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H J Gerig

Publications and source records attributed to H J Gerig.

17 recordsLinked to original sources
PubMed2006

[Videolaryngoscopy versus direct laryngoscopy for elective endotracheal intubation].

BACKGROUND: We compared the ease of viewing the glottis under direct vision during conventional laryngoscopy with the quality of indirectly viewing on a monitor during laryngoscopy with a Macintosh videolaryngoscope in a multicenter study. PATIENTS AND METHODS: After ethical approval and written informed consent of 300 patients with no anticipated difficult airway, conventional laryngoscopy with a Macintosh videolaryngoscopy blade was performed and the quality of the view of the glottis was assessed and documented according to the Cormack and Lehane scoring system as modified by Yentis and Lee. Subsequently, the indirect viewing conditions on the monitor were documented without changing the position of the blade. Differences between both distributions were analyzed using the Bland-Altman Test. RESULTS: Videolaryngoscopy improved the laryngoscopy score by 1 grade in 72 cases, by 2 grades in 17 cases and by 3 grades in 2 cases. A relevant improvement (from grades III/IV to II) was found in 28 patients. Viewing conditions worsened in 3 cases by 1 grade, in 4 cases by 2 grades and in 3 cases by 3 grades. A statistical analysis of the data gave a bias of 0.31 and an SD bias of 0.77.The 95% confidence interval of the distribution ranged from -1.12 to 1.81. CONCLUSION: Videolaryngoscopy can lead to better viewing conditions but in rare cases it may result in worse viewing conditions.

Adult↗
PubMed2005

Comparision of etomidate and propofol for fibreoptic intubation as part of an airway management algorithm:a prospective, randomizes, double-blind study.

BACKGROUND AND OBJECTIVE: In our algorithm for management of the anticipated difficult airway the induction agent (etomidate) is administered after the tip of the fibreoptic is placed in the trachea but before the tube is advanced over it. In a previous investigation we demonstrated the safety of this method. Due to its popularity as an induction agent, some would like to replace etomidate with propofol. However, because rapid recovery of spontaneous breathing is crucial with this technique, substitution might not be advisable. We compared the speed of recovery of spontaneous breathing after fibreoptic intubation between etomidate and propofol. METHODS: In this prospective, randomized, double-blind study we used either 0.2 mg kg[-1] etomidate or 2 mg kg[-1] propofol for induction. Our technique of nasotracheal fibreoptic intubation consists of using fentanyl, cocaine instillation into the lower nasal canals, cricothyroid injection of lidocaine, performing bronchoscopy, administration of etomidate and advancing the tube after loss of consciousness. We measured time to loss of consciousness, time to recovery of spontaneous breathing, lowest bi-spectral index value and time to lowest value. RESULTS: Time to loss of consciousness did not differ. The time to recovery of spontaneous breathing differed significantly: the median time (interquartile range [range]) for etomidate was 81 s (62--102 [0--166]), and for propofol 146 s (95--260 [65--315]); P=0.001. The lowest bi-spectral index values were not different. The time of the lowest bi-spectral index values differed significantly: for etomidate 58 s (51--68 [38--100]), and for propofol 90 s (52--125 [38--172]); P=0.015. CONCLUSION: For nasotracheal fibreoptic intubation, where the tube is advanced after induction of anaesthesia, we still recommend etomidate because spontaneous breathing recovers faster than with propofol.

Adolescent↗
PubMed2005

Prophylactic percutaneous transtracheal catheterisation in the management of patients with anticipated difficult airways: a case series.

Primary tracheostomy under local anaesthesia is indicated in the management of an anticipated difficult airway in patients in whom less invasive procedures are expected to fail or have already failed. However, primary tracheostomy is a relatively complex procedure and places not inconsiderable stress on the patient. In a prospective study in our hospital over a period of 22 months, we were able to avoid primary tracheostomy in 11 patients with very difficult airways. All 11 patients were managed with prophylactically inserted transtracheal catheters and jet ventilation of the lungs. This ensured an adequate oxygen supply during tracheal intubation, and made overall patient management much easier. This method has established itself as a standard procedure in our hospital.

Catheterization, Peripheral↗
PubMed2003

[Comparison of algorithms for management of the difficult airway].

Management of the difficult airway and maintenance of the oxygenation are the most important tasks of the anaesthetist. Respiratory problems are still the most important single cause for anaesthesia-related accidents with poor outcome. Algorithms are step-wise procedures developed from a great number of recommendations and are well suited to automation and training procedures. There is strong agreement among consultants that specific strategies lead to improved outcome, although, strictly speaking the degree of benefit on airway management cannot be clearly determined. Several anaesthesia societies, including the American Society of Anesthesiology,have developed their own algorithms for management of the difficult airway. The comparison of published algorithms shows that the management of the anticipated difficult airway has to be performed in the awake patient and fiberoptic intubation is a crucial part of that procedure. There are different techniques (different blades, guide wire, laryngeal mask, fiber optics) for the management of the unanticipated difficult airway. The laryngeal mask, transtracheal access and the Combitube are recommended for the management of the cannot intubate, cannot ventilate situation. More important than the questions which algorithm, which technique and which instruments should be used,is that each department has and practices its own algorithm. This strongly depends on local circumstances and personal preferences. Daily practice is the condition for the successful use in an emergency situation. The management is easier if one uses a simple algorithm and as few instruments as possible.

Algorithms↗
PubMed2003

Structure and process quality illustrated by fibreoptic intubation: analysis of 1612 cases.

The purpose of this investigation was the description of structure and process quality based on the analysis of 1612 fibreoptic intubations. We evaluated all fibreoptic intubations (nasotracheal in awake patients and orotracheal in anaesthetised patients) from a previously described database over a period of 2 years. We assessed structure quality by evaluating the distribution of the fibreoptic intubations across all staff anaesthetists, and process quality by analysing the number of attempts, the time required, the cases where we had to switch to conventional intubation and the complications. In all, 955 nasotracheal and 657 orotracheal intubations were evaluated. Almost all anaesthetists performed at least 15 nasotracheal and 10 orotracheal intubations. The success rate was 85.2% at the first attempt. Within 3 min, 93.9% of all fibreoptic intubations were successfully completed. In 24 cases, fibreoptic intubation was abandoned. Severe nasal bleeding as a major complication occurred in 1.3% of the nasotracheal intubations.

Adolescent↗
PubMed2001

Validation of a simple algorithm for tracheal intubation: daily practice is the key to success in emergencies--an analysis of 13,248 intubations.

A fundamental skill of the anesthesiologist is airway management. We validated a simple endotracheal intubation algorithm with a large proportion of fiberoptic tracheal intubations used for years in daily practice. Over 2 yr, 13,248 intubations (>90% of all intubations, including obstetrics and ear, nose, and throat patients) in a heterogeneous patient population at our acute care hospital were evaluated prospectively. About 80 physician and nurse anesthetists were involved. Once the indication for intubation (oral or nasal) was established, the first step was to choose between the primary conventional technique (laryngoscope with Macintosh blades) and the primary fiberoptic technique. For the conventional technique, a well defined procedure had to be followed (maximum of two attempts at intubation; if unsuccessful, switch to secondary oral fiberoptic intubation). For the primary fiberoptic technique, the anesthesiologist had to decide between nasotracheal intubation in awake patients and oral intubation in anesthetized patients. Fiberoptics were used for 13.5% of the intubations. By following our algorithm, intubation failed in 6 out of 13,248 cases (0.045%; 95% confidence interval 0.02%-0.11%). We demonstrate that a simple algorithm for endotracheal intubation, basically limited to fiberoptics as the only aid, is successful in daily practice. Only methods that are practiced daily can be used successfully in emergencies.

Adolescent↗
PubMed2001

Fiberoptically-guided insertion of transtracheal catheters.

IMPLICATIONS: Regular use of the transtracheal catheter (TTC) both offers an opportunity for training for the difficult airway and facilitates elective endoscopic surgery. Fiberoptic guidance and exploratory puncture improve the insertion of the TTC.

Adolescent↗
PubMed1998

[The difficult intubation. The value of BURP and 3 predictive tests of difficult intubation].

UNLABELLED: The value of BURP (= backwards-upwards-rightwards-pressure of the larynx) was tested as a improvement of the visualisation of the larynx. Simultaneously we wanted to assess the value of different predictive tests of a difficult intubation, which are easy to perform as bedside tests. PATIENTS AND MATERIAL: 1993 patients of all different surgical clinics in a tertiary care hospital in Switzerland were tested, the complete anaesthesiological staff was involved. We registered the original Mallampati classes, the thyromental distances of Patil and Frerk and the difference of the jugulomental distances in maximally reclined and neutral head position according to Chow. Every anaesthetist also noted his personal, subjective opinion of a possible difficult intubation. Under optimal conditions for intubation we assessed the grade of laryngoscopy according to Wilson and applied BURP if the grade was 3 or higher. Both laryngoscopic grades and the difficulty of intubation were noted. RESULTS: In our study we found 12.5% awkward (Wilson G3-G5) and 4.7% difficult (Wilson G4-G5) laryngoscopies. These could be changed with BURP into 5.0% and 1.9% respectively. With BURP we found 1.8% of difficult intubations. During our study we did not find any patients, whom we could not intubate either with a mandrin inside the tube or with help of the fiberoptic. The relation between sensitivity and specificity was in all single predictors and in two combinations very low. Our personal subjective predictions proofed to be better, but the rate of false negatives was too high for clinical use. CONCLUSION: BURP is a valuable method for rendering the majority of difficult laryngoscopies into easy ones. It is very easy to learn and does not need any additional equipment. Three commonly used and recommended predictive tests of the difficult intubation proofed to be of little use in clinical practice.

Adolescent↗
PubMed1989

[Does post-puncture syndrome following lumbar puncture depend on needle diameter?].

The impact of needle size on the frequency of post-lumbar puncture syndrome (PPS) was investigated in 77 patients undergoing diagnostic lumbar puncture. 22-gauge needles were used in 44 patients (group A) and 19-gauge needles in 33 (group B). Because of severe postdural headache, an epidural blood patch was applied in 6 patients and resulted in immediate relief of symptoms. In the remaining 71 patients, PPS occurred in 57% of group A and in 48% of group B. A statistically significant relationship could not be found between needle size and duration of PPS (p = 0.2), but an inverse ratio was found between age and duration of post-lumbar puncture headache (p = 0.006). A review of previous studies in this field shows that needles with a diameter smaller than 24 gauge reduce the incidence of PPS. However, technical skill is also of prime importance in lowering the frequency of postdural headache.

Adult↗
PubMed1987

[Postpuncture headache and blood patch].

Anesthetists performing spinal and epidural anaesthesia will inevitably be confronted with the problem of postspinal headache. Exact knowledge as to cause, diagnosis, and treatment of this troublesome complication are mandatory. The most important method of treatment, the epidural blood patch, belongs to the armamentarium of every anesthetist. The present review is based on the most important findings in the literature and adds some important experiences from the author's institution.

Anesthesia, Epidural↗
PubMed1986

[Difficult intubation due to an unusual anomaly of the larynx].

A patient, scheduled for an ophthalmic operation could not be intubated in spite of various different attempts. The cause of the difficulties was a cartilagineous thickening of the right ary-epiglottic fold, which was lying like a second epiglottis over the entry of the glottis. The importance of ventilation-management by mask and close cooperation with a laryngologist is stressed.

Aged↗
PubMed1985

[Success and failure rate in peridural anesthesia. A 1-year study].

The real significance of epidural anaesthesia is determined by its practicability in the daily routine. The present paper shows, that about 20% of all operations which will be anaesthetized by a large anaesthesia department can be done under epidural anaesthesia. In 84,6% of all patients under epidural anaesthesia, anaesthesia was satisfactory; 4.7% of epidural anaesthesias were failures. The difficulty of epidural puncture and of advancing the epidural catheter were examined, as well as the degree of the necessary sedation. The main complication is puncture of the dura, in our series in 1,7% of the cases. We also examined the results achieved in relation to the state of training and in special cases of epidural anaesthesia. In the most interesting special case, namely patients requiring repeated epidural anaesthesia the success rate decreased significantly and the number of complications increased. The dosage-scheme for local anaesthetic given by Bromage has been confirmed in our patients. A simplified diagram and an approximate formula for calculation of dosage are given.

Adolescent↗
PubMed1983

[Epidural buprenorphine for postoperative analgesia after hip operations].

Two groups of 20 patients each were given immediately after hip-operation an epidural injection of 0,15 or 0,3 mg buprenorphine. Effects and side effects are compared with those observed in two groups of patients having the same type of operation, and given either 4 mg of morphine or saline (placebo) by epidural injection. Buprenorphine in both doses produced a shorter duration of analgesia than 4 mg of morphine. In no case did respiratory depression occur. Urinary retention after buprenorphine was barely more frequent than in the placebo group. Nausea and vomiting occurred in 35-45% of patients. We do not see an advantage in replacing morphine by buprenorphine for epidural opiate-analgesia, because the same high rate of nausea/vomiting is associated with a significantly shorter duration of analgesia after buprenorphine. We are convinced that epidural opiate-analgesia is most valuable for postoperative pain relief but should be reserved for selected cases.

Aged↗
PubMed1982

[Postoperative analgesia with epidural morphine after hip operations (author's transl)].

80 patients undergoing hip surgery under lumbar epidural block have been studied (double blind) for postoperative analgesia. There were 4 groups, of 20 patients each, who received a single epidural injection of 0 mg, 2 mg or 4 mg morphine in 1 ml of saline added to 6 ml bupivacaine 0.5% or 4 mg morphine in 6 ml saline. In the morphine groups analgesia lasted between 37 and 50 hours. No neurological side-effects or severe respiratory depression have was observed; but a significant rise of paCO2 was found. Other side-effects were nausea/vomiting and the need for catheterisation in about 50% of patients. We conclude, that the indications for epidural analgesia with morphine have to be chosen carefully.

Aged↗
PubMed1979

[Methods influencing intraoperative heat balance in the sterile enclosure (author's transl)].

More and more operations are performed in a sterile enclosure ("Sterilboxe") with a high fresh air turnover to achieve an optimum aseptic standard. This study investigated the question whether the climate of the "Sterilboxe" has a depressing effect on the body temperature of anaesthetized patients. Furthermore various devices were tested for their value in compensating for heat losses. The temperature of 55 patients was recorded during major operations. We found evidence, that there was regularly a fall of core temperature during operations in the "Sterilboxe", somewhat different to the behaviour of temperature in conventional theatres. Three methods for the compensation of heat loss were compared each against other and against the control whilst continually recording the oesophageal temperature. In the control group the temperature fall was 0.44 degrees C/h, in the group in which respiratory gases were optimally warmed and humidified the decrease was only 0.11 degrees C/h. Warming up all perfused liquids in a water-bath heat-exchanger showed a fall of temperature of 0.2 degrees C/h; with a Fenwal heatexchanger temperature decreased by 0.27 degrees C/h.

Adolescent↗