[The Mallampati Score. Prediction of difficult intubation in otolaryngologic laser surgery by Mallampati Score]. / Der Mallampati-Score. Vorhersage der schwierigen Intubation in der HNO-Laserchirurgie mittels Mallampati-Score.

UNLABELLED: The Mallampati score (MS), later modified by Samsoon and Young, is a common method used to predict difficult intubation. We tested its predictive value in otolaryngologic (ENT) laser surgery. METHODS: Ninety-one patients scheduled for elective ENT laser surgery had the modified MS noted prior to induction in the supine position, with the tongue fully protruded and phonating "ah"; 22 patients were female, 69 male. The mean age was 54 +/- 15 (6-84) years, height 171 +/- 9 (130-190) cm, and weight 72 +/- 21 (20-99) kg. After a standard induction, the laryngoscopic view was graded according to Cormack and Lehane (C&L). An intubation was considered difficult if the C&L score was > or = 3, i.e., no part of the glottis seen during laryngoscopy. The hypothesis tested was that a MS > or = 3 (i.e., only the base of the uvula or nine of the uvula was seen) is predictive of difficult intubation in this group of patients. This chi-square test was used for calculation of significance. RESULTS: All intubations were performed in less than three attempts, and no C&L score of 4 (i.e., not even the epiglottis seen during laryngoscopy) was observed; 10 patients had a C&L score > or = 3, i.e., a difficult intubation according to our definition. Sixty-two patients had a MS < or = 2; of these, 4 (= 6%) were difficult to intubate. Twenty-nine patients had MS > or = 3; of these, 6 (= 21%) were difficult to intubate. This difference was significant (chi-square = 4.1, P < 0.05). CONCLUSION: Difficult intubation was significantly more common in patients with MS > or = 3. Low sensitivity (60%) and specificity (72%) limit the clinical value of this test, however.

[Inhalation anesthesia or "balanced anesthesia"? A comparative perioperative study in geriatric patients]. / Inhalationsanaesthesie oder "Balancierte Anaesthesie"? Eine vergleichende perioperative Studie geriatrischer Patienten.

During a prospective randomized trial, 50 geriatric patients underwent surgery for a fractured femoral neck. The perioperative circulatory and respiratory effects of anesthesia with enflurane or balanced anesthesia with enflurane and fentanyl were compared. We were particularly looking for postoperative respiratory depression after a standard dose of fentanyl given during balanced anesthesia. Method. In 25 patients anesthesia was induced with 0.2 mg/kg etomidate and 1 mg/kg succinylcholine and maintained with 0.15 mg/kg alcuronium and enflurane. Twenty-five patients received a additional dose of 5 micrograms/kg fentanyl divided into 0.1 mg/kg 2 min before endotracheal intubation and the remainder 5 min before the start of surgery. Systolic and diastolic arterial pressures, heart rate, central venous pressure, hemoglobin, hematocrit, and electrolytes were measured and arterial blood gases were analyzed. Results. There was no important difference between the two methods: during careful use of both techniques circulation remained stable. No marked postoperative respiratory depression occurred even after 5 micrograms/kg fentanyl. Conclusions. Both anesthetic procedures are suitable for hip surgery in elderly patients. In the early postoperative period geriatric patients should be observed carefully in the recovery room for at least 2 h. In some patients--especially if fentanyl is used intraoperatively--this time must be prolonged.

[Axillary brachial plexus block with lidocaine HCl and carbonated lidocaine]. / Axilläre Plexus brachialis Blockade mit Lidocain HCl bzw. carboniertem Lidocain.

An accordance with the clinical examination recommended by Lanz and Theiss, we studied 26 patients undergoing a blockade of the axillary plexus with lidocaine-CO2 or lidocaine-HCl. Furthermore, we determined the blood concentrations of these local anaesthetics. The study showed no significant differences between the two groups of patients, except that the onset of the blockade was more reliable in one group. There was less impairment of motor function than sensory function. Blood lidocaine concentrations amounted to 2.46 mg/l (mean value) within 25 min. Slight cerebral intoxication could be seen in four patients, with no correlation with possibly high lidocaine concentrations. Lidocaine CO2 is recommended as a rapid blockade of short duration in outpatient regional anesthesia.

[Differences in IgM increase following operations in general anesthesia and paraspinal regional anesthesia]. / Unterschiedlicher IgM-Anstieg nach Operationen in Allgemeinanästhesie und rückenmarksnaher Regionalanästhesie.

The serum immunoglobin levels of 74 patients with a prosthetic hip operation were studied. 36 patients received general anaesthesia with thiopental sodium, succinylcholine, alcuronium and halothane, whereas 38 patients were given a catheter epidural anaesthesia (CEA) with bupivacaine. Both collectives were subdivided into four groups, in whom the loss of blood was substituted by either human albumin 5%, dextrane, gelatine, or hydroxyethyl starch. Patients with a general anaesthesia had a high increase in serum IgM on the 7th day after operation, whereas there was no increase in the patients who had received CEA. In all the other parameters there was no difference between the various anaesthetics; likewise, the individual volume substitution management procedures did not produce differences in these parameters. IgM elevation is interpreted as a reaction to an affection of the tracheo-bronchial system; this reaction did not occur with the CEA group. The cause of the reaction is the interaction of immunomodulating drugs, and changes in ventilation that lead to an activation of the immune system.

The role of peroxidase isoenzyme groups of Nicotiana tabacum in hydrogen peroxide formation.

Three peroxidase isoenzyme-groups found in cell walls of tobacco were tested for their capacity to form H2O2. Isoenzyme-group GI, located only in cell walls (GII and GIII are also found in protoplasts) showed the highest Kapp-value for H2O2-formation. The lowest Kapp-value, i.e., maximal H2O2-formation was received for group GIII which is ionically bound to the cell wall. As shown before, GI yields maximal polymerization rates for coniferyl- and p-coumarylalcohol. These facts indicate that each of the peroxidase isoenzyme groups of the cell wall is involved with different catalytic functions within the same pathways of H2O2-formation and succeeding lignification. H2O2-formation catalyzed by all 3 groups was increased by very low concentrations of Mn(2+)-ions. The required amount of Mn(2+) leading to maximal stimulation was in each case dependent on the basic rate of H2O2-formation. Maximal stimulation of H2O2-formation by phenolic compounds was achieved by coniferylalcohol at a concentration of 10(-4)M for all groups. Stimulation by p-coumaryl-and by sinapylalcohol was not as significant.

[Investigations on the penetration of cefamandole into spinal fluid (author's transl)]. / Untersuchungen zur Liquorgängigkeit von Cefamandol.

In 20 test persons spinal fluid was taken at intervals of 15, 30, 60 and 90 minutes after a single injection of 40 mg cefamandole/kg body weight in order to determine the levels of the active substance. Whereas in serum an average peak value of 248 mcg/ml was determined after ten minutes, there was no trace at all of cefamandole in the spinal fluid.