[Anaesthesiologic Techniques for Patients at Risk of Aspiration]. / Einleitung des nicht nüchternen Patienten: Welche Techniken sind zu verwenden?

Rapid sequence induction and intubation (RSII) is the appropriate method of inducing general anaesthesia in patients who are at a risk of aspiration. The classical RSII is limited to a few treatment recommendations which are rarely based on evidence-based findings. New techniques (e.g., video laryngoscopy) as well as new means of diagnostics (e.g., sonography) require reevaluation of traditional techniques. In this article non-pharmacological treatment strategies of RSII are described. Furthermore, old and new methods to minimise the risk of aspiration are discussed. This includes gastric tube and gastric sonography as well as modalities for anaesthesia induction, e.g. patient positioning, face mask ventilation, relaxometry, cricoid and left-paratracheal pressure. In-hospital, RSII treatment standards must be familiar to all team members and treatment processes have to be well established and practiced regularly. The aim of this article is to present systematics that can be used as a decision-making basis for local operating procedures.

Epidemiology of aeromedical evacuation: an analysis of 504 cases.

BACKGROUND: Increasing air travel has resulted in a significant increase in aeromedical evacuation (AE) over the past decade. However, there are limited epidemiological data available on the diagnosis, costs, and transport characteristics of AE cases. METHODS: Cases of AE by a relief organization (Workers' Samaritan Federation Germany) were analyzed based on the following criteria: age, sex, and diagnosis of the patient, ventilation mode, days of illness before transport, type of transport, flight routes, flying time, flight distance, type of aircraft, type and distance of connecting transport from the destination airport to the final hospital, total cost per repatriation, cost per flight-minute, and cost per flight-kilometer of each transport type. RESULTS: A total of 504 patients (273 males, 231 females, aged 42 d-96 y, median 66 y) were included in the study. The top three diagnoses for adults were fracture of the femoral neck (n = 74, 15%), stroke (n = 69, 14%), and myocardial infarction (n = 39, 8%). Transport was carried out with an air ambulance (n = 391, 78%, 73.67 €/min), a scheduled aircraft with regular seating (n = 62, 12%, 17.57 €/min), a stretcher in a scheduled aircraft (n = 48, 10%, 35.28 €/min), or a patient transport compartment installed on board a scheduled aircraft (n = 3, < 1%). CONCLUSIONS: As the demand for AE is likely to increase in the future, the cost-effectiveness and selection of the appropriate form of air transportation, while assuring the right medical response, will be of increasing importance. Patients are likely to benefit from further epidemiological assessments like those presented in this study.