Der Anaesthesist
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Verification of the correct position of the endotracheal tube is a daily routine task of every anaesthesiologist. Accidental intubation of the oesophagus is a very rare complication in absolute terms but still the most frequent preventable anaesthetic mishap with fatal outcome. Even the most experienced anaesthetist is not immune to this complication. ⋯ Visualization of the endotracheal tube between the vocal cords and a typical CO2 excretion waveform are two of the best practical signs. After every change of position of the patient, especially after flexion or extension of the head, the position of the tube must be checked again. The old aphorism is still valid: When in doubt, take it out.
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Continuous spinal anaesthesia has a number of advantages, but there are a number of drawbacks as well: difficulties in threading the catheter, distribution of the local anaesthetics and the development of cauda equina syndrome. Spinaloscopy was done to visualize the fate of catheters during and after their insertion, as well as the distribution of local anaesthetics injected through these fine-bore catheters. METHOD. ⋯ Based on our observations, we conclude: The catheter should only be inserted 2 cm into the subarachnoid space. This may decrease the risk of malpositioning. After the tip of the catheter has reached the subarachnoid space, the stylet should be with drawn 2 or 3 cm to minimize the risk of nerve injury and/or bleeding.
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A series of 52 infants underwent general or urological surgery; all were ventilated with the CICERO. Two different flows of fresh gas were used. In group I (n = 21) the fresh gas flow was set exactly at the level of the minute volume, representing a half-open, non-rebreathing system. ⋯ In the CICERO system, heating the gases at the valve only prevents mechanical failure caused by water condensation. In pediatric anaesthesia, variable heating and non-condensing humidity are essential. The dry and heated gases of the CICERO are not acceptable in the daily practice of paediatric anaesthesia.
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Until recently, only the racemic mixture of ketamine has been used in anaesthesia. Little is known of the central nervous effects of the pharmacologically more potent S(+)-isomer. Information in regard to the putative receptor site involved in the mediation of its anaesthetic/analgesic effect is particularly sparse. ⋯ Hypersynchronisation of the EEG suggests a deep plane of anaesthesia after S(+)-ketamine. The pronounced blockade of impulses in the sensory nervous pathways suggests an efficient analgesic effect that is partly mediated by the opioid-receptor. The respiratory depression may be of importance when S(+)-ketamine is used in high dosages in man.
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Randomized Controlled Trial Comparative Study Clinical Trial
[General anesthesia vs. retrobulbar anesthesia in cataract surgery. A randomized comparison of patients at risk].
Several studies comparing retrobulbar block (RB) and general anaesthesia (GA) for cataract surgery in the elderly have been published. Most of them were retrospective. Our prospective study was designed in order to determine the benefits or disadvantages using RB or GA. ⋯ Intravenous acetazolamide did not influence ABG in a significant manner. With regard to the preference of each patient, we recommend both RB and GA for cataract surgery in high-risk patients on the assumption of sufficient preoperative treatment of co-existing diseases. In conclusion, cardiovascular and ABG stability were maintained during both anaesthetic techniques.