[The importance of the esophageal-tracheal-double lumen tube for clinical use and emergencies]. / Die Bedeutung des ösophago-trachealen Kombinationstubus in der klinischen Routine und bei Notfällen.

Difficult intubation can unexpectedly occur in clinical practice and emergencies. Oxygenation must be maintained with resumed artificial ventilation. Besides tracheal intubation with an ETT as the "gold standard" of airway management, the esophageal-tracheal Combitube(R) (ETC; Tyco-Healthcare, Neustadt/Donau, Germany; www.combitube.org) is another interesting device that has been used satisfactorily in a variety of circumstances, specially for management of the difficult airway. The ETC has been used during prehospital and hospital emergencies. Now, anesthesiologists have managed the ETC successfully in clinical practice also. The anesthesiological management does not differ from the management in other difficult airway situations. The use of the Combitube needs an appropriate teaching and continuous clinical practice.

Influence of prostaglandin E1 on tissue ischemia during surgical repair of the abdominal aorta.

OBJECTIVE: To evaluate tissue protection by PGE1 during leg ischemia in patients undergoing aortic surgery. DESIGN: Randomized, controlled prospective clinical trial. SETTING: Single university hospital. PARTICIPANTS: 19 consecutive patients undergoing abdominal aortic aneurysm repair. INTERVENTIONS: Patients received infusions of 30 ng/kg/min of PGE1 or saline. MEASUREMENTS AND MAIN RESULTS: Hemodynamic variables, lactate, creatine phosphokinase, and thromboxane B2 (TXB2) were measured. In the control group, the decrease in cardiac index (CI) after aortic cross-clamping (AXC) persisted until unclamping together with a decrease in femoral venous O2 content (CfvO2). In the PGE1 group, CI returned to baseline with a trend toward greater CfvO2 levels. During reperfusion in the PGE1 group, O2 consumption and lactate levels exceeded preclamp values. Pulmonary hypertension occurred equally in both groups but did not correlate with TXB2, which was not altered by surgery or by PGE1 infusion. CONCLUSIONS: Intraoperative PGE1 treatment offers no benefit and may exacerbate tissue ischemia during AXC by redistributing microcirculatory flow or limiting cellular oxygen utilization in a manner that overwhelms any possible protective effect.

Improved cardiac performance and reduced pulmonary vascular constriction by epinephrine administration via a left atrial catheter in cardiac surgical patients.

Diminished left ventricular contractility and increased right ventricular afterload are issues in cardiac surgery. The usual administration of catecholamines (epinephrine) via the central venous (CV) catheter increases cardiac output, but also may increase pulmonary vascular constriction. Epinephrine was, therefore, administered via the left atrial (LA) catheter or the CV catheter in 8 cardiac surgery patients, each serving as his or her own control. The LA administration of epinephrine has an advantage with its immediate effect on the coronary circulation, while avoiding associated pulmonary vasoconstriction by passing through the systemic capillary bed before reaching the lung. It was found in this study that administration of epinephrine via an LA catheter increased the average cardiac output by 1.05 L/min, which was significantly (P < 0.05) greater than with administration via the CV catheter. With LA administration of epinephrine, systemic arterial pressure (systolic arterial pressure and diastolic arterial pressure) (SAP, DAP) were also elevated to a greater extent than by CV administration. On the other hand, pulmonary arterial pressures (systolic pulmonary arterial pressure and diastolic pulmonary arterial pressure) (SPAP, DPAP) were less elevated than by administration via the CV catheter. This produced increased coronary perfusion and a smaller increase in pulmonary vascular tone by LA administration in contrast to CV administration of epinephrine. It is concluded that epinephrine administration via an LA catheter improved myocardial performance and pulmonary perfusion due to direct entry of the agent into the coronary circulation and partial metabolism while passing through the systemic capillary bed before reaching the lung.

[Indications for the insertion of a central venous catheter in emergency situations]. / Indikationen für das Anlegen eines zentralvenösen Katheters in Notfallsituationen.

The use of a central venous catheter (CVC) is associated with numerous complications despite its usefulness. Less experienced personnel have a higher complication rate, however complications are not totally avoidable even for more experienced persons. The complication rate increases under unfavorable working conditions. Therefore, the indication for a CVC even in the emergency situation must be considered very carefully.