Der Anaesthesist
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The last survey addressing postoperative pain management in Germany was published in 1987, special data concerning postoperative pain management in pediatric patients had not been presented previously. The goal of this survey is to present the standard of postoperative pain management in pediatric patients in Germany. A detailed questionnaire was mailed to all German anaesthesia departments and interdisciplinary intensive care units (n = 1,500) to determine the current management of postoperative pain management in pediatric patients. ⋯ The routine use of non-steroid antiinflammatory drugs (NSAIDs) and spasmolytics as well as the application of regional anaesthesia techniques is uncommon in pediatric postoperative pain management. Compared to other European countries, patient- or parent-controlled analgesia is more popular in Germany. Despite modern concepts of organization and a great variety of drugs available today, 71.1% of the responding anesthesiologists in this survey still believe that pediatric postoperative pain management needs to be improved.
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Case Reports
[Endotracheal intubation of patients with Pierre-Robin sequence. Successful use of video intubation laryngoscope].
Patients with Pierre Robin sequence are a classic model for patients with a difficult airway. In these patients tracheal intubation may be facilitated using the lateral approach. In a 3-day-old newborn with Pierre Robin sequence, scheduled for anaesthesia to take a mould of the cleft palate, we used a video-intubation laryngoscope to give a video-display of the lateral approach intubation technique to the junior colleagues. ⋯ In addition, video-transmission of the laryngoscope picture enabled the attendant anaesthetist to quickly recognise the need for suctioning the hypopharynx and to coordinate the direction and extent of laryngeal pressure according the video-laryngoscopic findings. Of special value for the intuboscopist was the improved view of the cords provided by the video-display compared with direct laryngoscopy. This facilitated a non-traumatic insertion of the tube into the trachea and allowed reliable confirmation of the intubation depth by the tube marking between the vocal cords.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Cardiovascular stress protection following anesthesia induction. Comparison of clonidine and esmolol].
Alpha-2-adrenoceptor-agonists as well as cardioselective betareceptor-antagonists have been shown to blunt stress response due to tracheal intubation. The purpose of our study was to investigate,whether clonidine or esmolol is more efficient to attenuate stress response due to intubation.44 patients were randomly assigned to receive either clonidine (n=22; 3 microg/kg) or esmolol (n=22; 2 mg/kg) immediately prior to a standardized induction of anaesthesia. ⋯ Absolute values and increase of mean arterial pressure and norepinephrine plasma concentrations were significantly less in the clonidine group (p<0,05). Clonidine (3 microg/kg) is more efficient than esmolol (2 mg/kg) in blunting stress response due to endotracheal intubation.