Der Anaesthesist
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Comparative Study
[Long-term results after surgical tracheotomy and percutaneous dilatation tracheostomy. A comparative retrospective analysis].
Besides surgical tracheostoma for treatment of long-term intubation, percutaneous dilatational tracheostomy (PDT) has become available during the last few years. Long-term results of the PDT are rare in the medical literature. This paper reports a retrospective analysis comparing the results after PDT with those after surgical tracheostomy. ⋯ The endoscopic examination showed minor stenosis of the trachea in both groups that were not functionally relevant. The average stenosis of 14% for the PDT was similar to that observed after surgical tracheostomy which was 19%. The choice of the best technique should be made in close cooperation between head- and neck surgeons and anesthesiologists.
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The aim of this prospective study was to evaluate the vertical infraclavicular approach to the brachial plexus for the insertion of a catheter to achieve continuous analgesia in postoperative patients and patients with chronic upper limb pain. ⋯ The placement of an infraclavicular plexus catheter is a suitable method for pain management in the upper limb. This approach may have advantages in patients with severe injuries who cannot abduct the arm. Our results are encouraging in terms of catheterisation time, patient comfort and incidence of complications.
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The use of opioids in the treatment of chronic pain is sometimes accompanied by inadequate pain relief and opioid-specific side-effects. Opioid rotation is a therapeutic approach, that can improve analgesia and provide a more advantageous analgesia and toxicity relationship. This article presents a case report and discusses the mechanisms, indications and possibilities of opioid rotation.