Der Anaesthesist
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In cases of craniofacial and mandibulofacial malformations, which are mostly treated during childhood, difficult intubation conditions must generally be expected. In such cases, the laryngeal mask airway (LMA) an alternative instrument for use in endotracheal intubation is a new aid for ventilation. In certain instances, it can be used alone to induce general anaesthesia. Reports of endotracheal intubation by means of the LMA in adults have also been published. ⋯ Therefore, the LMA is not only a ventilation aid, but also a valuable tool in difficult intubation conditions. In our opinion, it is necessary to provide this tool in every anaesthetic unit.
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Diagnosis of a perioperative myocardial infarction (PMI) on the basis of measurement of the creatine kinase MB fraction (CKMB) alone is not always easy. Surgical traumatisation of muscle fibres can lead to false-positive elevations. Newly introduced laboratory tests for cardiac troponins seem to facilitate the diagnosis of PMI. We measured serum values of cardiac troponin T in 139 patients described in detail in part I and compared them with common diagnostic tools for myocardial infarction. ⋯ Troponin T is a highly specific marker for perioperative myocardial cell necrosis. Patients with raised levels preoperatively seem to be at higher risk for postoperative reinfarction and left ventricular failure. The prognostic value of such an elevation is not clearly defined, especially in patients with chronic renal failure.
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Case Reports
[Anesthesia and intensive care management of severely burned children of Jehovah's Witnesses].
A 3.5-year-old girl suffered from a thermal injury affecting 37% of the body surface area. The parents, being Jehovah's witnesses, refused permission for their child to receive blood transfusions. As the haemoglobin level was only 7.5% and a necrectomy was planned, the patient was likely to need blood transfusions. ⋯ The lowest Hb was 3.3 g/dl on the 22th day after injury (3rd postoperative day). In this phase the patient was still playing and riding a tricycle. On the 45th day after injury the child was discharged home with Hb of 10.9 g/dl and reticulocytosis of 33%.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Changes in somatosensory evoked potentials after sevoflurane and isoflurane. A randomized phase III study].
Monitoring of somatosensory evoked potentials (SEP) is used to identify critical phases of cerebral ischaemia by means of characteristic changes in the signal patterns. A correct interpretation of the results is possible, however, only if the influence of drugs that act on the central nervous system is known. We were able to show that volatile anaesthetics have an impact on latencies and stimulus amplitudes. ⋯ Under the influence of N2O, there were marked reductions in amplitude of the cortical stimulus response. Thus, it can be recommended that supplementation with N2O should be avoided in the presence of low initial amplitudes. Based on our results, the use of isoflurane and sevoflurane concentrations up to 1.0 MAC seems to be compatible with intraoperative monitoring of SEP.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Awakening from anesthesia and recovery of cognitive function after desflurane or isoflurane].
Desflurane is a new volatile anaesthetic with an extremely low blood/gas partition coefficient of 0.42. This should provide a rapid recovery from anaesthesia. ⋯ Our results demonstrate that desflurane anaesthesia, even when supplemented by premedication, intraoperative opioids, and nitrous oxide may offer clinical advantages over isoflurane as far as the post-anaesthetic recovery profile is concerned.