Der Anaesthesist
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In single-step surgery of panfacial fractures or conversion osteotomies of the visceral cranium, nasal as well as oral intubation or tracheal intubation via tracheostomy is necessary. If complicated tracheostomy is not done, intraoperative nasal-oral repositioning of the tube is required. ⋯ After a laterosubmental fistula is created at the base of the mouth, directly behind the anterior mandibular dentition, the tube is guided through the oral floor, lateral to the muscles and the salivary duct, and fixed extraorally. The advantages of this method are: no more intraoperative repositioning of the endotracheal tube and no need for tracheostomy, thus eliminating the risks and side effects, as well as tracheal scarring, and free accessibility of the operative field.
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Continuous positive pressure ventilation (CPPV) is an established therapy for treatment of acute respiratory failure (ARF). However, cardiac performance may be severely disturbed due to elevated intrathoracic pressure, inducing a decrease in cardiac output (CO) and oxygen delivery (DO2). Alternatively, mechanical ventilation with prolonged inspiratory to expiratory duration ratio (inversed ratio ventilation IRV) has been successfully used in ARF. ⋯ Occlusion of the RIVA coronary artery typically induces an infarction of 35% of left ventricular muscle mass; however, non-ischaemic myocardium reveals an unchanged or increased contractility. Thus, a reduction of left ventricular preload secondary to CPPV mainly contributes to haemodynamic depression, which is less pronounced during IRV due to a lower peak inspiratory airway pressure and mean airway pressure. IRV may be useful for mechanical ventCntCo
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Randomized Controlled Trial Comparative Study Clinical Trial
[Propofol, isoflurane and neuroleptanesthesia. Ophthalmic surgery in geriatric patients].
Ophthalmic surgeons require anaesthesia to ensure that the patient is completely relaxed for microsurgical operations and that the intraocular pressure is reduced. These conditions must be maintained throughout the operation. In addition to these requirements, the anaesthetist mostly deals with elderly patients with multiple diseases. ⋯ Therefore, it seems on the whole that there are benefits from propofol-fentanyl anaesthesia because of the fact that in comparison with the rather techniques, elderly patients become alert again faster. However, sufficient postoperative pain therapy is necessary to free the patients of pain to the same degree as with neuroleptanaesthesia. In most cases peripherally acting analgesic substances with no interference with vigilance are sufficient.
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Randomized Controlled Trial Clinical Trial
[Topographic-quantitative EEG-analysis of the paradoxical arousal reaction. EEG changes during urologic surgery using isoflurane/ N2O anesthesia].
Increases in slow-wave (delta) activity in the EEG may reflect increased depth of anaesthesia provided that hypoxia, haemodynamic instability and drug overdose have been excluded. In contrast, similar intraoperative EEG responses have been described as paradoxical arousal reactions. The aim of this study was to assess the effects of surgical stimulation on spatial EEG changes during anaesthesia with 0.6% isoflurane/66% nitrous oxide. ⋯ Since these events occur predominantly at frontal areas they may not be detected with single-channel parietal recordings. Our data suggest that topographical EEG monitoring may useful for assessing painful events during surgery. Using EEG monoparameters like spectral edge frequency or median the occurrence of paradoxical arousal reactions may be falsely interpreted as an increased depth of anaesthesia.