Zentralblatt für Chirurgie
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Anaesthesia of patients for bariatric surgery is a major challenge. It is essential to take into account the specific pathophysiology, comorbidities and related complications associated with obesity. ⋯ Based on this knowledge it is possible to estimate the perioperative risk situation for the obese patient. Furthermore, the following text presents concepts in performing anaesthesia for the pre-, peri- and postoperative phases and deals with some complications and their possible solutions.
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The aim of the present study was the verification of the accuracy of 2D fluoroscopy-based navigated pedicle screw placements at the thoracic and lumbar spine in a case series of traumatised patients. Within 36 months 111 pedicle screws were instrumented using C-arm based navigation in 29 patients, 60 at the thoracic and 51 at the lumbar spine. All screw positions were evaluated postoperatively by a routine thin-slice CT scan using multiplanar reconstruction. ⋯ Segmentation of the C-arm navigation into two comparable treatment periods showed a learning curve with a reduction of perforations in the second sequence (after 57 pedicle instrumentations) of about 15%, this was not found to be statistically significant. The fluoroscopic navigation of pedicle screws is a safe procedure at the lumbar spine with equal accuracy compared to the non-navigated conventional instrumentation. Application of C-arm navigation at the thoracic spine showed more inaccuracies, so that 3D-based navigation seems to be more advantageous in this region.
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Paediatric perioperative care represents specific challenges related to the distinct developmental, anatomic and physiological characteristics of children, requiring specialised expertise, including pharmacology. A specially trained anaesthesia team, an appropriate environment and appropriate paediatric-sized equipment (endotracheal tubes, cannulas) represent key factors in determining the perioperative outcome for this population. Other important equipment that must be adapted to the paediatric population include: Non-invasive anaesthesia monitoring equipment (ECG, blood pressure cuff, pulse oximetry, capnography, oxygen monitor, volatile gas concentration monitor, peripheral nerve stimulator and temperature probe); as well as specialised ventilators that allow pressure- and volume-controlled ventilation with volumes as low as 20 ml, variable high frequency ventilation up to 60 breaths per minute and paediatric ventilator hose systems with automatic correction for compliance. ⋯ These techniques, however, should be performed by experienced anaesthesologists and surgeons only. If these conditions are not met, surgical procedures should not be performed except in the case of an emergency when transportation to a specialised paediatric facility cannot be done safely. This is particularly critical for premature babies, newborns, and infants up to 3 years of age.