Der Anaesthesist
-
Principles and characteristics of the recently introduced Microcuff paediatric tracheal tube (Microcuff, GmbH, Weinheim, Germany) with anatomically based depth markings, cuff-free subglottic tube shaft and short high volume-low pressure cuff with ultrathin cuff membrane are presented. First available tubes (ID 4.0 mm) were evaluated regarding cuff pressures required to seal the trachea and regarding the distance from the tube tip to the carina. ⋯ The new Microcuff paediatric tracheal tube with ultrathin high volume-low pressure cuff required tracheal sealing pressures below tracheal wall pressures usually required with uncuffed tracheal tubes for efficient sealing and ventilation at 20 cm H(2)O peak inspiratory pressure. The distance from the tube tip to carina was in the safe range in all patients.
-
Sepsis is still a leading cause of death in many intensive care patients. The pathophysiology of the disease is dominated by complex immune cascades. Recent research demonstrates that immune cells respond to sepsis with an increased rate of programmed cell death. ⋯ Overexpression of Bcl-2 or inhibition of caspases resulted in an increased survival in animal models of sepsis. Recent reports indicate the relevance of apoptosis in patients with severe sepsis. These results may spawn novel immunomodulatory strategies in the treatment of sepsis.
-
Clinical Trial
[Feedback control of muscle relaxation with a varying on-off controller using cisatracurium].
Under clinical conditions constant neuromuscular blockade can also be maintained by a simple closed-loop system. However, delayed onset time, non-linearity of the dose-response curve and different sensitivity to muscle relaxants for each patient are limiting factors. ⋯ It can be concluded that a simple closed-loop system allows the safe use of the intermediate term muscle relaxant cisatracurium for the performance of surgical procedures.
-
Clinical Trial
[The effects of active and passive humidification on ventilation-associated nosocomial pneumonia].
Airway humidification of ventilated patients in an intensive care unit may be established by heated humidifying systems (active) or by the means of a (passive) heat and moisture exchange filter (HMEF). There is a controversial discussion about the influence of the type of humidification on the rate of ventilator-associated pneumonia (VAP). Among 3,585 patients both methods were tested over a period of 21 months in an open, non-randomized cohort study. The aim of the investigation was to compare the incidence of VAP caused by a change of humidification strategy. ⋯ Our results showed that the rate of VAP could be significantly reduced by changing the strategy from active to passive humidification devices, especially concerning patients requiring long-term respirator therapy. A more physiological humidification and a reduced number of airway manipulations are discussed as a possible explanation.
-
Intracerebral haemorrhage is a rare complication of spinal anaesthesia in obstetrics. A 37-year-old woman without any accompanying disease during a twin pregnancy, underwent an urgent caesarean section due to insufficiency of the placenta under spinal anaesthesia using hyperbaric bupivacain (0.5%) and a pencil-point spinal needle Sprotte 27 Gauge. The patient developed severe headache, a hemiparesis of the right upper limb and became somnolent and finally unconscious 80 min after the procedure. ⋯ On postoperative day 7 the remaining neurologic deficits included aphasis and severe hemiparesis of the right upper limb and a right extensor plantar response. The neurologic status did not improve substantially until 6 months after the complication. The case and the recent literature are discussed.