Der Anaesthesist
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Clinical Trial
[PercuTwist dilational tracheostomy. Prospective evaluation of 54 consecutive patients].
Percutaneous dilational tracheostomy (PDT) is considered to be an accepted method in intensive care patients. In 2002 Frova and Quintel described a method of dilation that employed controlled rotation of the PercuTwist dilational device. The goal of the present study was to evaluate the new technique employed by an experienced team. ⋯ The PercuTwist tracheostomy is a safe procedure for intensive care patients. More prospective studies that would compare the PercuTwist tracheostomy with the other PDT methods are necessary.
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About twenty years ago, Peter Stewart had already published his modern quantitative approach to acid-base chemistry. According to his interpretations, the traditional concepts of the mechanisms behind the changes in acid-base balance are considerably questionable. The main physicochemical principle which must be accomplished in body fluids, is the rule of electroneutrality. ⋯ Contrary for example, a decrease in [A(-)] (e. g. during hypoalbuminemia) leads to an increase in [Bic(-)] and therefore to an alcalosis (and vice versa). Thus, by Stewart's approach, completely new acid-base disturbances, like "hyperchloremic acidosis" or "hypoalbuminemic alcalosis" (which, of course, can also exist in combination) can be detected, which had been unrecognised by the classic acid-base concepts. Consequently, Stewart's analysis can lead to a better understanding of the mechanisms behind the changes in acid-base balance.
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The following article summarizes different aspects of local anesthetic effects that cannot be explained purely by a sodium channel blockade. Particularly remarkable is hereby their antiinflammatory activity, e.g. the inhibition of pathological changes such as excessive stimulation of the inflammatory system, without compromising the host defense system. ⋯ In addition, local anesthetics are known for their potency to minimize bronchial hyperreactivity, although details of the underlying mechanisms are not yet elucidated. These effects of local anesthetics may represent interesting prospects for which their relevance has to be determined.
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Randomized Controlled Trial Clinical Trial
[Cuff pressure monitoring and regulation in adults].
In adults the use of cuffed endotracheal tubes is the standard technique. Nitrous oxide increases the cuff pressure secondary to diffusion through the cuff membrane. The aim of the study was to verify a newly designed cuff pressure regulating device and comparison of postoperative complications. ⋯ In conclusion our data demonstrate that the automatic cuff pressure and regulation device was useful and reliable in an adult population of intubated patients in the studied pressure range.
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Numerous pathophysiological mechanisms are known to cause nausea or vomiting but their role for postoperative nausea and vomiting (PONV) is not quite clear. Volatile anesthetics, nitrous oxide and opioids appear to be the most important causes for PONV. Female gender, non-smoking and a history of motion sickness and PONV are the most important patient specific risk factors. ⋯ A or an antiemetic is reasonable and only a (very) high risk justifies the combination of several prophylactic antiemetic interventions. For the treatment of PONV an antiemetic should be chosen which has not been used prophylactically. The necessary doses are usually a quarter of those needed for prophylaxis.