Klaus Eyrich

Laryngo-pharyngeal complaints following laryngeal mask airway and endotracheal intubation

Study Objective To investigate the incidence and severity of laryngo-pharyngeal complaints following anesthesia with the use of a laryngeal mask airway (LMA) compared with endotracheal intubation in adults. Design Prospective study with randomized patient selection. Setting University medical center. Patients 202 adult ASA physical status I, II, and III patients scheduled for elective surgery of either an extremity or breast, or a transurethral resection. Interventions Following intravenous induction of anesthesia, a standard LMA size #3, #4, or #5 corresponding to the patients body weight, was inserted in 103 patients; 99 patients were intubated with a polyvinylchloride endotracheal tube [7.5 mm inner diameter (ID) in women and 8.0 mm ID in men]. Cuff pressures in the LMA group were initially reduced to a minimum pressure at which an air-tight seal between the LMA and the laryngeal inlet was provided at a positive pressure of 20 cm H 2 O during manual bag ventilation. Cuffs of endotracheal tubes were inflated and controlled to a volume needed to prevent gas leak at 35 cm H 2 O pressure. Measurements and Main Results Cuff pressures were continuously monitored in both groups. Patients assessed their laryngo-pharyngeal complaints on a 101-point numerical rating scale on the evening after surgery and the following two days. No difference was found in the incidence and severity of sore throat on the evening following surgery or on the two following days. Dysphonia was more frequent following intubation than following LMA insertion on the day of surgery (46.8% vs. 25.3%) and on the first postoperative day (28.1% vs. 11.6%) ( p Conclusions There is a distinct pattern of laryngo-pharyngeal complaints following the use of the LMA and endotracheal intubation. With regard to minor laryngo-pharyngeal morbidity, the advantage of the LMA to endotracheal intubation is questionable.

A comparison of sevoflurane with halothane in outpatient adenotomy in children with mild upper respiratory tract infections

STUDY OBJECTIVE To investigate the efficacy and safety of sevoflurane compared with halothane in pediatric outpatient ear-nose-throat (ENT) surgery during the induction, maintenance, emergence, and recovery of anesthesia. DESIGN Prospective, randomized, comparative, open-label study. SETTING ENT operating room and postoperative recovery room at a university medical center. PATIENTS 41 ASA status I and II children between the ages of 2 to 10 years, with mild upper respiratory tract infection (URI). INTERVENTIONS Induction and maintenance of anesthesia with either sevoflurane or halothane for outpatient adenotomy, otomicroscopy, and myringotomy. MEASUREMENTS AND MAIN RESULTS Induction (means +/- SEM) was significantly shorter in the sevoflurane group (2.6 +/- 0.2 minutes) than in the halothane group (3.2 +/- 0.2 minutes). There was no difference between the two groups with regard to complications that occurred during the induction and maintenance period. The time to emergence and recovery was significantly shorter with sevoflurane than with halothane (means +/- SEM; time to extubation 9.9 +/- 0.98 minutes vs. 13.4 +/- 1.06 minutes, time to eye opening 12.9 +/- 1.6 minutes vs. 24.5 +/- 1.8 minutes, command response time 20.7 +/- 2.5 minutes vs. 36.4 +/- 2.8 minutes). No difference in the incidence of complications during emergence and recovery was found. Evaluation of recovery as assessed by a modified Aldrete score showed that children who had received sevoflurane reached higher scores in the first 30 minutes following the discontinuation of the anesthetic. The Pain/Discomfort Scale demonstrated a difference in the sevoflurane group, with more children being agitated and restless. CONCLUSION Sevoflurane provides a safe and rapid anesthetic induction with no differences in complications during the induction, maintenance, and emergence period. With sevoflurane, the time of emergence and recovery was significantly shorter. The characteristics of sevoflurane as evaluated in the present study make it a suitable anesthetic in pediatric outpatient surgery even in the presence of mild URI.

Safe and normothermic massive transfusions by modification of an infusion warming and pressure device.

A fluid-warming pressure infusion device (H-500/H25i, Level 1) was modified to meet the demands for safe, normothermic, and effective massive transfusions. By incorporating an autoventing 40 microns filter (Pall AV-SP), which was originally manufactured for use in an extracorporal circulation, the risk of accidental air embolism can be eliminated. Feasibility and efficiency of this model were tested in ten patients. The mean volume transfused and infused (packed red cells and colloids) was 6750 mL (SD +/- 2519) during a mean period of acute volume resuscitation of 55 minutes (SD +/- 30). Calculated flow rates averaged 140 mL/min, which were sufficient to stabilize all but one patient. This patient subsequently died because of uncontrollable surgical bleeding. Body temperature remained stable with a minimal mean drop of -0.3 degrees C. Supplying the Level 1 warming and pressure device with a Pall AV-SP filter allows for safe, effective, and demand-adapted massive transfusions in a large number of trauma patients at a reasonable cost.

Intraoperative Atemwegsobstruktion bei Anwendung der Larynxmaske Fallbericht und fiberoptische Befunde

ZusammenfassungDie Atemwegsobstruktion im Bereich des Larynx kann bei Maskennarkosen und bei Narkosen mit der Larynxmaske zu einer bedrohlichen Gefährdung des Patienten führen. Da mit der Larynxmaske ein Fremdkörper in den Hypopharynx und prälaryngeal eingebracht wird, gilt es zu unterscheiden, ob diese Atemwegsobstruktion durch die Larynxmaske selbst oder durch andere Faktoren verursacht wird. Verständnis der pathophysiologischen Abläufe und Erfahrung im Umgang mit der Larynxmaske sind Voraussetzung für die richtigen therapeutischen Maßnahmen. Nicht das Entfernen einer korrekt plazierten Larynxmaske, sondern die Vertiefung der Narkose ist die vordringlichste erste Maßnahme bei einer intraoperativen Atemwegsobstruktion.AbstractLaryngeal obstruction is a challenging complication during anaesthesia with a face mask or laryngeal mask and is due to insufficient analgesia in most cases. However, with a laryngeal mask in place it must be differentiated whether the airway obstruction is caused by the laryngeal mask itself or by other factors. Knowledge of the pathophysiology of the laryngeal closure and experience with the use of the laryngeal mask are essential for adequate treatment. Not the removal of a correctly inserted laryngeal mask which initially provided a satisfying airway, but the relaxation of laryngeal muscle activity by adequate anaesthesia is the first mandatory treatment if intraoperative airway obstruction occurs.

Störungen der Atmung

Ursachen von Storungen der Atmung konnen sein: Storungen des Atemzentrums (Opiat- oder Barbiturat-Intoxikation, Cometa aller Art, Hirndruck [s. S. 224], direkte traumatische Schadigung); Verlegung der Luftwege (zuruckgefallene Zunge, Bolus, Larynx-odem, Bronchospasmus, Aspiration); Engstellung der unteren Luftwege (Asthma bronchiale, Bronchospasmus); Storung der neuromuskularen Ubertragung (Poliomyelitis, Tetanus, Muskelrelaxation); gestorte Lungenentfaltung (Pneumo-, Hamatothorax); Storung der Diffusion, Verteilung und Perfusion treten auf bei: Asthma bronchiale, Pneumonie, Lungenemphysem, Lungenodem (intraalveolar, interstitiell), Lungenembolie.

Kreislauffunktion in Narkose

Metabolisches Regulationssystem. Die Durchblutung der Organe bzw. des Gesamtorganismus wird durch den Sauerstoffverbrauch der Gewebe bestimmt. Somit werden das Herzminutenvolumen und der Gefastonus bei steigendem Sauerstoffbedarf den Bedurfnissen entsprechend angepast.

Methoden der Schmerztherapie

Man unterscheidet zentral und peripher wirkende Analgetika. Aus der Reihe der peripher wirkenden Analgetika sind Acetylsalicylsaure und Paracetamol sowie Metamizol die wichtigsten Vertreter. Sie wirken in erster Linie uber eine Hemmung der Synthese der Prostaglandine, die durch die physikalischen, thermischen und chemischen Schadigungen freigesetzt werden und die eine Stimulation der sensiblen Nervenenden verursachen.

Atemfunktion in Narkose

Der Gasaustausch von Sauerstoff und Kohlendioxid zwischen Alveole und Blut in der Lunge wird als ausere Atmung bezeichnet. Dabei ist die Ausscheidung des CO2 von der alveolaren Ventilation (Atemzugvolumen minus Totraumvolumen × Atemfrequenz) abhangig. Diese wird beim spontan atmenden Patienten uber den arteriellen Kohlendioxid-Partialdruck (paCO2) und das Atemzentrum gesteuert.

Präeklampsie und Eklampsie

Atiologie und Pathogenese. Ursachen und Pathogenese der Eklampsie sind nicht bekannt. Man weis jedoch, das diese wahrend der Schwangerschaft auftretende Komplikation vornehmlich auftritt bei Erstgebarenden, entsprechender Familienanamnese, Mehrlingsschwangerschaften, Schwangeren mit Diabetes, Schwangeren mit chronischem Bluthochdruck Schwangeren mit Blasenmole, Schwangerschaften mit fetalem Hydrops.