Awake nasotracheal fiberoptic intubation requires an anesthetic management that provides sufficient patient comfort, adequate intubating conditions, and stable hemodynamics. Short-acting and easily titratable analgesics are excellent choices for this maneuver. In this study, our aim was to determine an appropriate dosage regimen of remifentanil for awake nasotracheal fiberoptic intubation. For that reason, we compared two different dosage regimens. Twenty-four patients were randomly assigned to receive remifentanil 0.75 micro g/kg in bolus, followed by a continuous infusion of 0.075 micro g x kg(-1) x min(-1) (Group L), or remifentanil 1.5 micro g/kg in bolus, followed by a continuous infusion of 0.15 micro g x kg(-1) x min(-1) (Group H). All patients were premedicated with midazolam 0.05 mg/kg IV and glycopyrrolate 0.2 mg IV. Both dosage regimens ensured patient comfort and sedation. Discomfort did not differ between groups. Patients in Group H were sedated more profoundly. Hemodynamic stability was maintained with both remifentanil doses. Intubating conditions were adequate in all patients and comparable between the groups. The large dosage regimen did not result in any additional benefit compared with the small dosage. For awake nasotracheal fiberoptic intubation, we therefore recommend remifentanil 0.75 micro g/kg in bolus followed by continuous infusion of 0.075 micro g x kg(-1) x min(-1), supplemented with midazolam 0.05 mg/kg.

No abstract

Quality control is an important tool ensuring continuous medical efficacy. Outcome scores, however, are unfavorable from a statistical point of view, are not meaningful for less severely injured patients, and may put the treating physicians under pressure to limit therapeutic efforts. In this study the variables of the abbreviated burn severity index (ABSI), primarily an outcome score, were used to predict length of hospital stay (HLS), a continuous quantitative variable reflecting treatment costs and incidence of complications even in less severely injured patients. For 365 patients a multiple linear regression analysis was used to evaluate the influence of the ABSI variables on HLS. Among survivors, age and total body surface area burned (TBSA) contributed significantly to HLS, whereas for nonsurvivors only TBSA significantly influenced HLS. Neither gender nor presence of full-thickness burn or inhalation injury showed a significant influence on HLS. The impact of age and TBSA on HLS might be used as a benchmarking system to evaluate quality of care. However, although HLS is probably widely dependent on regional health care systems, TBSA and age proved to be the only variables of the ABSI to correlate with HLS.

No abstract

Neither the isoflurane nor the esmolol/nitroglycerin method of producing deliberate hypotension compromises splanchnic tissue oxygen balance in healthy patients. Furthermore, overall organ perfusion was sufficient in both groups, because none of the patients showed an increase in blood lactate.