Der Anaesthesist
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With the inclusion of new monitoring devices over the last two decades, the distribution of the anesthesiologists vigilance has changed which might influence the ergonomic profile of an optimal anesthesia workstation. The aim of this pilot study was the evaluation of an eyetracking device to analyze the vigilance distribution of an anesthesiologist during routine cases in an operating theatre of the 21st century. ⋯ Eye-tracking studies proved to be a suitable way to analyze the distribution of vigilance of anesthesiologists in a modern operating theatre. For further studies examining the influence of detailed modifications of the OR environment, a standardized study design with the same level of education, the same anesthesia technique and the same surgical procedure needs to be chosen.
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Since its introduction into the operating room, transesophageal echocardiography (TEE) has proven to be an invaluable diagnostic tool for perioperative patient management. TEE allows direct visualization of structural and functional cardiac abnormalities. Therefore, it has become the most important imaging technique to evaluate valular function. ⋯ The severity of regurgitant blood flow across an incompetent valve can be assessed using color flow, continuous or pulsed-wave Doppler. Surgical patients experience significant changes in blood pressure, intrathoracic pressures and volume status in the perioperative period. Therefore, the interaction between these parameters and valvular function is the focus of recent clinical studies and might in future contribute to the perioperative as well as anesthesiological management of patients with valvular dysfunction.
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Tracheostomy is one of the oldest procedures in surgery. Although it was traditionally used for treatment of upper airway stenosis, the primary surgical indication is now in the long-term intensive care unit patient. Here, the aims are avoidance of damage to the larynx, earlier weaning from artificial respiration and improved nursing care. ⋯ Current meta-analyses of prospectively randomised studies show a lower complication rate than with conventional methods. Furthermore, serious sequelae such as tracheal stenosis are rare in the long-term course. However, conventional operative tracheostomy still has its place, particularly in circumstances where the new methods are contraindicated.