Der Anaesthesist
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Anesthesiological challenges during craniotomy result from the anatomically related low compensatory capacity of the intracranial space in response to increased volume and the low ischemic tolerance of brain tissue. The anesthetic agents used should therefore not increase the intracranial volume and improve the ischemic tolerance. ⋯ Optimal implementation of anesthesia necessitates a detailed knowledge of the surgical approach and potential complications. Postoperatively, patients should be extubated as soon as possible to closely monitor cognitive function so that potential deterioration can be detected.
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Review Meta Analysis
[Estimation of the optimal tube length : Systematic review article on published formulae for infants and children].
The correct placement of an endotracheal tube in children is essential as incorrect placement following unilateral ventilation and tube displacement may lead to far-reaching consequences, such as volutrauma and hypoxia, respectively. Different formulae referring to the correct placement of nasotracheal and orotracheal tubes have been published with reference to body weight and age. ⋯ The published formulae were comparatively simply to apply but had notable limitations. Correlating the position of the endotracheal tubes with chest x-rays, the concordance analysis showed that for the age-based formulae using orotracheal as well as nasotracheal intubation and in both age groups, an accordance could only be achieved in a maximum of 81%. In the presence of a lack of alternative possibilities, only one formula based on the gestational age seemed to have an impact on estimation of correct endotracheal tube depth placement in newborns and infants. Therefore, a generally valid formula cannot be recommended without verification by auscultation or chest x-ray.
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Review Meta Analysis
[Estimation of the optimal tube length : Systematic review article on published formulae for infants and children].
The correct placement of an endotracheal tube in children is essential as incorrect placement following unilateral ventilation and tube displacement may lead to far-reaching consequences, such as volutrauma and hypoxia, respectively. Different formulae referring to the correct placement of nasotracheal and orotracheal tubes have been published with reference to body weight and age. ⋯ The published formulae were comparatively simply to apply but had notable limitations. Correlating the position of the endotracheal tubes with chest x-rays, the concordance analysis showed that for the age-based formulae using orotracheal as well as nasotracheal intubation and in both age groups, an accordance could only be achieved in a maximum of 81%. In the presence of a lack of alternative possibilities, only one formula based on the gestational age seemed to have an impact on estimation of correct endotracheal tube depth placement in newborns and infants. Therefore, a generally valid formula cannot be recommended without verification by auscultation or chest x-ray.
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Review Meta Analysis
[Interdisciplinary consensus statement on alternative airway management with supraglottic airway devices in pediatric emergency medicine : Laryngeal mask is state of the art].
Airway management with supraglottic airway devices (SGA) in life-threatening emergencies involving children is becoming increasingly more important. The laryngeal mask (LM) and the laryngeal tube (LT) are devices commonly used for this purpose. This article presents a literature review and consensus statement by various societies on the use of SGA in pediatric emergency medicine. ⋯ Considering the scientific data and the large clinical experience with the LM in medical routine and emergency situations in children, currently only the LM can be recommended for alternative (i.e. non-intubation) airway management in children. If alternative airway management is part of a local emergency strategy, the LM should be provided in all pediatric sizes (1, 1.5, 2, 2.5, 3, 4 and 5) for prehospital and in-hospital emergency use and all users should be regularly trained in its application.
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Being called to a firefighting operation is a rare albeit typical scenario for emergency physicians, which apart from medical expertise requires efficient collaboration with the firefighting team. ⋯ Medical expertise and basic knowledge of methods and tactics employed by the fire service are prerequisites for successful participation as an emergency physician in a firefighting operation. An integrative view of all aspects of injuries of the fire victims and the subsequent therapeutic decisions represent special challenges, which have not yet received much attention in the medical literature.