[Perioperative risk management of patients with obstructive sleep apnea]. / Perioperative Risikobetreuung bei Patienten mit obstruktiver Schlafapnoe.

Obstructive sleep apnea (OSA) has a relatively high prevalence of 3-7% in the general population in western industrialized countries. The prevalence is higher in older patients and in patients with cardiac or metabolic disorders. In the general surgical population patients with OSA are often unrecognized prior to surgery so that unexpected problems can occur due to the higher risk of airway collapse. Severe apnea can result even hours later and especially after surgery of the upper airway. Anesthesists and ear nose and throat surgeons are equally responsible for the perioperative surveillance. The article will show the importance of the preoperative identification of OSA patients and the perioperative risk management in the different risk phases apart from surgery. Although the importance of guidelines is very high there are no mandatory guidelines in Germany in contrast to the USA and the implementation should be given priority.

[First experiences with ultrasound guided subclavian vein port placement in ENT]. / Erste Erfahrungen in der sonografisch kontrollierten Portanlage der V. subclavia in der HNO.

BACKGROUND: Description of ultrasound guided port placement in the subclavian vein in ENT and discussion of clinical advantages and disadvantages. MATERIALS AND METHODS: 50 Patients underwent ultrasound guided port placement. The catheter tip was placed over subclavian vein or jugular vein between the superior vena cava and the right atrium. Correct placement was confirmed radiographically. All patients received ports prior to chemotherapy and were followed up in our institution. RESULTS: Port placement was successful in all 50 cases. In 2 cases the suclavian vein could not be punctured. The internal and external jugular veins were used as alternatives in one case each. Subcutaneous hematoma was observed in 4 cases, in 2 cases revision was required. In one case a discrete pneumothorax was observed in radiographic imaging. However, further treatment was not required. During the application of chemotherapy one case of catheter infection was observed and one case of catheter thrombosis. Thrombosis followed incorrect use of the catheter in an external department. In both cases the port catheter was removed. In one further case removal of the catheter was performed after completion of the chemotherapy. In total 3 different port catheter systems were used. CONCLUSION: Ultrasound guided placement of port catheters in the subclavian vein is a simple procedure for ENT settings. Complication rates were very low, application of chemotherapy is simple and quality of life for the oncologic patient is increased.

[Outpatient anesthesia for patients with obstructive sleep apnea: results of a national survey]. / Ambulante Anästhesie bei Patienten mit obstruktivem Schlafapnoesyndrom: Ergebnisse einer deutschlandweiten Umfrage.

BACKGROUND: In Germany there is currently no national standard for the management of patients with obstructive sleep apnea syndrome (OSAS). The object of this survey was to obtain information on the treatment concept for patients with OSAS and to report on the current practice in Germany. METHODS: Data collection was obtained through an online questionnaire. A total of 12,113 members of the supporting anesthesia societies from all over Germany were invited to participate via e-mail. Additionally an announcement was made in a professional journal. RESULTS: A total of 1,671 questionnaires were analyzed. The average age of the respondents was 45 years, 64% were male and 36% were female. The average work experience was 16 years and 85% of the respondents were consultants. In total 85% of anesthesiologists were predominantly working in inpatient care and 12% were predominantly active in outpatient care. Of the respondents 63% preferred regional anesthesia, 20% preferred general anesthesia for patients with OSAS and 17% did not have a preference for a specific anesthesia procedure. Outpatient surgery for patients with OSAS was performed by 72% of the respondents using regional anesthesia and by 55% of the respondents using local anesthesia with sedation. Of the anesthesiologists 49% consented to outpatient surgery using general anesthesia and 14% to interventions involving the airways. Compared to anesthesiologists working predominantly in inpatient departments, those working predominantly in outpatient departments treated patients with OSAS more frequently on an outpatient basis, used general anesthesia significantly more often, discharged those patients significantly earlier and observed less complications. CONCLUSIONS: This survey shows that outpatient surgery for patients with sleep apnea is common practice in Germany. It is also performed when patients have moderate or severe OSAS and for respiratory tract surgery. This means that the management is not conform to the guidelines of the American Society of Anesthesiologists (ASA).

[Midfacial fractures. Diagnosis and treatment]. / Mittelgesichtsfrakturen. Diagnostik und Therapie.

The clinical diagnosis and treatment of midfacial fractures have been optimized by modern computer tomography and the development of plate osteosynthesis. Even complex fractures involving the orbit and scull base can be accurately reconstructed and stabilized. The use of titanium mini- and micro-plates as well as resorbable materials allows customized treatment of this esthetically and functionally important area. The preservation of basic functions such as vision, scent, speech, occlusion and swallowing, in addition to aesthetic aspects, should be the primary goals of surgical treatment. In general, reconstruction is not required immediately and polytrauma patients will need interdisciplinary care. Conservative treatment of midfacial fractures should be the exception.

[ENT-recommendations for tracheobronchoscopy]. / HNO-Leitlinie Tracheo-Bronchoskopie.

INTRODUCTION: Tracheobronchoscopy allows endoscopic inspection and management of the tracheobronchial system. MATERIAL: The recommendation was developed in 1997 and updated in 2004 and 2009. RESULTS: The recommendations comment on indications and contra-indications, instruments, anesthesia and complications of endoscopic tracheobronchoscopy. DISCUSSION: Rapid technical advances in endoscopy have led to changes in indications for different procedures, especially as pertains to rigid and flexible endoscopy. The recommendations are designed to provide guidance for ENT and affiliated specialties for choosing and processing instruments and sedation methods.

[ENT-recommendations for esophagoscopy]. / HNO-Leitlinie Osophagoskopie.

INTRODUCTION: Esophagoscopy allows endoscopic inspection and management of the esophagus and stomach. MATERIAL: The recommendations were developed in 1997 and updated in 2004 and 2009. RESULTS: The recommendations comment on indications and contra-indications, instruments, anesthesia and complications of esophagoscopy. DISCUSSION: Rapid technical advances in endoscopy have led to changes in indications for different procedures, especially as pertains to rigid and flexible endoscopy. The recommendations for esophagoscopy are designed to provide ENT and affiliated specialties guidance for choosing and processing instruments and sedation methods.

[Update on therapy with positive airway pressure in sleep-related breathing disorders]. / Update: Therapie des Schlafapnoe-Syndroms mit positivem Atemwegsdruck.

Positive airway pressure (PAP) is the therapy of choice for most sleep-related breathing disorders. A variety of PAP devices exist (continuous PAP, bi-level PAP, automatic PAP, adaptive servo-ventilation) and must be carefully considered before application. The data presented are from an ENT sleep laboratory perspective and are designed to help the inexperienced ENT practitioner support patients before and after PAP therapy has begun. Patient compliance can be increased with individualized therapy. PAP treatment is very effective in eliminating obstruction-related sleep diseases and symptoms. However, because it generally has to be used throughout the patient's life, the optimal PAP device must be carefully selected, taking into account side effects that influence compliance.

[Therapeutic options after the accidental application of cyanacrylate into the outer ear canal]. / Therapieoptionen bei akzidenteller Applikation von Cyanacrylat in den äusseren Gehörgang.

BACKGROUND: The accidental application of cyanacrylate (superglue) into the outer ear canal requires different treatments depending on location and extent. METHODS: Two case studies are presented. Treatment included surgical removal, with or without prior conservative treatment, for complete canal obstruction, as well as conservative treatment for partial ear canal obstruction. RESULTS: Because of its unique anatomy, treatment of accidentally applied superglue into the outer ear canal differs from treatment in other locations. Conservative treatment was ineffective for complete obstruction, making secondary surgical removal necessary. Partial obstruction was successfully treated conservatively. No complications were observed after the surgical removal of superglue obstructing the complete outer ear canal. CONCLUSIONS: Conservative treatment is adequate for cases of partial obstruction of the outer ear canal with superglue. In cases of complete obstruction or inclusion of the ear drum, surgical treatment is recommended.

[Extramedullary manifestation of plasmocytoma in ENT]. / Dreifachmanifestation eines extramedullären Plasmozytoms im HNO-Bereich - Ein Fallbericht.

Plasmocytomas are non-Hodgkin's tumors which occur with an incidence of 4/100,000. Malignant plasma cells in bone marrow produce monoclonal antibodies which are typically found in urine and blood samples. In rare instances plasmocytoma occur exclusively in extramedullary locations preferring head and neck region. We report about two patients with extramedullary plasmocytoma, one of them with an extremely rare triple manifestation in the upper airway.

[Clinical experience with the hygienic reprocessing of rigid endoscopes lacking a working channel with reference to practicability in clinical routine]. / Erfahrungen in der hygienischen Aufbereitung starrer optischer Instrumente mit Reinigungs-Desinfektions-Geräten in Bezug auf Praktikabilität im klinischen Alltag.

BACKGROUND: Contaminated medical products may be vectors for infections. A safe disinfection method for the optical instruments used by ENT specialists is undoubtedly needed. So far, a standard method that sufficiently covers the risk of infection for patients and medical staff alike, while serving the need of practicability in daily routine, has not been established. PATIENTS AND METHODS: In the ENT departments of the Mannheim and Kaiserslautern hospitals, a study on the practicability of disinfection rigid optical instruments lacking working channels was conducted using cleaning and disinfection automats. A total of 735 patients were examined (Hopkins 30 degrees and 70 degrees) and the endoscopes subsequently sterilized using a cleaning and disinfection automat. RESULTS: Each cleaning cycle took about 40 min. Examining 70-100 patients a day, a minimum of eight 70 degrees Hopkins endoscopes would be needed. CONCLUSION: The sterilization of medical products such as endoscopes is the best practice, but certain hindrances, such as loss of time and costs involved, complicate its general application.

[Therapy for sleep-related breathing disorders using positive airway pressure. Data from an HNO sleep laboratory]. / Therapie schlafbezogener Atmungsstörungen mit positivem Atemwegsdruck. Datenanalyse eines HNO-Schlaflabors.

BACKGROUND: Computer-assisted cardiopulmonary polysomnography is generally required to differentiate common snoring from serious sleep-related breathing disorders (SRBD) such as sleep apnea. METHODS: This study investigates data from 2,683 diagnostic and therapeutic cardiopulmonary polysomnographies of 1,087 patients over the period 2003-2004. Indications and efficacy of therapy using positive airway pressure (PAP) in SRBD are analyzed as well as alternative procedures. RESULTS: Of the 1,087 patients, 260 (23.9%) needed PAP therapy. In 61% of the patients CPAP-therapy was applied, 19% needed Bi-PAP-ST and 10% Bi-PAP-S-therapy. A total of 91 patients (8.4%) were treated with alternative procedures, partially combined with positive airway pressure. In 760 patients (69.9%) PAP-therapy was controlled or SRBD was excluded. CONCLUSION: There are no generally accepted guidelines for the therapy of SRBD. Indications for conservative and/or surgical procedures in the treatment have to be determined individually, depending on polysomnographic findings, subjective discomfort and physical comorbidities of the patients.

[IMOLA -- a new larynx model for surgical training. Education in transoral laser microsurgery of the upper airways]. / IMOLA -- ein interventionsfähiges Larynxmodell. Ausbildung in der transoralen Lasermikrochirurgie der oberen Atemwege.

BACKGROUND: Education in laser microsurgery is generally acquired under the supervision of an experienced surgeon. During training phases, however, increased complication rates may occur. Viable models for training are therefore important. METHODS: Larynx models should be anatomically accurate in size, form and texture, and be able to simulate normal as well as pathological findings. RESULTS: The main component is gelatin. Elasticity and thermal qualities can be modified by additives. We have been able to develop a synthetic larynx model for CO(2)-laser surgery that closely resembles the physical and tactile qualities of human tissue. Further modification of the material produced cutting characteristics for CO(2)-laser similar to human tissue. CONCLUSION: The new larynx model allows the simulation of typical surgical situations. Surgeons in training can practice even difficult surgical procedures at low costs and without putting patients at risk, before carrying out the procedure on patients.

[Diagnostic and therapeutic endoscopy in ENT. Possibilities and limits]. / Diagnostische und interventionelle HNO-Endoskopie. Möglichkeiten und Grenzen.

Both flexible and rigid endoscopy have become very common in ENT in the last decade. This has led to an increase in the diagnostic and therapeutic spectrum, and, in particular, quality control. Because the purchasing price of optical systems, as well as their maintenance, can be quite expensive, the expected spectrum of applications should be taken into account in choosing endoscopic equipment. This review provides aid in choosing the right system without defining legally binding parameters.

[Cardiotoxicity of 5-fluorouracil. Clinical relevance of palliative radiochemotherapy of malignant head-neck tumors]. / Kardiotoxizität des 5-Fluorouracil. Klinische Relevanz bei palliativer Radiochemotherapie von malignen Kopf-Hals-Tumoren.

BACKGROUND: In the past cardiotoxicity has been increasingly reported as 5-fluorouracil is widely used as well in curative adjuvant as in palliative chemotherapy of malignant neoplasms. METHODS: We report on two cases of 5-fluorouracil-associated cardiotoxicity on palliative treatment of head and neck cancer and evaluate the importance of intensive drug monitoring. RESULTS: 5-fluorouracil-associated cardiotoxicity occurs with an incidence of 1.1-4.5%. Ischaemic cardiopathy due to vasospasms is believed to be the most common manifestation. CONCLUSIONS: Since most patients with head and neck cancer have risk factors for cardiovascular disease, 5-fluorouracil-associated cardiotoxicity should not be underestimated and patients should be monitored carefully.