M. Wrobel

The efficacy of the non-opioid analgesics parecoxib, paracetamol and metamizol for postoperative pain relief after lumbar microdiscectomy.

In this prospective, double-blind, randomized, placebo-controlled study we compared the efficacy of three IV non-opioid analgesics for postoperative pain relief after lumbar microdiscectomy. Eighty healthy patients were randomly divided into 4 treatment groups (n = 20 each) to receive either parecoxib 40 mg, paracetamol 1 g, metamizol 1 g, or placebo IV 45 min before the end of surgery. In the postanesthesia care unit (PACU) patients were treated using patient-controlled analgesia (PCA) with piritramide. In the metamizol group the pain score at arrival in the PACU was significantly lower compared with the paracetamol, parecoxib, and placebo groups. In addition, in the metamizol group significantly fewer patients required additional PCA compared with the other groups studied. However, in those patients who required additional pain therapy in the four treatment groups, there was no significant difference in time to first request for piritramide and cumulative consumption of piritramide as assessed by the PCA data in the PACU. The incidence of adverse side effects was infrequent in all groups. These results suggest that in patients undergoing lumbar microdiscectomy, metamizol is superior to parecoxib, paracetamol, and placebo for immediate postoperative pain relief with minimal side effects.

Atemwegsmanagement, Narkose und Notfallbeatmung

Ein 36-jahriger, muskuloser Mann (195 cm, geschatzt 120 kg) wird von der Notaufnahme auf die Intensivstation gebracht. Er war zuhause krampfend aufgefunden worden und hatte daraufhin vom Notarzt insgesamt 30 mg Diazepam erhalten. In der Notaufnahme hat der Patient einen erneuten Grand-mal-Anfall gezeigt, sodass nun von einem Status epilepticus ausgegangen werden muss. Trotz erweiterter Therapie mit Phenytoin 250 mg uber 5 min kann der Krampfanfall nicht beendet werden, der Patient ist tief bewusstlos und zyanotisch, sodass sich der Intensivarzt zu Intubation und Beatmung entschliest.

Parker Flex-It intubation stylet versus a 90-degree curved stylet during intubation with the McGrath videolaryngoscope performed by novices: a manikin study with 5 airway scenarios

STUDY OBJECTIVE To compare the Parker Flex-It intubation stylet with a 90-degree curved stylet using the McGrath videolaryngoscope in 5 airway scenarios (from easy to difficult) in a manikin. DESIGN Prospective, randomized study. SETTING Academic hospital. SUBJECTS 20 staff anesthesiologists with no previous experience in videolaryngoscopy. MEASUREMENTS Subjects performed a total of 200 intubations with the McGrath Series 5 videolaryngoscope and completed a questionnaire afterwards. RESULTS Overall success rate was significantly higher with the Parker Flex-It intubation stylet (96 successful intubations with the Parker Flex-It vs 79 intubations in the 90° curved stylet group; P < 0.05). Intubation time was not significantly different. Subjects rated the Parker Flex-It intubation stylet as the better device for intubation with the McGrath videolaryngoscope in routine or emergency situations. CONCLUSION Intubation of the manikin with the McGrath videolaryngoscope had more success with the Parker Flex-It intubation stylet than a 90° curved stylet.