Der Anaesthesist
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Although the incidence of difficult airway is very low, involving less than 1% of all patients, failed air-way management is the main cause of mortality or serious morbidity during anaesthesia. Successful management of a difficult airway starts with recognition of the potential problem. A careful preoperative history and clinical examination should elicit obvious problems to allow prediction of a potentially difficult airway. ⋯ The LMA is a new device developed to provide an airway for anaesthesia. However, since the LMA can be inserted quickly and blind, it can be used as an alternative airway in patients in whom the trachea is difficult to intubate. The lower incidence of post-operative complications than with endotracheal intubation is a further advantage, particularly during anaesthesia for day surgery.
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A marked decrease in both personal and environmental pollution with anaesthetic gases as well as in costs is possible with anaesthesia machines which can be run with a low fresh gas flow (FGF) [9]. Low-flow anaesthesia can be performed with appropriately equipped circle systems, although strongly reduced FGF minimises the control of depth of anaesthesia and gas concentrations. Microprocessor-controlled feedback systems allow the utilisation of closed-circuit systems throughout the whole duration of anaesthesia, maintaining full anaesthetic control [3,5]. ⋯ With the method of quantitative anaesthesia as performed by the PhysioFlex, it is now possible to reduce gas expenditure according to the requirements of the patient as well as maintaining full control of anaesthesia depth. Simultaneously, multiple secured feedback control systems guarantee adequate monitoring and storage of respiratory and metabolic parameters. The duration of nitrous oxide wash-out can be a problem, in particular, when a changeover to O2/air is required.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Ropivacaine 1% versus bupivacaine 0.75% without a vasoconstrictor. A comparative study of epidural anesthesia in orthopedic surgery].
The long-acting local anaesthetic agent ropivacaine, S(-)-1-propyl-2',6'-pipecoloxylidid, is characterised by lower lipid solubility and lower cardiotoxicity compared with bupivacaine. This study was designed to evaluate its clinical efficacy and motor blocking properties when using lower volumes and higher concentrations of both plain substances. METHODS. ⋯ Ropivacaine 1% produced a longer duration of analgesia and better clinical efficacy than bupivacaine 0.75%. The clinical difference in motor blockade was not statistically significant. The Bromage scale is not representative for a substance with good analgesic effects and moderate motor blocking properties, as has been shown in sophisticated studies on ropivacaine motor blockade.
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Randomized Controlled Trial Clinical Trial
[Pharmacodynamics and clinical adverse effects of mivacurium. The effect of oral premedication with H1/H2 antagonists].
Duration of neuromuscular block may be prolonged by H1/H2 antagonists. This study was designed to determine the influence of H1/H2 antagonist treatment on onset, duration and recovery after mivacurium chloride (MIV), a new nondepolarizing neuromuscular blocking agent with a relatively short duration of action, which is metabolized by human plasma cholinesterase (PChE). METHODS. ⋯ The recovery of neuromuscular function, once it has begun, is prolonged neither by MIV nor by H1/H2 antagonists. As MIV is mainly broken down by PChE, it is evident that its duration of action is more prolonged by atypical PChE activity than by interaction with other drugs. Oral H1/H2 premedication may diminish haemodynamic side-effects and clinical signs of histamine release.
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Many neurosurgeons prefer the sitting position for patients undergoing surgery in the posterior fossa because of the easier access and better conditions for haemostasis. Pneumatocephalus is a possible consequence of surgery in the posterior fossa with the patient in the sitting position. When this occurs air may enter the subarachnoid space, the cisternae, the ventricular system or the subdural space; it becomes more likely when any of the following is/are present: loss of CSF, a large cavity resulting from surgery, external or internal drainage of CSF, osmotic diuresis, and hyperventilation. ⋯ As complete skin had already been closure no explanation for the air embolism could be found. The patient was positioned supine, and air was no longer detectable in the right heart after 1 min. Approximately 1 h later both pupils were dilated and unreactive to light.(ABSTRACT TRUNCATED AT 250 WORDS)