[The importance of the laryngeal mask in the difficult intubation and early experience with the intubating laryngeal mask airway--ILMA--Fastrach].

Unlabelled: The conventional laryngeal mask airway ("Standard" laryngeal mask airway SLMA is of outstanding importance in the management of the difficult airway. The intubating laryngeal mask airway (ILMA, commercial name Fastrach) has become available recently. First results indicate that the excellent ventilation characteristics of SLMA are maintained, but in addition blind intubation is successful in more than 90% of patients with normal anatomy as well as with difficult intubation.

[First experience with the laryngeal intubation mask].

Objective: We report our initial experience with an improved model of the laryngeal mask airway, the intubating laryngeal mask airway (ILMA, commercial name Fastrach), which was designed by A.I.J.

[Intubating laryngeal mask].

To improve the success of blind intubation through a laryngeal mask, Dr. A.I.

[Safe handling of the laryngeal mask airway in eye surgery].

Background: We prospectively used the laryngeal mask airway (LM) in eye surgery to evaluate: 1) the limits of safe handling; 2) the feasibility of its use in long operative procedures, and 3) whether patients with higher anaesthetic risk (hypertension, asthma, children) may profit from the LM.

Methods: In 792 patients leak pressure, cuff volume, duration of anaesthesia, and complications were noted; 33 were children under 10 years of age, 100 had hypertension or severe asthma. In 54 patients cuff volume was increased to measure its influence on leak pressure; in 241 leak pressure was also measured at the end of the procedure; in 31 cuff pressure was measured under standard conditions over time; in 7 dead space was evaluated with the BANALYZER program; and in 300 blind endotracheal suction was attempted through the LM.

[Inspiratory pressure support via facial mask in acute respiratory insufficiency].

A patient in acute respiratory failure (Murray score 2.0) caused by pneumonia in the remaining lung 4 days after left-sided pneumonectomy was successfully treated with non-invasive pressure support by face mask. Non-invasive ventilation was chosen to keep the time of ventilating as short as possible, to achieve minimum pressure within the airways, and to retain natural defense and clearance mechanisms.

[Difficult intubation in adults].

Unlabelled: GOAL OF THIS REVIEW: We review the recent literature and our experience in order to determine how one can recognize and handle patients with difficult endotracheal intubation.

Definition And Incidence: "An intubation is called difficult if a normally trained anesthesiologist needs more than 3 attempts or more than 10 min for a successful endotracheal intubation." The incidence of difficult intubation depends on the degree of difficulty encountered showing a range of 1-18% of all intubations to about 2/10000-1/million for "cannot ventilate-cannot intubate" situations.

[The laryngeal mask airway in the difficult intubation. The results of a prospective study].

Objective: The laryngeal mask airway (LMA) was prospectively used in patients who were difficult to intubate to evaluate whether it improves ventilation compared to a face mask, facilitates fibreoptic intubation, and how often blind intubation would be possible.

Methods: In a university hospital, 30 patients who were difficult to intubate (35 operative procedures) and 50 normal subjects were investigated; 23 patients had had radical resection of a facial tumor with irradiation at a previous time and 7 could not be intubated conventionally (grade 3 and 4 visibility of the larynx according to Cormack [14]). Blind intubation was attempted with a bent bougie, a 6.

[Quantifying pathological disorders of consciousness. Reliability criteria, aims, feasibility].

Within a survey of coma scales we distinguish scales of clinical findings (Glasgow Coma Scale [GCS], Glasgow Liège Scale [GLS], Innsbruck Coma Scale [ICS], Comprehensive Level of Consciousness Scale [CLOCS]), grading tests (Vigilance Scale [VS], Funktionspsychose-Skala-B [FPBS-B]) and level-scales (Reaction-Level-Scale [RLS-85], Munich Coma Scale [MCS]). With regard to the purpose we differentiate a classification of depth, the prediction of prognosis and the monitoring of changes. For the purpose of classification of depth, the RLS-85 because of its superior objectivity is preferable, but the GCS is of comparable validity and more widely used.

[Diagnosis of brain death: limitations of angiography after osteoclastic trepanation].

A 50-year-old man sustained severe skull-brain trauma with intracerebral bleeding, cortical contusion foci and fracture of the petrosal bone. He went into coma a few hours after the accident. Three days after surgical removal of an intracerebral bleeding via a frontoparietal osteoclastic trepanation (removal of a 4 x 5 cm piece of bone) there occurred complete brainstem areflexia, respiratory arrest and drop in temperature; the encephalogram was isoelectric.

Continuous positive pressure breathing without and with inspiratory pressure support in acute respiratory failure when mean airway pressure is constant.

Objective: Mean airway pressure (Pawm) may be a major factor for PaO2, functional residual capacity, and cardiac output in acute respiratory failure (ARF). To clarify effects of inspiratory pressure support (IPS) as a ventilatory mode in ARF, we studied patients in ARF either using IPS or continuous positive pressure breathing (CPAP) at the same level of Pawm, measuring respiratory and circulatory parameters.

Methods: After consent, 10 patients in ARF of moderate severity (PaO2:FiO2 205 +/- 108 at positive end expiratory pressure (PEEP) 8.

[Emergency ventilation using an Ambu-bag with a new coniotomy set].

A new coniotomy set (Mini-Trach, Portex Ltd) for endotracheal suction was modified with a 4-mm tube adapter and used for ventilation with standard resuscitation bags (Ambu, Laerdal) in two corpses. Minute volumes achieved with open glottis were 36 +/- 1.9 l/min for Ambu, 33 +/- 2.

Accurate measurement of N2 volumes during N2 washout requires dynamic adjustment of delay time.

Measurement of respiratory gas composition by a mass spectrometer lags behind the measurement of gas flow. To obtain specific gas volumes (e.g.

A simple method for estimating compliance.

In intensive care medicine, pulmonary compliance is one of the very helpful diagnostic indices. Because of technical difficulties, however, the measurement of pulmonary compliance is often reduced to a rough guess of the compliance of the total respiratory system. The technical problems can be overcome using a computer to solve the basic equations with the least-squares fit (LSF) method.

Reliable detection of inspiration and expiration by computer.

A new computer assisted method is proposed to distinguish between the inspiratory and expiratory phases of breathing. The method is based on the analysis of both gas flow and CO2-concentration. The algorithm is effective and reliable and is most suitable in critical care patients when an uninterrupted sequence of breaths is to be analysed immediately at the bedside.

[Behavior of functional residual capacity in acute respiratory insufficiency].

Variations of functional residual capacity (FRC, estimated by the N2-washout technique) and oxygenation (PaO2/FIO2) were investigated in patients mechanically ventilated for acute respiratory failure (ARF, caused by pneumonia). The various ventilatory modes were compared. The results were as follows: 1.

[The impossibility of direct flow measurements in lung function studies. Analysis of errors and compensation].

The authors demonstrate that the conditions for correct flow measurement are not fulfilled when a resistive flow transducer (Fleisch pneumotachograph, screen pneumotachograph etc.) is connected directly to the mouth or to the end of the endotracheal tube. This is because the composition, temperature and water content of the respiratory gas varies markedly within a respiratory cycle, the mechanically ventilated patient exhales with a huge expiratory initial peak flow, and laminar flow tends to switch over to turbulent flow in this system.

Direct accurate gas flow measurement in the patient: compensation for unavoidable error.

It is shown that the conditions for accurate flow measurement are not met if the resistant flow meter (e.g., Fleisch pneumotachograph or screen pneumotachograph) is attached directly at the mouth or endotracheal tube and the breath flows directly through it, firstly because its gas composition, temperature, and humidity change radically even within the course of one respiratory cycle, secondly because the expiratory peak flow of the patient being ventilated rapidly tends to become too high, and thirdly because the entire system is sensitive to turbulence.

A concept for breath by breath computing of lung compliance in the ventilated patient.

A concept for calculating dynamic lung compliance (CL) by computer in ventilated supine patients is described. The primary signals are gas flow, airway pressure, esophageal pressure (PES) and ECG. Endinspiratory and endexpiratory PES is calculated as a mean value during an R/R interval's time just before the end of inspiration and expiration.

[Catheter epidural analgesia for treatment of postoperative and post-traumatic pain].

Postoperative epidural local anesthetics or opiates provide excellent analgesia but do not reduce the incidence of respiratory complications compared with systemic analgesics. Additional and sometimes lethal side effects reserve the routine use of epidural analgesia for highly selected patients. Thoracic epidural analgesia (TEA) may prevent ventilation in patients with serial rib fractures (SRF) without gross pulmonary parenchymal lesion.