Preclinical Pediatric Care by Emergency Physicians: A Comparison of Trauma and Nontrauma Patients in a Population-Based Study in Austria.

Objectives: Fewer than 10% of emergency medical system (EMS) calls concern children and adolescents younger than 18 years. Studies have shown that the preclinical care of children differs from that of adults regarding assessment, interventions, and monitoring. The aims of this study were to describe the preclinical care and emergency transport of pediatric patients in Vorarlberg, Austria and to compare trauma and nontrauma cases.

Bioreactor and scaffold design for the mechanical stimulation of anterior cruciate ligament grafts.

Various studies have shown that physical stimuli modulate cell function and this has motivated the development of a bioreactor to engineer tissues in vitro by exposing them to mechanical loads. Here, we present a bioreactor for the physical stimulation of anterior cruciate ligament (ACL) grafts, whereby complex multi-dimensional strain can be applied to the matrices. Influences from environmental conditions to the behavior of different cells on our custom-made silk scaffold can be investigated since the design of the bioreactor allows controlling these parameters precisely.

Emergency medical helicopter operations for avalanche accidents.

Background: In the European Alps emergency medical helicopter services are regularly involved in avalanche rescue missions. How the helicopter emergency medical system best supports avalanche rescue missions is controversial.

Aim Of The Study: To study advantages and limitations of the early dispatch of emergency medical helicopters after avalanche accidents.

Surgical vein occlusion--comparison of four different methods in a rat model.

Background: Among many aspects, wound healing depends on early restoration of venous blood flow across wound margins. The type of surgical occlusion of vein stumps during operations was assumed to have an influence on the early postoperative reunion of vein stumps and thereby on wound healing. Currently, there are different methods of vein stump occlusion available: ligation (e.

Experience with helicopter rescue missions for crevasse accidents.

We retrospectively studied incidence, patterns, and severity of injury and hypothermia in 95 victims of crevasse accidents. Fifteen (16%) victims were already dead when the rescue team arrived on the scene. Asphyxia (8 victims) was typically caused by snow burial owing to a collapse of snow bridges covering crevasses and was observed only during winter sports activities on glaciers.

Submission of clinical studies to ethics committees or clinical trials registers: the authors' point of view.

To evaluate the satisfaction of clinical scientists when submitting study drafts to an ethics committee/clinical trials register (CLINICALTRIALS, EUDRACT, ISRCTN) we conducted an online survey of 240 authors publishing in anesthesia/critical care medicine (A) or in major general medical (M) journals from January to December 2007. No statistical difference between groups A and M was seen with regard to the number of studies submitted to ethics committees or registered in various clinical trials registers. On a visual analogue scale (VAS -10 to +10), the subjective evaluation of the effort required to submit a study draft to an ethics committee or enter it in a clinical trials register produced almost only negative grades in both groups.

The laryngeal mask airway Supreme--a single use laryngeal mask airway with an oesophageal vent. A randomised, cross-over study with the laryngeal mask airway ProSeal in paralysed, anaesthetised patients.

The LMA Supreme is a new extraglottic airway device which brings together features of the LMA ProSeal, Fastrach and Unique. We test the hypothesis that ease of insertion, oropharyngeal leak pressure, fibreoptic position and ease of gastric tube placement differ between the LMA ProSeal and the LMA Supreme in paralysed anesthetised patients. Ninety-three females aged 19-71 years were studied.

Radiological aspects of injuries of avalanche victims.

Objective: Increasing numbers of avalanche victims with polytrauma have highlighted their need for radiological injury characterisation, which this study examines.

Methods: People in Tirol injured by avalanche during 1994-2005 and admitted to the Innsbruck Medical University Hospital were included. Data for this retrospective study were obtained from the Austrian avalanche register and local electronic patient files archive.

Gum elastic bougie-guided insertion of the ProSeal laryngeal mask airway is superior to the digital and introducer tool techniques in patients with simulated difficult laryngoscopy using a rigid neck collar.

Background: We compared three techniques for insertion of the laryngeal mask airway ProSeal (PLMA) in patients with simulated difficult laryngoscopy using a rigid neck collar.

Methods: Ninety-nine anesthetized healthy female patients aged 19-68 yr were randomly allocated for PLMA insertion using the digital, introducer tool (IT) or guided techniques. Difficult laryngoscopy was simulated using a rigid neck collar.

Rescue missions for totally buried avalanche victims: conclusions from 12 years of experience.

The planning and execution of avalanche rescue missions to search for totally buried avalanche victims are mostly based on personal experience and preference, as evidence-based information from literature is almost completely missing. Hence, the aim of this study was to identify major factors determining the survival probability of totally buried victims during avalanche rescue missions carried out by organized rescue teams (Austrian Mountain Rescue Service, Tyrol). During the 12-year period studied, 109 totally buried persons (56 off-piste, 53 backcountry), were rescued or recovered; 18.

Preoperative administration of esomeprazole has no influence on frequency of refluxes.

Study Objective: To examine the effect of esomeprazole in a fixed time setting on gastric content volume, gastric acidity, gastric barrier pressure, and reflux propensity.

Design: Randomized, controlled, double-blind trial.

Subjects: 21 healthy, ASA I physical status volunteers.

Traumatic intracranial haemorrhage in conscious patients with facial fractures--a review of 1959 cases.

Objective: Facial fracture patients who are conscious with a Glasgow Coma Scale (GCS) score of 15 in the absence of clinical neurological abnormalities are commonly not expected to have suffered severe intracranial pathology. However, high velocity impact may result in intracranial haemorrhage in different compartments.

Methods: Over a 7-year period, 1959 facial fracture patients with GCS scores of 15 and the absence of neurological abnormalities were analysed.

Lornoxicam characteristically modulates cerebral pain-processing in human volunteers: a functional magnetic resonance imaging study.

Background: Lornoxicam like other non-steroidal anti-inflammatory drugs (NSAIDs) is widely used for postoperative pain therapy. Evaluation of the effect of lornoxicam on cerebral processing of surgical pain was thus the aim of the present functional magnetic resonance imaging (fMRI) study.

Methods: An fMRI-compatible pain model that mimics surgical pain was used to induce pain rated 4-5 on a visual analogue scale (VAS) at the anterior margin of the right tibia in volunteers (n=22) after i.

Comparison of high- and low-dose intrathecal morphine for spinal fusion in children.

Background: The purpose of this prospective study was to assess the blood-sparing effect, the quality of analgesia, and the incidence of side-effects of a low-dose regime of intrathecal opioids (ITO) when compared with those of a high-dose regime in scoliosis surgery in children.

Methods: Forty-six children were randomly included into one of the three groups to receive morphine 5 microg kg(-1) plus sufentanil 1 microg kg(-1) [low-dose intrathecal opioid (LITO)], morphine 15 microg kg(-1) plus sufentanil 1 microg kg(-1) [high-dose intrathecal opioid (HITO)] intrathecally, or no intrathecal opioid. Postoperative analgesia was provided by i.

A study of airway management using the ProSeal LMA laryngeal mask airway compared with the tracheal tube on postoperative analgesia requirements following gynaecological laparoscopic surgery.

In a randomised double blind prospective study, we tested the hypothesis that postoperative pain is lower in patients who receive an ProSeal LMA laryngeal mask airway compared with a tracheal tube. One hundred consecutive female patients (ASA I-II, 18-75 years) undergoing laparoscopic gynaecological surgery were divided into two equal-sized groups for airway management with the ProSeal LMA or tracheal tube. Anaesthesia management was identical for both groups and included induction of anaesthesia using propofol/fentanyl, and maintenance with propofol/remifentanil, muscle relaxation with rocuronium, positive pressure ventilation, gastric tube insertion, dexamethasone/tropisetron for anti-emetic prophylaxis, and diclofenac for pain prophylaxis.

Bacterial contamination of anaesthetists' hands by personal mobile phone and fixed phone use in the operating theatre.

Following hand disinfection, 40 anaesthetists working in the operating room (OR) were asked to use their personal in-hospital mobile phone for a short phone call. After use of the cell phone, bacterial contamination of the physicians' hands was found in 38/40 physicians (4/40 with human pathogen bacteria). After repeating the same investigation with fixed phones in the OR anteroom 33/40 physicians showed bacterial contamination (4/40 with human pathogen bacteria).

The impact of avalanche rescue devices on survival.

Background: Within Europe and North America, the median annual mortality from snow avalanches between 1994 and 2003 was 141. There are two commonly used rescue devices: the avalanche transceiver, which is intended to speed up locating a completely buried person, and the avalanche airbag, which aims to prevent the person from being completely buried.

Objective: This retrospective study aimed to evaluate whether these avalanche rescue devices had an effect on mortality.

Effect of total intravenous anaesthesia and balanced anaesthesia on the frequency of coughing during emergence from the anaesthesia.

Background: The effects of total intravenous anaesthesia (TIVA) and balanced anaesthesia (BAL) on coughing during emergence from the general anaesthesia have not yet been compared.

Methods: Fifty patients, aged 18-60 yr, undergoing elective lumbar disk surgery were randomly allocated to undergo TIVA (propofol-remifentanil) or BAL (fentanyl-nitrous oxide-sevoflurane). Extubation was performed in the knee-elbow position, documented on video, and subsequently evaluated by blinded examiners.

Postoperative nausea, vomiting, airway morbidity, and analgesic requirements are lower for the ProSeal laryngeal mask airway than the tracheal tube in females undergoing breast and gynaecological surgery.

Background: We test the hypothesis that the frequency of postoperative nausea and vomiting is similar for the ProSeal laryngeal mask airway (LMA) and the tracheal tube.

Methods: Two hundred consecutive female patients (ASA I-II, 18-75 yr) undergoing routine breast and gynaecological surgery were divided into two equal-sized groups for airway management with the ProSeal LMA or tracheal tube.

Results: Ventilation was better and airway trauma less frequent for the ProSeal LMA.

[Management of accidental hypothermia].

Patients with hypothermia are frequently encountered in emergency medicine. Particularly trauma patients, but also other predisposed persons, can be expected to suffer from hypothermia at any time of the year. Therapy focuses not only on symptom-oriented intensive care to stabilize and secure vital functions, but also on rewarming.

Pattern of injury after rock-climbing falls is not determined by harness type.

Objective: Experimental data indicate that when using a sit harness alone, any major fall during rock climbing may cause life-threatening thoraco-lumbar hyperextension trauma or "head down position" during suspension. To clarify the actual influence of the type of harness on the pattern and severity of injury, accidents involving a major fall in a climbing harness were analyzed retrospectively.

Methods: Individuals with a height of fall equal to or exceeding 5 m were identified through a search of accident and emergency records for the period from 2000 to 2004.

Pattern and severity of injury in avalanche victims.

In avalanche accidents, the significance of major trauma as a cause of morbidity and mortality is controversial. The aim of this retrospective study is to determine the severity and pattern of injury in avalanche victims admitted to the University Hospital of Innsbruck between 1996 and 2005. A total of 49 significant injuries were found in 105 avalanche victims; the most frequent were of the extremities (n = 20), the chest (n = 18), and the spine (n = 7).

Tyrolean tensiometer: a new instrument for easy intraoperative tension measurement before vascular anastomosis.

Background And Aim: In reconstructive surgery microsurgical repair of dissected arteries sometimes has to be done under longitudinal tension. Guidelines to support an objective decision on whether tension associated with direct suture is acceptable or whether grafting is needed, do not exist. All experimental data found concerned the clinical outcome of a certain length defect treated in various animal models.

Accidental intracerebroventricular injection of anaesthetic drugs during induction of general anaesthesia.

A 51-year-old patient scheduled for surgery under general anaesthesia was accidentally given remifentanil 150 microg and propofol 1% 10 ml through an intracerebroventricular totally implantable access port placed in the right infraclavicular region, which was mistakenly thought to be an intravenous line. Severe pain in the head and neck caused the mistake to be discovered rapidly, and 20 ml of a mixture of cerebrospinal fluid and the anaesthetic drugs were aspirated from the implantable access port. The patient suffered no apparent adverse neurological sequelae.

Tyrolean tensiometer: A new instrument for easy intraoperative tension measurement before nerve coaptation.

Background: In reconstructive surgery microsurgical repair of dissected nerves can be done end-to-end or by using a nerve graft. Guidelines to support an objective decision, whether tension associated with direct suture is acceptable or grafting is needed, do not exist. All experimental data found concerned the clinical outcome when a certain length defect was treated in various animal models.