[Lethal vascular erosion after percutaneous dilatation tracheostomy].

We report on a patient who underwent dilatational tracheostomy (Ciaglia technique) because of ARDS. 29 days after the procedure she died of hemorrhage from an arrosion of the bracheocephalic trunk, caused by the cuff of the tracheal cannula. This complication has, so far, been reported only after surgical tracheostomy.

[Preoperative stress. Research approach and methods of treatment].

The scientific approach to preoperative stress includes the identification of stressors and the measurement of stress responses. The stress responses include physiological (sympathetic nervous system, hypothalamic--hypophyseal and adrenocortical system), psychological (anxiety, depression etc.) and behavioural ones.

[Use of the laryngeal mask in adenoidectomy in childhood--a comparison with endotracheal intubation].

Purpose: Anaesthesia for adenoidectomy is possible during infancy without succinylcholine. One possibility is intubation with vecuronium bromide, whereas another possibility is the use of the laryngeal mask (LMN). The conditions for intubation as well as further details during anaesthesia are listed and compared.

Respiratory changes during laparoscopic operations.

The influences of laparoscopic techniques on respiratory function are reviewed according to the published literature. The influences are aroused by the applied pressure and the diffusion and absorption of the gas used. The published incidents of the technique are commented and the necessity of meticulous monitoring of the applied pressure and gas exchange is stressed.

[Acupressure in the prevention of postoperative nausea and vomiting].

Despite modern anaesthetic procedures, postoperative nausea and vomiting are still the side-effects most often mentioned: acupressure is reported to be an additional method of preventing these effects in minor gynaecological surgery. We investigated the effectiveness of acupressure in patients undergoing gynaecological operations of longer duration (6-8 h) in a verum acupressure group compared to a placebo group. Before beginning the study we investigated a control group to find out the frequency of emesis.

[Oral ketamine as preferred preanesthetic medication of uncooperative patients].

We report on oral ketamine for the preinduction of 3 patients who aggressively refused the commonly used induction of anaesthesia, due to young age or mental retardation. One child and two mentally retarded patients aged 30 and 31 years who were to undergo dental surgery aggressively refused the induction of anaesthesia, either by inhalation or rectal, intramuscular, or intravenous application of drugs. One of them previously injured the medical personnel and destroyed the interior equipment of a gynaecologist, who tried to perform an examination.

[The action of flumazenil in combination with fentanyl on spontaneous respiration].

Whereas the efficacy of flumazenil (Fl) for improving vigilance in the presence of other benzodiazepine agonists (BZA) is undoubted, its effect on BZA- and/or opioid agonists (OA)-induced respiratory depression is the subject of controversies. Some authors describe an improvement of a midazolam (Mi)-induced increase in paCO2, whereas others cannot find any influence on diazepam-induced respiratory depression. In two studies in which Fl was used to antagonize Mi/Fentanyl (Fe) anaesthesia we found even worse oxygen saturation values than with placebo (Pl).

[Acupuncture for the treatment of pain-a prospective study.].

Acupuncture is increasingly being used in Western medicine. In the present study the effect of acupuncture treatment was examined in 60 patients with chronic pain. The long-term success after 6 months was evaluated in 45 patients.

[Epidural steroid injections in the treatment of back pain. A retrospective and prospective analysis.].

Epidural steroid injections are frequently used in the conservative treatment of backache, although they are still subject to critical discussion. Relief of pain is attributed to the anti-inflammatory effect of the steroid. During a 3-year period, 53 patients with back pain or differing aetiology were treated with one or more epidural injections of 14 mg betamethasone (2 ml Celestan) in a prospective and retrospective fashion.

[The effects of the carbon dioxide pneumoperitoneum in laparoscopic cholecystectomy on postoperative spontaneous respiration].

Laparoscopic cholecystectomy (LSC) is being performed increasingly often. The carbon dioxide cavity increases end-expiratory carbon dioxide (exCO2), which can be regulated by mechanical ventilation. Because about 20-40% carbon dioxide remains in the patient at the end of surgery, we were interested in its influence on spontaneous respiration.

Drug-related methods for alleviation of stress in dentistry.

For many patients, dental procedures can cause a great deal of anxiety and fear. These emotions are part of a stress reaction, which, in physiologic terms, can pose a serious risk, particularly to patients with pre-existing cardiopulmonary disorders. In each case the dentist must decide whether anxiolytic stress-reducing treatment is indicated, and which method should be used.

[Rectal, oral and nasal premedication using midazolam in children aged 1-6 years. A comparative clinical study].

Midazolam is often used for the premedication of children in the pre-school age group. Different noninvasive routes of administration have been described. In a prospective study we compared the effects of oral, rectal, and nasal midazolam in commonly used dosages.

[Perioperative treatment of a patient with myotonic muscular dystrophy (Curschmann-Steinert disease)].

The perioperative period is hazardous for patients with neuromuscular disorder. In case of dystrophia myotonica the anaesthesist must avoid all stimuli that may cause a myotonic crisis. If neuromuscular blockade is required, the moderately long-acting vecuronium bromide seems to be the drug of first choice.

[The effect of fentanyl on spontaneous respiration].

Unlabelled: AIM OF THE INVESTIGATION: The effects of fentanyl on spontaneous respiration have been investigated in both animals and humans. The investigations in humans have been performed under circumstances and using methods that do not relate the results to clinical practice, e.g.

[Effects of various alfentanil doses on blood pressure, heart rate and plasma catecholamine level in endotracheal intubation].

Method: In 56 patients undergoing arthroscopy of the knee blood pressure (BP), heart rate (HR) and plasma catecholamines were measured during induction of anaesthesia. To a standard treatment including etomidate (K), either 1 (A1), 2 (A2) or 3 (A3) mg alfentanil were added. The control-group included 8 patients, the other groups consisted of 16 patients.

[The influence of premedication with dipotassium chlorazepate on preoperative stress and postoperative pain].

Despite the fact that dipotassium chlorazepate (DC) is widely used for oral premedication there are few studies demonstrating the effects of this drug reliably in the preoperative patient. Therefore, we investigated the influence of DC on preoperative sleep, stress and postoperative pain, which is presumed to be influenced by the long-acting anxiolytic property of DC compared to a placebo in a double-blind study. Sixty patients undergoing dental surgery received either 20 mg DC or a placebo in the evening and at 7 o'clock in the morning before the operation, both administered orally.

[Midazolam for premedication of infants. A comparison of the effect between oral and rectal administration].

Midazolam (M) has been successfully used in oral and rectal premedication of children of one to six years of age. The following study was designed to investigate the efficacy of both methods when used as premedication "on demand". 60 children (1-6 years) were randomly assigned to 0.

[Postoperative, opiate-induced respiratory depression is not dependent on arousal].

Introduction: Respiratory depression after intravenous anesthesia is supposed to be related to vigilance. This hypothesis could not yet be tested because of the lack of methods measuring continuously important parameters of respiration without altering the patient's vigilance. Pulse Oximetry offers this possibility.