Der Anaesthesist
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The practice of regional anaesthesia in German speaking countries was investigated by a survey. The first part of the trilogy contains the presentation and evaluation of the data about quality assurance and training concepts. In 2002 questionnaires were mailed to 750 randomly selected departments of anaesthesia and 384 hospitals participated (51.2%). ⋯ The exact beginning (48%) and end (15%/13%) of the training were often not fixed, 80% of all anaesthesia departments requested an improvement in the training for peripheral and 53% for neuroaxial regional anaesthesia techniques. Regional anaesthesia plays a highly important role. Concepts of training and quality assurance that are backed up by evidence-based medicine should be worked out to improve the training and further education in regional anaesthesia.
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Anaesthesiologists must be familiar with the particularities of the respiratory physiology of newborns and infants when providing perioperative care to these patients. Even brief periods of inadequate respiratory support can cause atelectatrauma and volutrauma which in turn can have deleterious cardiorespiratory consequences and accentuate pre-existing lung disease. ⋯ Optimal PEEP and normal tidal volumes during conventional ventilation, high volume strategy during high frequency ventilation, and permissive hypercapnia are the corner stones of a lung protective strategy. Using an interdisciplinary approach, surgery in the intensive care unit using total intravenous anaesthesia with the uninterrupted use of the ICU equipment is an attractive option for the most vulnerable patients in this age group.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Laryngeal tube versus laryngeal mask airway in anaesthetised non-paralysed patientsA comparison of handling and postoperative morbidity].
The purpose of this study was to compare the classical laryngeal mask airway (LMA) with the laryngeal tube (LT) in anaesthetised non-paralysed patients. ⋯ In anaesthetised non-paralysed patients the LT compares favourably to the LMA in terms of ease of insertion and postoperative morbidity.
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Acute respiratory distress syndrome (ARDS) is characterized by perfusion in favor of non-ventilated areas of the lungs as the main cause of intrapulmonary right-to-left shunt and hypoxemia. Therapeutic interventions to selectively influence pulmonary perfusion in ARDS became possible with the introduction of inhaled nitric oxide (iNO), which provided a way not only to reduce pulmonary hypertension, but also to acutely improve ventilation-perfusion mismatch, and thus to treat severe hypoxemia. Clinical studies in ARDS demonstrated that the combination of iNO with other interventions, such as positive end-expiratory pressure (PEEP) and prone positioning, yielded beneficial and additive effects on arterial oxygenation. Although randomized controlled trials of this concept have up to now failed to show an improved outcome, iNO is a valuable option for the treatment of severe refractory hypoxemia in ARDS patients.