and double-blind manner. ⋯ Therefore nerve damage might occur despite the use of peripheral nerve stimulation. Thus, the multiple injection technique in a close anatomical area has to be considered critically, because anesthetized or partially anesthetized nerves have a lower stimulating ability and could be damaged by a second or third puncture.
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Despite the development of new devices and strategies to manage and secure the difficult airway, morbidity and mortality in anaesthesia due to airway problems such as difficult intubation or unrecognised failed intubation remain high. The problem seems to lie in the transfer of skills and strategies to daily clinical practice. ⋯ This article outlines new training concepts in airway management with the help of simulation and simulators. We describe technical prerequisites and provide information on the implementation of difficult airway scenarios.