[Should opioids be routinely used for the induction of general anaesthesia for caesarean section?]. / Leser fragen - Experten antworten - Rapid-Sequence-Induction bei Sectio caesarea: Sollte standardmäßig ein Opioid gegeben werden?

The spinal anaesthesia, epidural anaesthesia or combinations of these techniques (combined spinal epidural anaesthesia) so far remain the gold standard to facilitate caesarean section. For some reasons such as refusal by the patients, medical reasons or emergency caesarean section, a general anaesthesia can be necessary. In patients with preeclampsia hypertension during endotracheal intubation has to be avoided. Here the application of an opioid is possible or even necessary to lessen increases of the heart rate and blood pressure. To lessen cardiovascular response, short acting Remifentanil has advantages, e.g. the fast clearance rate in newborns. However, the risk for the newborn from respiratory depression has to be considered and experienced staff to care for the newborn should be present after childbirth. Therefore, an interdisciplinary approach seems to be vital to cope with adverse effects that may arise due to the more frequent use of opioids in conjunction with general anaesthesia for caesarean section.

Comparison of the Airtraq and the Macintosh laryngoscope for double-lumen tube intubation: a randomised clinical trial.

CONTEXT: The Airtraq is a disposable optical laryngoscope that is available in a double-lumen tube version. Inserting a double-lumen tube is generally more difficult compared to conventional endotracheal intubation, mainly due to its configuration. OBJECTIVE: The aim of this study was to compare the Airtraq with the Macintosh laryngoscope for intubation with a double-lumen tube in patients undergoing elective thoracic surgery. The main outcome was time needed for successful intubation. DESIGN: Prospective, randomised clinical trial. SETTING: A single centre, University Hospital of Würzburg, Germany, between July 2009 and June 2011. PATIENTS: After a scout laryngoscopy with a Macintosh laryngoscope, 60 adult patients were intubated by an anaesthesiologist with either an Airtraq (n = 30) or a Macintosh laryngoscope (n = 30). MAIN OUTCOME MEASURES: The time needed for correct intubation, checked by flexible bronchoscopy, was recorded. The intubation difficulty scale (IDS) and Cormack and Lehane grade were noted. Haemodynamic variables and any evidence of oropharyngeal trauma were documented as well as postoperative sore throat, hoarseness and dysphagia. RESULTS: The mean time needed for correct intubation was 20.1 ± 16.5 s in the Airtraq group and 17.5 ± 10 s in the Macintosh group (P = 0.86). All intubations in both groups had an IDS less than 4. The Cormack and Lehane grade was I in all 30 patients in the Airtraq group; in the Macintosh group, it was I and II in 17 and 13 patients, respectively. The incidence of hoarseness was significantly higher in the Airtraq group 24 h postoperatively (P = 0.01). CONCLUSION: There was no significant difference between the Airtraq and the Macintosh laryngoscopes regarding the time needed to insert a double-lumen tube during elective thoracic surgery. Only subtle enhancement of visualisation and a higher incidence of hoarseness were observed in the Airtraq group. The Airtraq device did not result in superior patient safety in this setting.

[Videolaryngoscopy for endotracheal intubation - new developments in difficult airway management]. / Videolaryngoskope für die endotracheale Intubation - Neue Entwicklungen für das Management des schwierigen Atemweges.

Difficulties in tracheal intubation are the major causes of anaesthesia related morbidity and mortality. Novel videolaryngoscopes facilitate endotracheal intubation by indirect visualisation of glottic structures through optical systems. In this review, differences and the advantages and disadvantages of videolaryngoscopes are discussed.

[Risk communication in anaesthesia consultations]. / Das Anästhesierisiko im Aufklärungsgespräch--Von der schwierigen Prognose und der Wahl der richtigen Worte.

It is the responsibility of all anaesthesiologists to inform their patients about the risk and benefits of available treatment options. It is also our duty to obtain the patient's informed consent. But how much information do patients want about risks, and how should this topic be approached during the preoperative consultation? In this article we will discuss risk perception in general and options to describe potential medical risks.