Der Anaesthesist
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This study evaluates the current practice of premedication and preoperative fasting in pediatric anaesthesia in Germany. A total of 90 questionnaires were mailed to randomly selected hospitals with departments or sections of anaesthesiology and pediatric surgery. 71 questionnaires were returned and analysed (reply rate 79%). 60% of the responding hospitals start premedication between the ages of 3 and 12 months and 32% between 1 and 2 years of age. Premedication ist most often given orally (64%), followed by rectal (29%) and intranasal (3%) routes. ⋯ The survey shows that premedication is started during the first two years of age by nearly all responding hospitals. Oral or rectal midazolam is the most frequently used premedication regimen. Preoperative fasting guidelines vary.
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Randomized Controlled Trial Comparative Study Clinical Trial
[CSE vs. augmented epidural anesthesia for cesarean section. Spinal and epidural anesthesia with bupivacaine 0.5% "isobar" require augmentation].
Incomplete anaesthesia is a major clinical problem both in single spinal and in single epidural anaesthesia. The clinical efficacy of epidural anaesthesia with augmentation (aEA) and combined epidural and spinal anesthesia (CSE) for cesarean section was investigated in a prospective randomized study on 45 patients. ⋯ The extension of anaesthesia achieved in epidural anaesthesia after an initial dose of 101.8 mg bupivacaine and augmenting dose of 99 mg lidocaine reached the segment Th5. The primary spinal anaesthesia dose up to 15 mg corresponding to height led to a segmental extension to a maximum of Th3 under CSE. Augmentation was necessary in 13 patients; in 5 cases because of inadequate extent of anaesthesia and 8 cases because of pain resulting from premature reversion. The augmenting dose required was 13.9 ml. Readiness for operation was attained after 19.8 min (aEA) and after 10.5 min (CSE). No patient required analgesics before delivery. The additional analgesic requirement during operation was 63.6% (aEA) and 39.1% (CSE). Taking into account pain in the area of surgery, the requirement of analgesics was 50% (aEA) vs. 17.4% (CSE). Antiemetics were required in 18.2 (aEA) and in 65.2% (CSE). The systolic blood pressure fell by 17.7% (aEA) and in 30.3% (CSE). The minimum systolic pressure was observed after 13.4 min in aEA, and after 9.5 min in CSE. The APGAR score and the umbilical pH did not show any differences. General anaesthesia was not required in any case.
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Injuries to the oro-dental tissue are still one of the most frequent mishaps during endotracheal intubation and general anaesthesia. However, damage to the soft and hard tissues in most cases involves oral structures already showing advanced pathogenic alterations. Injuries to the teeth are therefore rather more often due to the disease of the teeth than to mistakes during anaesthesia. ⋯ This review gives information about the causes and types of injuries to the oral and maxillofacial region during general anaesthesia. In addition, the anatomical conditions and pathological changes associated with an increased risk for oro-dental injuries and the facilities for prevention are discussed. Finally, the main aspects of emergency treatment of injuries to the dental hard tissues are presented.