Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[The effects of age on onset and recovery from atracurium, rocuronium and vecuronium blockade].
Elderly patients may show an age-related decline in physiologic functions, which may be responsible for the prolonged duration of some neuromuscular blocking agents. Previous studies have yielded conflicting results as to the effects of these drugs in the elderly. ⋯ This study suggests that onset time for atracurium, rocuronium and vecuronium is not age-dependent. Recovery was prolonged in the elderly for all three relaxants. This effect appears to be secondary to changes in body composition and function accompanying the aging process. Neither atracurium nor vecuronium depends significantly on the kidney for elimination, but the negative correlation between Ccr and rocuronium suggests an appreciable role for the kidney in the elimination of this relaxant. The long recovery times observed in this study could also be related to enflurane anaesthesia. We suggest that failure of EMG responses to return to baseline values during recovery from neuromuscular block may be related to age, especially for atracurium and rocuronium.
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Randomized Controlled Trial Clinical Trial
[Movement of the temporomandibular joint during tracheal intubation].
Laryngoscopy causes temporary postoperative dysfunction of the temporomandibular joint (TMJ): during iatrogenic TMJ manipulation in anaesthetised patients, the TMJs have lost the protection afforded by the tone of the surrounding muscles. Thus far, the exact type and extent of TMJ movements have not been known. The purpose of this study was to develop a method to visualise and assess TMJ movements during intubation by means of electronic axiography, a diagnostic monitor of TMJ movements used in dentistry: registration of the hinge axis (HA) as an equivalent of the condylar paths on extra-oral sagittaly mounted, parallel plates. ⋯ MOTs and EITs were recorded and analysed with the system described and typical EIT patterns were identified: bland, clinically uneventful intubations (n = 7), massive distraction and laterotrusion of the EIT compared to the MOT (n = 24), and blocked or limited TMJ movements resulting in intubation problems (n = 1). With the method presented, TMJ movements could be visualised during endotracheal intubation for the first time. It can be used to assess techniques, routes, and instruments for intubation as well as to evaluate potential traumatising movements during endotracheal intubation.
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Randomized Controlled Trial Clinical Trial
[Adaptive lung ventilation (AVL). Evaluation of new closed loop regulated respiration algorithm for operation in the hyperextended lateral position].
The lateral decubitus position is the standard position for nephrectomies. There is a lack of data about the effects of this extreme position upon respiratory mechanics and gas exchange. In 20 patients undergoing surgery in the nephrectomy position, we compared a new closed-loop-controlled ventilation algorithm, adaptive lung ventilation (ALV), which adapts the breathing pattern automatically, to the respiratory mechanics with conventionally controlled mandatory ventilation (CMV). ⋯ However, an adaptation to individual respiratory mechanics was clearly evident with ALV. In conclusion, we found that the effects of positioning for nephrectomy are minor and may give rise to problems only in patients with restrictive lung disease. The novel ALV controller automatically selects ventilatory parameters that are clinically sound and are better adapted to the respiratory mechanics of ventilated patients than the standardized settings of CMV are.
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Comparative Study Clinical Trial Controlled Clinical Trial
[The transillumination technique. An alternative to conventional intubation?].
The technique of light-guided intubation is based on the principle that a source of light brought into the trachea results in clearly visible and defined transcutaneous illumination, while no illumination can be observed with the light source in the oesophagus (Fig. 1-7). The Trachlight is a reintroduced instrument for this alternative intubation technique. The essential developments are: a length-adjustable stylet with a removable internal metal wire, a brighter light source, a stable handle with tight fixation of the endotracheal tube, and a time-dependent warning device to avoid extended intubations. ⋯ The indication for the technique is given in patients in whom no difficulty with intubation is expected, to avoid soft tissue damage and traumatising temporomandibular joint movements. Preclinical use may be limited due to environmental brightness. In patients with expected difficult airway management, fiberoptic intubation will remain the method of choice.
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Trauma and associated major blood losses in Germany represent the leading cause of mortality in patients up to 45 years of age. The endpoints of prehospital fluid resuscitation in traumatic-hemorrhagic shock are the restitution of intravascular volume und cardiac preload, in order to increase cardiac output and thus provide adequate oxygen delivery to the tissues. The key therapeutic factor to prevent the development of multiple organ failure complicating trauma and shock, however, is the normalization not only of macrohemodynamics (systemic blood pressure. cardiac output), but the restitution of the disturbed microvascular perfusion. ⋯ A new concept consists of i.v. bolus infusion of a small volume (4 ml/kg body weight) of a hyperosmolar (7.2-7.5%) NaCl/colloid solution, which is termed "Small-volume Resuscitation". Recently presented data from a cohort analysis of 8 preclinical studies show an increase in survival rate by about 5% when compared to standard of care. In addition, artificial oxygen carrying solutions are currently investigated. by which-through an increase of O2-blood content-oxygen delivery to the tissues might be augmented.