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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Der Anaesthesist 45 (1996), S. 923-930 
    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
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  • 2
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Neuromuskuläres Monitoring ; M. adductor pollicis ; M. orbicularis oculi ; Cisatracurium ; Atracurium ; Key words Neuromuscular monitoring ; Adductor pollicis muscle ; Orbicularis oculi muscle ; Cisatracurium ; Atracurium
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Objectives: Muscle relaxants have different pharmacodynamic profiles in various muscles. Therefore, results obtained for one muscle cannot be extrapolated to other muscles. In the adductor pollicis muscle cisatracurium exerts a pharmacodynamic profile comparable to atracurium, despite the known difference in onset time. However, studies evaluating the neuromuscular effect of cisatracurium in different muscles are lacking. Accordingly, this study compares the pharmacodynamic profile of cisatracurium and atracurium in the orbicularis oculi muscle (OO) – which shows a neuromuscular course similar to the diaphragm and the laryngeal muscles – and the adductor pollicis muscle (AP). Methods: Forty-five patients (ASA I–II), scheduled for elective spinal surgery were anaesthetized with propofol and fentanyl. Endotracheal intubation was performed without using a muscle relaxant. Neuromuscular transmission was monitored using acceleromyography in both muscles. Patients received 0.1 mg/kg (2× ED95) or 0.15 mg/kg (3× ED95) cisatracurium, or 0.5 mg/kg atracurium (2× ED95) at random. Onset and recovery times were measured according to the recommendation of the Copenhagen Consensus Conference. Results: Onset time was significantly shorter in the OO than in the AP following 0.15 mg/kg cisatracurium and 0.5 mg/kg atracurium (P〈0.05). No differences in onset time between the two muscles were found after 0.1 mg/kg cisatracurium. The recovery of T1 to 10% of its control was completed sooner in the OO than in the AP in all three groups (P〈0.05). Conclusions: Cisatracurium shows a dose-dependent shorter onset time in the OO than in the AP. This is consistent with the current view that the onset of non-depolarizing neuromuscular blockers is more rapid in the OO than in the AP. However, at least a dose of 3× ED95 of cisatracurium was necessary to show a difference in onset time between both muscles. In contrast, atracurium is reported to lead to a significantly shorter onset of neuromuscular block in the OO following 2× the ED95. The more rapid recovery of T1 to 10% of its control in all three groups in the OO is due to the relative resistance of this muscle to muscle relaxants.
    Notes: Zusammenfassung Fragestellung: Muskelrelaxanzien zeigen ein unterschiedliches pharmakodynamisches Wirkungsprofil an verschiedenen Muskelgruppen. Am M. adductor pollicis hat Cisatracurium, bis auf eine längere Anschlagzeit, ein vergleichbares pharmakodynamisches Profil wie Atracurium. Untersuchungen an anderen Muskelgruppen wurden für Cisatracurium bisher nicht durchgeführt. In der vorliegenden klinischen Studie sollte daher die neuromuskuläre Wirkung von Cisatracurium am M. orbicularis oculi (OO) – dessen neuromuskuläre Reaktion annähernd derjenigen des Diaphragmas und der Larynxmuskulatur entspricht – und am M. adductor pollicis (AP) im Vergleich mit Atracurium untersucht werden. Methodik: Untersucht wurden 45 Patienten (ASA I–II), die sich einer elektiven Wirbelsäulenoperation unterziehen mußten. Nach Narkoseeinleitung erfolgte die Intubation ohne vorherige Injektion eines Muskelrelaxans. An beiden Muskeln wurde die evozierte Muskelantwort mittels Akzeleromyographie gemessen. Die Patienten erhielten randomisiert 0,1 mg/kg (2× ED95), 0,15 mg/kg (3× ED95) Cisatracurium oder 0,5 mg/kg Atracurium (2× ED95). Die Anschlag- und Erholungszeiten wurden entsprechend den Empfehlungen der Copenhagen Consensus Conference definiert. Ergebnisse: Nach 0,15 mg/kg Cisatracurium und 0,5 mg/kg Atracurium waren die Anschlagzeiten am OO kürzer als am AP (p〈0,05). Nach 0,1 mg/kg Cisatracurium fanden sich keine Unterschiede in den Anschlagzeiten zwischen beiden Muskeln. Der Zeitintervall bis zur 10% Erholung der T1-Antwort war in allen drei Gruppen am OO kürzer als am AP (p〈0,05). Schlußfolgerung: Cisatracurium zeigt eine dosisabhängig kürzere Anschlagzeit am OO als am AP. Dieser Befund steht im Einklang mit der bisherigen Erfahrung, daß nicht- depolarisierende Muskelrelaxanzien dosisabhängig eine kürzere Anschlagzeit am OO haben im Vergleich mit dem AP. Auffallend war, daß dieser Unterschied zwischen beiden Muskeln erst ab einer 3fachen ED95 auftrat, während für Atracurium eine schnellere Anschlagzeit am OO bereits ab einer 2fachen ED95 beschrieben wird. Die höhere Resistenz des OO gegenüber Muskelrelaxanzien erklärt die schnellere Erholung der T1-Antwort.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 153 (1994), S. 702-703 
    ISSN: 1432-1076
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 151 (1992), S. 715-715 
    ISSN: 1432-1076
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    College Park, Md. : American Institute of Physics (AIP)
    Journal of Mathematical Physics 36 (1995), S. 3308-3319 
    ISSN: 1089-7658
    Source: AIP Digital Archive
    Topics: Mathematics , Physics
    Notes: Using an approach based on the canonical formalism, the Yang–Mills theories on a cylinder are rigorously analyzed. In this way the moduli space A/G, can be explicitly described with A being the space of connections and G the group of gauge transformations. In particular A/G0, G0 being the group of the pointed gauge transformations, is diffeomorphic to the structure group of the theory G, whereas A/G is G modulo the group of inner automorphisms. It is also proven that A → G is a principal fiber bundle with structure group G0. © 1995 American Institute of Physics.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Cell Differentiation and Development 27 (1989), S. 31 
    ISSN: 0922-3371
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Annals of the New York Academy of Sciences 551 (1988), S. 0 
    ISSN: 1749-6632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Natural Sciences in General
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Annals of the New York Academy of Sciences 551 (1988), S. 0 
    ISSN: 1749-6632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Natural Sciences in General
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Annals of the New York Academy of Sciences 551 (1988), S. 0 
    ISSN: 1749-6632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Natural Sciences in General
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Archives of Biochemistry and Biophysics 251 (1986), S. 25-35 
    ISSN: 0003-9861
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology , Chemistry and Pharmacology , Physics
    Type of Medium: Electronic Resource
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