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  • 1
    Electronic Resource
    Electronic Resource
    Analyse von Hilfeersuchen (1994)
    Springer
    Der Anaesthesist 43 (1994), S. 187-193 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter:Ärztlicher Notfalldienst – Leitstelle – Notarzt – Notrufnummer – Rettungsdienst ; Key words: Dispatching centers – Emergency calls – Emergency medical service – Emergency physicians – General practitioners service
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract. There is no doubt that a single emergency phone number is desirable, but in contrast to other countries, in Germany different emergency phone numbers and dispatching centers exist for the fire brigade (FB), the emergency medical service system (EMS), and the general practitioners' emergency service (GPS). Due to this fact, valuable time is often wasted by connecting or transferring emergency calls from one dispatching center to another. The purpose of this study was to analyse all calls received by the different dispatching centers in the city and county area of Mainz with respect to total number, fraction of emergency calls, and specificity. Further, the total number of calls potentially referring to a hypothetic single dispatching center with a general emergency phone number (112) was calculated. During a 4-month period, all telephone calls were registered and related to day, time, and origin of the call (city or county) and classified as non-urgent or emergency calls, calls appropriate to the dispatching center dialed, emergency calls to be transferred, or unspecific calls. A total of 80 987 calls were received (city area 84.3%, county area 15.7%), most of them directed to the FB of Mainz (33 086). The EMS dispatching center received 31 286 calls, the five GPS-centers 15 256 calls; 1359 emergency calls that were directed to the police or FB needed transfer to the EMS. During weekdays the EMS and FB received the most calls, with a reduced frequency on Saturdays and Sundays (Table 2). Nevertheless, the highest total numbers of calls were received on Saturdays due to multiple calls directed to the GPS. The FB had the highest specificity of calls; more than 50% of the calls to the GPS were unspecific (Fig. 1). Of all calls, 4.37% were classified as emergency calls; two-thirds of these came from the area of Mainz during the daytime. During off-duty hours of the GPS in the city, 51% of the emergency calls reached the EMS directly; 49% had to be connected by the police or FB. During duty hours of the GPS, the fraction of calls directed to the EMS decreased significantly to 35%. During duty hours of the GPS centers in the county area, only 14% of the urgent emergency calls reached the EMS dispatcher directly (Fig. 2). Compared to the multiple-center mode, a hypothetic single dispatching center for all systems would probably be followed by a slight increase in total number of calls due to the fact that the GPS numbers would be answered 24 h a day, but there would be only minimal differences in the total number received on most days; only on Sundays would a decrease be expected. The EMS area of Mainz, with a total of 13 different telephone numbers for 7 dispatching centers, can be regarded as typical of the German situation. The high number of emergency calls to be transferred (up to 86% under special circumstances) demonstrated that this weak point in the German EMS system must be eliminated by introducing a single emergency number. This should occur when a Europe-wide three-digit number "112" will be instituted, probably in 1995. Additionally, the continued existence of 5- or 10-digit telephone numbers for non-urgent calls may be useful for allowing non-verbal differentiation of calls. In any case, all telephone numbers, including the latter calls, have to enter one dispatching center. The main advantage of a single dispatching center would be avoidance of the time-consuming transfer of emergency calls from one dispatching center to the other.
    Notes: Zusammenfassung. In Deutschland existieren unterschiedliche Notrufnummern, über die sowohl nicht dringliche Hilfeersuchen als auch Notrufe an die jeweiligen Einsatzzentralen gerichtet werden. Durch Weitervermittlung wird häufig wertvolle Zeit uneinholbar verloren. Mit einer viermonatigen, repräsentativen Analyse wurde daher das gesamte Anrufvolumen, der Anteil von Notrufen, der Anteil von Notrufweiterleitungen analysiert sowie das potentielle Anrufvolumen einer hypothetischen einheitlichen Notrufnummer errechnet. Insgesamt wurden 80 987 Anrufe, die zu 84,3% aus der Stadt Mainz stammten, registriert. Die meisten Anrufe gingen bei der Berufsfeuerwehr Mainz ein (33 086), gefolgt von der Rettungsleitstelle Mainz (31 286) und den Ärztlichen Notfalldienstzentralen (15 256). In dem Gesamtanrufaufkommen waren 3542 Notrufe enthalten (4,37%). 67% dieser Notrufe stammten aus dem Stadtgebiet. Im Stadtgebiet Mainz wurden außerhalb der Dienstzeiten des ärztlichen Notfalldienstes 51% der Notrufe primär an die Rettungsleitstelle gerichtet (Abb. 2). Während der Dienstzeiten der Ärztlichen Notfalldienstzentrale Mainz verringerte sich dieser Anteil auf 35%. Im Kreisgebiet erreichten während der Dienstzeiten der Ärztlichen Notfalldienstzentralen nur 14% der Notrufe primär die Rettungsleitstelle. Bei Hilfeersuchen an nur eine einheitliche Notrufzentrale wäre eine gleichmäßigere Auslastung der Leitstelle zu erwarten. Der Rettungsdienstbereich Mainz-Bingen mit insgesamt 13 verschiedenen Notrufnummern ist durchaus als typisch für die deutsche "Notrufvielfalt" anzusehen. Der hohe Anteil von Notrufen, die weitervermittelt werden mußten (bis zu 86%) zeigt, daß diese Schwachstelle des Rettungssystems nur mit einer einheitlichen Notrufzentrale und einer generellen Notrufnummer 112 beseitigt werden kann.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050048
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  • 2
    Electronic Resource
    Electronic Resource
    Die Transilluminationstechnik (1996)
    Springer
    Der Anaesthesist 45 (1996), S. 923-930 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Airway-Management ; Schwierige Intubation ; Trachlight ; Transilluminationstechnik ; Key words Airway management ; Difficult intubation ; Light-guided intubation ; Trachlight®
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The technique of light-guided intubation is based on the principle that a source of light brought into the trachea results in clearly visible and defined transcutaneous illumination, while no illumination can be observed with the light source in the oesophagus (Fig. 1–7). The Trachlight® is a reintroduced instrument for this alternative intubation technique. The essential developments are: a length-adjustable stylet with a removable internal metal wire, a brighter light source, a stable handle with tight fixation of the endotracheal tube, and a time-dependent warning device to avoid extended intubations. One hundred twenty patients (Mallampati I, ASA I–III) were included in the study (conventional intubation [group KL, n=60], Trachlight® intubation [group TT, n=60]. The goals of the investigation were to examine the handling, application, problems, limitations, and possible indications of the method. The recorded parameters were: number of intubation attempts: course and duration of intubation; complications; and difficulties. In 40 patients (20 in each group) the indication for invasive blood presure measurement was given due to the surgical procedure, and circulatory parameters were recorded at defined moments during the intubation course. In group KL 55 patients were intubated in the attempt, 4 on the second, and 1 on the third (mean duration 23.6±10.4 s, range 12–60 s). Complications were: unilateral intubation (3 patients), bradycardia (2), asystole (1) and soft-tissue injury (1). Of the 60 patients in group TT, 54 were intubated successfully, the mean time needed being 29.9±14.8 s (range: 6–61 s). The remaining 6 were then intubated by the conventional method. Positive results in group TT included: easy handling and application, no injury to soft tissues or teeth, and invariably correct placement of the tube. Problems included: sufficient transillumination was achieved only after (entire) dimming of the room, insufficient control over the distal end of the tube due to an unfixed metal wire, unintentional switching off of the light while with-drawing the metal wire, difficulties in with-drawing the metal wire (too strong fixation), as well as disturbing effects of the warning device (blinking of the light 30 s after switching on). Reasons for the 6 intubation failures were introduction of the instrument into the oesophagus despite a supposed correct position, impossibility of correct placement in a patient with an extremely large goiter, and insufficiently clear transillumination in 3 extremely obese patients. The cardiovascular parameters showed no changes during laryngeal manipulation; a clear rise in heart rate and blood pressure was recorded, however, when the tube was inserted into the trachea. The cardiovascular parameters during conventional intubations were similar. The light-guided intubation technique can be regarded as a further alternative for airway management, due to the described improvements of the instrument. The indication for the technique is given in patients in whom no difficulty with intubation is expected, to avoid soft tissue damage and traumatising temporomandibular joint movements. Preclinical use may be limited due to environmental brightness. In patients with expected difficult airway management, fiberoptic intubation will remain the method of choice.
    Notes: Zusammenfassung Bei der Transilluminationstechnik führt eine Lichtquelle zur transkutanen Durchleuchtung im Larynxbereich. Das Trachlight ® ist ein hierfür neues Instrument mit wesentlichen Weiterentwicklungen: längenadaptierbares Führungsstilett mit innerem Metalldraht, hellere Lichtquelle, stabiler Handgriff mit Fixation des Tubus und Zeitautomatik zur Warnung vor zu langer Intubationsdauer. Das neue Instrument wurde randomisiert im Vergleich zur konventionellen Intubation eingesetzt (n=120). Meßparameter: Anzahl, Verlauf der Intubationsversuche und Komplikationen. Bei jeweils 20 Patienten wurden die Kreislaufparameter invasiv erfaßt. Mit dem Trachlight ® konnten 54 Patienten erfolgreich intubiert werden (Zeitbedarf 29,9±14,8 s [6–61 s]), konventionell 23,6±10,4 (12–60 s). Positiva: Einfache Handhabung, keine Verletzungen, korrekte Einführtiefe des Tubus. Probleme: Ausreichende Transillumination erst nach völliger Abdunkelung, unzureichende Kontrolle über distales Tubusende, unbeabsichtigtes Ausschalten der Lichtquelle, Schwierigkeiten beim Zurückziehen des Metalldrahts sowie Störung durch den Blinkmechanismus. Gründe für Intubationsversager: Einführung des Instruments in den Ösophagus trotz vermeintlich korrekter Position, Unmöglichkeit der Plazierung sowie unzureichende Transillumination. Die Kreislaufparameter zeigten in beiden Gruppen keine Veränderungen während der laryngealen Manipulation, jedoch einen deutlichen Anstieg beim Vorschieben des Tubus in die Trachea. Die Transilluminationstechnik kann als eine Alternative im Airway-Management bezeichnet werden. Im präklinischen Bereich ist sie problematisch, bei Patienten mit schwierigen Intubationsverhältnissen sollte der Fiberoptik der Vorzug gegeben werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050326
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  • 3
    Electronic Resource
    Electronic Resource
    Analgosedierungsverfahren für zahnärztlich-chirurgische Eingriffe mit Midazolam/Pentazocin und Midazolam/Ketamin Klinische Doppelblindstudie zu Anxiolyse, Analgesie, Sedierung und Amnesie (1995)
    Springer
    Der Anaesthesist 44 (1995), S. 566-572 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Analgodesierungsverfahren ; Ketamin ; Midazolam ; Pentazocin ; Key words Conscious sedation ; Ketamine ; Midazolam ; Pentazocine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Ketamine and midazolam, applied as intravenous medication for conscious sedation in day-case maxillo-facial surgery, has been proven to be superior to pentazocine and midazolam concerning cardiovascular parameters and respiratory depression. The aim of this study was to evaluate the effects of low-dose ketamine/midazolam on anxiety, analgesia, amnesia and subjective feelings. Methods. 140 out-patients (ASA I) were randomly divided into four groups. The double-blind study was prospective. Control group: Local anaesthesia (LA), articaine 4% plus epinephrine 1:200000 (n=35); test group P/M: LA, additional pentazocine 0.40 mg/kg bw and midazolam 0.075 mg/kg bw i.v. (n=35); test group K25/M: LA, additionally ketamine 0.25 mg/kg bw and midazolam 0.075 mg/kg bw i.v. (n=35), test group K50/M: LA, additionally ketamine 0.5 mg/kg bw and midazolam 0.075 mg/kg bw i.v. (n=35). LA was injected 3 min after application of the systemic medication in the test groups or application of a placebo (saline 0.9%) in the control group. Three further minutes later, operation was started. For evaluation questionnaires, visual analogue scales (VAS) and the state-trait anxiety inventory (STAI) were used. For testing retrograde and anterograde amnesia, acoustic sensations were delivered before application of the systemic medication (a Christmas carol) and during operation (the German national anthem). Results. The control group and the test groups were comparable with regard to biological data, duration of operation, applied dosage of local anaesthetics and actual anxiety before operation. The patients in all test groups rated intraoperative anxiety as mild, in contrast to the control group. Nearly no pain sensation during the operation was remembered in all test groups. Retrograde amnesia was not found in any group. Complete anterograde amnesia was observed in all test groups with respect to the intraoperative sensation, but even in the control group 50% of the patients did not remember having heard the national anthem. As subjective feelings negative criteria were mainly reported in the control group, where as in all test groups positive sensations dominated. Dreams were reported mostly after the higher dosage of ketamine, but no patient experienced any unpleasant dreams. The clinical assessment of the different regimes were excellent for test groups P/M and K50/M, modest for the control group and test group K25/M. Postoperatively, patients of test group P/M were remarkably sedated, but no clinically relevant sedation or motor weakness were observed in the other groups. Postoperative pain sensations were rated more intense in all test groups than in the control group. In test groups P/M and K25/M an increasing pain level was recorded during the postoperative period, with the consequence of a higher demand rate for analgesics. Conclusions. Dental surgery can be performed safely with low-dose ketamine/midazolam. Compared to pentazocine/midazolam, the higher dosage of ketamine (0.5 mg/kg bw) showed identical results intraoperatively, but was superior during the postoperative period (vigilance), and thus may represent a suitable dosage. The lower dosage of ketamine resulted in worse operating conditions, but a dosage higher than 0.5 mg/kg bw might lead to unconscious sedation and might increase the frequency of unpleasant dreams.
    Notes: Zusammenfassung Ketamin/Midazolam zur Analgosedierung erwies sich in bezug auf Kreislauf und Atmung gegenüber Pentazocin/Midazolam überlegen [23]. Diese Studie sollte klären, ob 0,25 oder 0,5 mg/kg KG Ketamin, 0,075 mg/kg KG Midazolam, unter den Aspekten Anxiolyse, Analgesie, Sedierung und Amnesie eine Alternative zu Pentazocin/Midazolam ist. Kontrollgruppe (KG): Lokalanästhesie (LA) mit Articain 4%/Adrenalinzusatz 1:200.000 (n=35); Testgruppe P/M: LA und 0,40 mg/kg KG Pentazocin/0,075 mg/kg KG Midazolam i.v. (n=35); Testgruppe K25/M: LA und 0,25 mg/kg KG Ketamin/0,075 mg/kg KG Midazolam i.v. (n=35); Testgruppe K50/M: LA und 0,50 mg/kg KG Ketamin/0,075 mg/kg KG Midazolam i.v. (n=35). Die LA wurde 3 min nach Analgosedierung injiziert. In den Testgruppen empfanden die Patienten intraoperativ nur geringe Angst und minimale Schmerzen. Negative Empfindungen wurden in der KG benannt, nicht in den Testgruppen. Träume (K50/M) hatten einen angenehmen Charakter. Operateur und Prüfer beurteilten Anästhesie, Kooperation und Gesamteindruck sehr gut in P/M und K50/M, schlechter in KG und K25/M. Postoperativ fiel in P/M eine stärkere Sedierung auf. Bei den postoperativen Schmerzen zeigte sich eine steigende Tendenz in den P/M und K25/M (Konsequenz: häufigere Analgetikaanforderungen). Midazolam/Ketamin ist für zahnärztlich-chirurgische Operationen geeignet: P/M und K50/M zeigten intraoperativ identische Ergebnisse, postoperativ sind K25/M und K50/M bezüglich der Vigilanz überlegen. Als ideale Dosierung von Ketamin können 0,5 mg/kg KG angesehen werden – 0,25 mg/kg KG verschlechtert die operativen Bedingungen – höhere Dosen könnten zu unerwünschten Nebenwirkungen führen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050190
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  • 4
    Electronic Resource
    Electronic Resource
    Qualitätssicherung in der notärztlichen Fortbildung (1996)
    Springer
    Der Anaesthesist 45 (1996), S. 363-371 
    Details
    ISSN: 1432-055X
    Keywords: SchlüsselwörterÄrztliche Fortbildung ; Fachkundenachweis Rettungsdienst ; Qualitätselemente ; Qualitätssicherung ; Key words Continuous advanced training ; Continuous medical education ; Emergency medicine ; Quality assessment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Medical performance is subject to quality control. Continuous advanced training (CAT) and continuous medical education (CME) are essential, and quality must be checked and assured: structure (contents, organizational form, framework, term, demands on teachers), process (term of the CAT, interaction between teachers and participants) and results (satisfaction and acceptance, increased knowledge, influence on medical treatment, improvement of the success rate of medical treatment. In emergency medicine one must differentiate between the necessity for CAT (e.g., certified proof required for working as an emergency physician) and a desire for CME (the individual task of the physician). The diversity of forms for CAT/CME reflects the different individual requirements. Using the new German guidelines to obtain qualitifcation as an emergency physician, „Fachkundenachweises Rettungsdienst“ offers measures for quality assessment and assurance can be obtained. Structure quality. The recommendations for obtaining the „Fachkundenachweis Rettungsdienst“ which have been valid until now date from the year 1983 and were set fourth explained very differently in the individual countries medical boards. This led to problems in the comparability of the essential CAT. The quality of the structure has now been improved by establishing new minimum requirements for clinical activity, specification of particular knowledge, number of supervised calls for the emergency car as well as participation in interdisciplinary CAT courses, dealing with general and special aspects of emergency medicine. The aim of these measures is not the (senseless) regimentation of CAT training measures, but the qualified transfer of specific medical knowledge and treatment guidelines. Process quality. On qualifying, hardly any physician has any didactic and/or rhetorical education; the physician must make a personal effort to obtain a qualification of this kind. Conventional and commonly practised forms of learning must therefore be set aside in favour of modern teaching methods (e.g. problem-orientated learning). This will lead to a better acceptance of CAT/CME measures. It is essential for the process quality that the teachers' education meets the following requirements: relevant knowledge of preclinical emergency medicine, rhetorical and didactic abilities, employment of relevant teaching techniques, flexibility in presentation, extensive experience in emergency medicine as well as enthusiasm for high-quality education. Result quality. Questionnaires can be used to evaluate the satisfaction and acceptance of the participants, as well as their rating of individual speakers. The results are decisive for planning future CAT/CME measures. The transfer of knowledge can be estimated at the end of advanced training by questionnaire. However, this makes allowance for previous knowledge/skills and how much is forgotten. The influence of advanced training on further medical treatment can be seen in the quality of a given CAT/CME measure, but not in the success rate of medical treatment. The result desired can only be achieved by linking all system components of medical quality control and assurance. Advanced training provides a fundamental contribution to this end.
    Notes: Zusammenfassung Medizinische Leistungen unterliegen der Qualitätssicherung, die kontinuierliche Fortbildung ist ein wesentliches Instrument, dessen Qualitätselemente ebenfalls kontrolliert werden müssen: Struktur (Inhalte, Organisationsformen), Prozeß (Ablauf) und Ergebnis (Akzeptanz, Vermehrung des Wissens). Es muß zwischen Fortbildungsbedarf (z.B. zertifizierter Nachweis) und -bedürfnis (Aufgabe des Arztes) differenziert werden, die Vielfalt der Fortbildungsformen spiegelt unterschiedliche Lernanforderungen wider. Anhand der neuen Richtlinien zum Fachkundenachweis „Rettungsdienst“ können qualitätssichernde Maßnahmen dargestellt werden. Strukturqualität: Die bisherigen Empfehlungen von 1983 wurden in den Landesärztekammern sehr unterschiedlich ausgelegt (Probleme in der Vergleichbarkeit). Die Verbesserung der Strukturqualität wurde nun erreicht durch Festlegung von Mindestvoraussetzungen: Inhalte der klinischen Tätigkeit, Spezifizierung der besonderen Kenntnisse, Zahl der nachzuweisenden Einsätze sowie Teilnahme an definierten Kursen. Ziel aller Maßnahmen ist nicht Reglementierung, sondern die Umsetzung medizinischer und lernphysiologischer Erkenntnisse. Prozeßqualität: Ärzte besitzen bei Approbation keine didaktische Ausbildung. Hergebrachte Lehrformen müssen zugunsten moderner Wissensvermittlung überwunden werden. Wesentlich für die Prozeßqualität ist die Ausbildung der Ausbilder, Anforderungen sind: relevantes Fachwissen, didaktische Fähigkeiten, angepaßter Einsatz von Hilfsmitteln, Flexibilität in der Präsentation, Freude an „Qualitätsfortbildung“. Ergebnisqualität: Zufriedenheit der Teilnehmer sowie Bewertung der Referenten (Befragung) stellen eine Entscheidungsgrundlage dar. Die Vermittlung des Wissens kann am Ende einer Fortbildung eingeschätzt werden, erlaubt jedoch keine Erkenntnisse zur Vergessensrate. Der Einfluß auf das ärztliche Handeln ist in Abhängigkeit von der Qualität nachweisbar, nicht jedoch auf den Behandlungserfolg. Dies kann nur durch Einbindung aller Systemkomponenten erzielt werden, die Fortbildung ist hierbei fundamental.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050273
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  • 5
    Electronic Resource
    Electronic Resource
    Bewegungen der Kiefergelenke während der endotrachealen Intubation (1996)
    Springer
    Der Anaesthesist 45 (1996), S. 907-922 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Kiefergelenke ; endotracheale Intubation ; elektronische Achsiographie ; Key words Endotracheal intubation ; Temporomandibular joint ; Dysfunction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Laryngoscopy causes temporary postoperative dysfunction of the temporomandibular joint (TMJ): during iatrogenic TMJ manipulation in anaesthetised patients, the TMJs have lost the protection afforded by the tone of the surrounding muscles. Thus far, the exact type and extent of TMJ movements have not been known. The purpose of this study was to develop a method to visualise and assess TMJ movements during intubation by means of electronic axiography, a diagnostic monitor of TMJ movements used in dentistry: registration of the hinge axis (HA) as an equivalent of the condylar paths on extra-oral sagittally mounted, parallel plates. The HA is individually defined in each patient by the pure, rotating TMJ movement during initial mouth opening (no farward gliding of the condyles, incisor distance up to 10 mm). The parallel plates are placed in the TMJ region in the skull-mounted plate bow; both registration tips („drawing“ the HA tracings on the electronic plates) are connected to the mandible by a face bow, paraocclusally fixed to the teeth. The face bow is individually shaped for each patient to allow mask ventilation and free movement of the laryngoscope during intubation. HA tracings are registered and calculated for both sides independently every 24 ms with the SAM/Klett system and presented on sagittal and frontal projections. In the operating theatre, the active mouth-opening traces (MOT) are registered first and the passive endotracheal intubation traces (EIT) after induction of anaesthesia (same head position). With informed consent and approval by the ethics committee of the Landesärztekammer Rheinland-Pfalz, 40 male patients (ASA I, Mallampati I, limb surgery) were randomly allocated to four groups (n=10 each). OS: Oral intubation, suxamethonium (1.5 mg/kg); OV: Oral intubation, vecuronium (0.1 mg/kg); NS: Nasal intubation, suxamethonium (1.5 mg/kg); and NV: Nasal intubation, vecuronium (0.1 mg/kg). Intubation was performed 100 s after injection of the relaxant. Pre- and postoperatively (every 24 h over 3 days, in case of positive findings longer) recorded were: active movements of the mandible (maximal mouth opening/max. laterotrusion); dysfunction of the TMJ; and pain sensation in the TMJ (Helkimo rating). MOTs and EITs were recorded and analysed with the system described and typical EIT patterns were identified: bland, clinically uneventful intubations (n=7), massive distraction and laterotrusion of the EIT compared to the MOT (n=24), and blocked or limited TMJ movements resulting in intubation problems (n=1). With the method presented, TMJ movements could be visualised during endotracheal intubation for the first time. It can be used to assess techniques, routes, and instruments for intubation as well as to evaluate potential traumatising movements during endotracheal intubation.
    Notes: Zusammenfassung Zwischen der Funktion der Kiefergelenke und der Intubation besteht eine wechselseitige Beziehung: Dysfunktionen können ein Intubationshindernis darstellen. Die Intubation kann umgekehrt auch zu Funktionsstörungen im orofazialen System führen oder Auslöser akuter Kiefergelenkbeschwerden sein. Eine Aussage zu der nach Aufhebung der physiologischen Schutzmechanismen möglicherweise veränderten Motilität war bislang nicht möglich. Die Arbeit beschreibt die Anwendung einer Methode zur Erfassung der Kiefergelenkbewegungen sowie typische Befunde während der Intubation. Das Prinzip der elektronischen Achsiographie wurde dahingehend modifiziert, daß der Vergleich einer aktiven Mundöffnungsbewegung mit der Intubationsbewegung möglich wurde. Anhand der Ergebnisse von 40 Patienten (orale oder nasale Intubation, Relaxation mit Suxamethonium oder Vecuronium) konnten typische Kiefergelenkbewegungen demonstriert werden: Die Narkoseeinleitung führte zu einer Passivverlagerung nach kaudal, während der Einführung des Layngoskops verblieben die Gelenke in einer reinen Rotationsbewegung (physiologisch: Translationsbewegung). Die Einstellung der Trachea führte zu einer massiven (pathologischen) Distraktion. In einem Fall wurde die Ruptur des Ligamentum laterale dokumentiert. Die Methode erlaubt erstmals die Visualisierung der Kiefergelenkbewegungen während der Intubation. Als potentiell schädigende Momente wurden die unphysiologisch weite initiale Rotation und eine massive Kiefergelenkdistraktion identifiziert. Das Verfahren eröffnet die Möglichkeit, verschiedene Techniken, Medikamente und Instrumente zu untersuchen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050325
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  • 6
    Electronic Resource
    Electronic Resource
    Topological Characterization of the Lymphoid-Specific Seven Transmembrane Receptor BLR1 by Epitope Tagging and High Level Expression
    Amsterdam : Elsevier
    Biochemical and Biophysical Research Communications 197 (1993), S. 214-220 
    Details
    ISSN: 0006-291X
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology , Chemistry and Pharmacology , Physics
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1006/bbrc.1993.2463
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  • 7
    Electronic Resource
    Electronic Resource
    A General-Method for Screening mAbs Specific for G-Protein-Coupled Receptors as Exemplified by Using Epitope-Tagged BLR1-Transfected 293 Cells and Solid-Phase Cell ELISA
    Amsterdam : Elsevier
    Biochemical and Biophysical Research Communications 196 (1993), S. 1496-1503 
    Details
    ISSN: 0006-291X
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology , Chemistry and Pharmacology , Physics
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1006/bbrc.1993.2421
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  • 8
    Electronic Resource
    Electronic Resource
    Cloning and chromosomal organization of a gene encoding a putative amino-acid permease from Saccharomyces cerevisiae
    Amsterdam : Elsevier
    Gene 143 (1994), S. 129-133 
    Details
    ISSN: 0378-1119
    Keywords: Recombinant DNA ; amino-acid transport ; chromosome IV ; fungal gene ; membrane protein ; transcript mapping
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology
    Type of Medium: Electronic Resource
    URL: http://linkinghub.elsevier.com/retrieve/pii/0378-1119(94)90617-3
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  • 9
    Electronic Resource
    Electronic Resource
    Excited-state proton transfer in 2-(2'-hydroxyphenyl)benzothiazole: Transient electronic absorption measured on the picosecond time scale
    Amsterdam : Elsevier
    Chemical Physics Letters 148 (1988), S. 112-118 
    Details
    ISSN: 0009-2614
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Chemistry and Pharmacology , Physics
    Type of Medium: Electronic Resource
    URL: http://linkinghub.elsevier.com/retrieve/pii/0009-2614(88)80285-9
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  • 10
    Electronic Resource
    Electronic Resource
    Intracavity laser spectroscopy of RF plasmas of methane and benzene used in depositing diamondlike carbon films (1994)
    Woodbury, NY : American Institute of Physics (AIP)
    Applied Physics Letters 65 (1994), S. 1317-1319 
    Details
    ISSN: 1077-3118
    Source: AIP Digital Archive
    Topics: Physics
    Notes: Spatially resolved concentrations of excited atomic hydrogen (n=2), generated from 13.56 MHz RF hydrocarbon discharges, are determined during film formation using intracavity laser spectroscopy. Self-bias voltages and pressures of methane (25 and 100 mTorr) and benzene (25 mTorr) are selected so that diamondlike carbon films are deposited. In all cases, the minimum concentration occurs at the power electrode. Benzene produces the least amount of excited atomic hydrogen overall. The results may have implications concerning the proposed impact induced fragmentation of hydrocarbon molecules during film growth.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1063/1.112040
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