Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 2003
Case Reports[Time costs cardiac muscle tissue--prehospital therapy of acute myocardial infarct--a case report].
Symptoms of an acute myocardial infarction are a common reason for calling the emergency physician. Pre-hospital mortality caused by cardiac infarction is constantly high. The main potential for decreasing infarction mortality lies in the pre-hospital period. ⋯ A particular focus is the management of pre-hospital thrombolysis, the preconditions, realization and risks of which are described. In this context, the experience and competence of the emergency physician is prerequisite for the exact diagnosis and therapy. Furthermore, the importance of a smooth transition from pre-hospital therapy to intensive care is emphasized.
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Anaesthesiol Reanim · Jan 2003
Comparative Study[Regional anesthesia in newborn infants, infants and children--what prerequisites must be met?].
In general, every anaesthetic technique should only be used with a given indication after a careful risk-benefit evaluation, when there are no contraindications and when the physician has sufficient knowledge and skill to safely perform the technique. ⋯ the great advantage of regional blocks is that they can be administered without the risks of opioids, e.g. respiratory depression, nausea, vomiting and delayed gastric emptying. Regional anaesthesia is rarely indicated instead of general anaesthesia: even ex-premature babies can safely undergo general anaesthesia supplemented with a regional block. Special risks occur when regional blocks are performed in anaesthetised children, and special care is needed. However, in contrast to adult practice, this is a generally accepted modality of paediatric anaesthesia worldwide. In addition, perfect analgesia may obscure the signs of compartment syndrome and beginning pressure sores. Preoperative evaluation: the preoperative evaluation relies mainly on the patient's history. Coagulation tests are not performed as routine screening. However, even with a careful history, bleeding disorders can be overlooked, especially in neonates and infants. Mastering the technique: caudal anaesthesia can be used for a large variety of interventions below the umbilicus; therefore, a sufficient caseload can be achieved by most anaesthetists, and the technique can be easily learned. It should belong, together with wound infiltration, ilioinguinal and penile block, to the armamentarium of all anaesthetists caring for children. However, regional blocks are of limited duration and are therefore only part of a concept of balanced analgesia, which also involves nonsteroidals, paracetamol and opioids.
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Anaesthesiol Reanim · Jan 2003
Randomized Controlled Trial Clinical Trial[Mesenteric traction syndrome during the operation of aneurysms of the abdominal aorta--histamine release and prophylaxis with antihistaminics].
Mesenteric traction syndrome occurs during abdominal surgery and is described as sudden tachycardia, hypotension and flush. Among other etiological factors, eventeration or mesenteric traction of the small intestine may cause histamine release from mesenteric mast cells. Therefore, our hypothesis was that mesenteric traction syndrome could be positively influenced by prophylactic administration of H1- and and H2-antihistamines. ⋯ In the placebo group, however, the haemodynamics only stabilised 5 min after mesenteric traction when anaesthetic gas concentration was repeatedly reduced and vasopressor/volume administration was increased (placebo group = 20 times vs. antihistamine group = 8 times (p = 0.001, Chi2-test). From these results we conclude that prophylactic administration of antihistamines reduces in particular the incidence of arrhythmias and the number of stabilising measures during mesenteric traction. Prophylaxis with H1- and H2-antihistamines may therefore be of perioperative benefit and should be considered in AAA surgery.
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Anaesthesiol Reanim · Jan 2003
Review[Smoking and preoperative fasting--are there evidence-based guidelines?].
Over the last years several clinical studies have modified the guidelines for preoperative fasting to reduce the risk of pulmonary aspiration. In most western countries the following guidelines are accepted: for clear liquids 2 hours, breast feeding 4 hours, small meals and breast milk substitutes 6 hours, heavy meals 8 hours. Since preoperative smoking is acknowledged as a risk factor, it should be ceased in most clinics 6 hours before induction of anaesthesia, as well. ⋯ To reduce the risk of perioperative pulmonary complications, cessation of smoking is necessary 8 weeks before operation. Stopping smoking only a few days before operation and anaesthesia even tends to increase the risk of pulmonary complications. Regarding cardiac complications, cessation of smoking 12 hours before anaesthesia is sufficient to reduce the incidence of cardiac ischaemia.
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Anaesthesiol Reanim · Jan 2003
Review[Management of pediatric airway--anatomy, physiology and new developments in clinical practice].
Due to the special features of paediatric anatomy and physiology, the expected and unexpected difficult paediatric airway is one of the major challenges to every anaesthesiologist, paediatrician and emergency physician. During the last years, some new devices have been made available to improve airway management in children and infants, and several studies have advanced our understanding of the risks and benefits of our clinical practice. ⋯ Recent studies have also demonstrated specific problems with the LMA in infants, as well as possible advantages of a new prototype LMA for children, similar to the ProSeal. Furthermore, the following review presents data about the use of the Cuffed Oropharyngeal Airway (COPA) and the Laryngeal Tube (LT) in paediatric patients.