Der Anaesthesist
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The specialty of anesthesiology has made extraordinary advances in anesthesia safety. Yet, anesthetic mortality and morbidity continue to be far from tolerable. Efforts to enhance safety in anesthesia must include adherence to explicit and implicit safety standards, must make use of equipment that offers modern safety features, must seek to detect and correct developing safety threats as early as possible and must have a structured system to analyze problems and to institute remedies to prevent their recurrence.
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Clinical Trial
[The modified technique of continuous suprascapular nerve block. A safe technique in the treatment of shoulder pain].
This study assesses a modified approach for suprascapular nerve block in a single shot and continuous catheter technique for the treatment of chronic shoulder pain. After thorough anatomic examinations, a new technique was performed in 30 patients by inserting the catheter into the suprascapular fossa. Complications of the technique, time of onset, effect and patient satisfaction were evaluated. ⋯ Local inflammation occurred in one patient and dislocation of the catheter in another patients. Patient satisfaction (97%) was very high. The modified technique of continuous suprascapular nerve block is a safe and easy-to-perform technique in the treatment of acute and chronic shoulder pain.
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We have developed a modern strategy for the anaesthetic management of the pediatric airway using anaesthetic drugs such as sevoflurane, propofol, mivacurium and remifentanil, together with new techniques including the laryngeal mask. This strategy provides optimal conditions for the examiner and maximum safety for the pediatric patient. ⋯ Important indications include acute and chronic stridor, chronic obstructive airway disease, mucoviscidosis and foreign body aspiration. The best and safest techniques are outlined depending on the clinical situation, and the most frequent complications are discussed, e.g. hypoxaemia, respiratory arrest, laryngospasm, bronchial obstruction, pneumothorax and overdosing of local anaesthetic agents.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Preoxygenation with the NasOral((R)) system or the standard face mask?].
Adequate preoxygenation of patients before onset of apnea for orotracheal intubation is of major importance in general anaesthesia. Various preoxygenation techniques are available but a face mask providing an oxygen supply via the circle absorber system of a mechanical respirator is most frequently used. Recently, a new device for preoxygenation - the NasOral((R)) system - has become available. The aim of the present study was to compare the efficacy of intrapulmonary oxygen storage with either the NasOral((R)) device or the standard face mask. ⋯ Both the NasOral((R)) system and the face mask are effective for intrapulmonary oxygen storage. In both systems the O(2) flow has to be adequately high and the masks have to be held tightly in order to avoid any contamination of the inhaled oxygen with nitrogen. Due to its unidirectional flow, the NasOral((R)) system additionally requires the patient to be cooperative. As the NasOral((R)) system is more expensive and has no clinical advantages without apneic oxygenation, we prefer the standard face mask for patient preoxygenation.
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Catecholamines are currently the most often used vasopressor agents in the treatment of vasodilatory shock. However, progressive catecholamine resistance is a feared complication. Recent studies have shown that arginine vasopressin, an endogenous hormone of the neurohypophysis, may be a potent vasopressor when used in combination with catecholamines. ⋯ In the guidelines of both the "American Heart Association" and the "International Liaison Committee on Resuscitation" from the year 2000, arginine vasopressin is recommended as a possibly helpful agent in therapy refractory vasodilatory septic shock. There is currently limited data on possible side effects of a continuous arginine vasopressin therapy in vasodilatory shock. Therefore, arginine vasopressin should be restricted to patients where adequate stabilization of hemodynamic function cannot be achieved by conventional vasopressor therapy alone.