Fiberoptisch unterstützte endotracheale Intubation durch die Larynxmaske im Kindesalter

Zusammenfassung: Die fiberoptisch assistierte endotracheale Intubation durch die Larynxmaske ist ein sicheres Verfahren, um beim pädiatrischen Patienten mit unerwarteter sowie auch bei bekannter schwieriger Intubation den Atemweg einfach und zuverlässig zu sichern. Die Methode stellt eine Standardtechnik in der Atemwegssicherung dar; sie muss einerseits Bestandteil der klinischen Ausbildung sein und andererseits regelmäßig trainiert werden. Das Entfernen der Larynxmaske über den Endotrachealtubus wird durch dessen kurze Länge erschwert bzw. der Endotrachealtubus kann dabei sehr leicht aus der Trachea dislozieren. Nebst einer Vielzahl von Techniken, die Larynxmaske sicher über den Endotrachealtubus zu entfernen, bietet der Cook Airway Exchange Catheter in der Kinderanästhesie eine einfache Methode, nicht nur die Larynxmaske sicher über den Tubus zu entfernen, sondern anschließend auch den geeigneten Tubus einzuführen. Dies ist insbesondere bei gecufften Tuben wünschenswert, bei denen der Pilotballon des gecufften Tubus zu groß ist, um Larynxmasken der Größen 2,5 und kleiner zu passieren. Die vorliegende Arbeit zeigt schrittweise die fiberoptisch assistierte endotracheale Intubation durch die Larynxmaske beim Kind und diskutiert ihre Bedeutung. Eine Liste mit aufeinanderabgestimmten Größen von Larynxmasken, Endotrachealtuben und Airway Exchange Cathetern ist ebenfalls enthalte

Altering the properties of graphene on Cu(111) by intercalation of potassium bromide

The catalytic growth on transition metal surfaces provides a clean and controllable route to obtain defect-free, monocrystalline graphene. However, graphene's optical and electronic properties are diminished by the interaction with the metal substrate. One way to overcome this obstacle is the intercalation of atoms and molecules decoupling the graphene and restoring its electronic structure. We applied noncontact atomic force microscopy to study the structural and electric properties of graphene on clean Cu(111) and after the adsorption of KBr or NaCl. By means of Kelvin probe force microscopy, a change in graphene's work function has been observed after the deposition of KBr, indicating a changed graphene-substrate interaction. Further measurements of single-electron charging events as well as X-ray photoelectron spectroscopy confirmed an electronic decoupling of the graphene islands by KBr intercalation. The results have been compared with density functional theory calculations, supporting our experimental findings

Sympathetic activity and early mobilization in patients in intensive and intermediate care with severe brain injuries: a preliminary prospective randomized study.

Patients who experience severe brain injuries are at risk of secondary brain damage, because of delayed vasospasm and edema. Traditionally, many of these patients are kept on prolonged bed rest in order to maintain adequate cerebral blood flow, especially in the case of subarachnoid hemorrhage. On the other hand, prolonged bed rest carries important morbidity. There may be a clinical benefit in early mobilization and our hypothesis is that early gradual mobilization is safe in these patients. The aim of this study was to observe and quantify the changes in sympathetic activity, mainly related to stress, and blood pressure in gradual postural changes by the verticalization robot (Erigo®) and after training by a lower body ergometer (MOTOmed-letto®), after prolonged bed rest of minimum 7 days. Thirty patients with severe neurological injuries were randomized into 3 groups with different protocols of mobilization: Standard, MOTOmed-letto® or Erigo® protocol. We measured plasma catecholamines, metanephrines and blood pressure before, during and after mobilization. Blood pressure does not show any significant difference between the 3 groups. The analysis of the catecholamines suggests a significant increase in catecholamine production during Standard mobilization with physiotherapists and with MOTOmed-letto® and no changes with Erigo®. This preliminary prospective randomized study shows that the mobilization of patients with severe brain injuries by means of Erigo® does not increase the production of catecholamines. It means that Erigo® is a well-tolerated method of mobilization and can be considered a safe system of early mobilization of these patients. Further studies are required to validate our conclusions. The study was registered in the ISRCTN registry with the trial registration number ISRCTN56402432 . Date of registration: 08.03.2016. Retrospectively registered

Electronic reconstruction forming a C2C_2-symmetric Dirac semimetal in Ca3_3Ru2_2O7_7

Electronic band structures in solids stem from a periodic potential reflecting the structure of either the crystal lattice or an electronic order. In the stoichiometric ruthenate Ca$_3$Ru$_2$O$_7$, numerous Fermi surface sensitive probes indicate a low-temperature electronic reconstruction. Yet, the causality and the reconstructed band structure remain unsolved. Here, we show by angle-resolved photoemission spectroscopy, how in Ca$_3$Ru$_2$O$_7$ a $C_2$-symmetric massive Dirac semimetal is realized through a Brillouin-zone preserving electronic reconstruction. This Dirac semimetal emerges in a two-stage transition upon cooling. The Dirac point and band velocities are consistent with constraints set by quantum oscillation, thermodynamic, and transport experiments, suggesting that the complete Fermi surface is resolved. The reconstructed structure -- incompatible with translational-symmetry-breaking density waves -- serves as an important test for band structure calculations of correlated electron systems

Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

BACKGROUND: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. METHODS: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. RESULTS: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1–6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. CONCLUSIONS: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Electron-driven C2-symmetric Dirac semimetal uncovered in Ca3Ru2O7

Two-dimensional semimetals have been the center of intensified investigations since the realization of graphene. In particular, the design of Dirac and Weyl semimetals has been scrutinized. Typically, Dirac metals emerge from crystal-field environments captured by density functional theory (DFT). Here, we show by angle-resolved photoemission spectroscopy (ARPES) how a rotational symmetry broken massive Dirac semimetal is realized in Ca3Ru2O7. This Dirac semimetal emerges in a two-stage electronic transition driven by electron correlations beyond the DFT paradigm. The Dirac point and band velocity is consistent with constraints set by quantum oscillation, thermodynamic and transport experiments. Our results hence advance the understanding of the peculiar fermiology found in Ca3Ru2O7. As the two-stage Fermi surface transition preserves the Brillouin zone, translational broken symmetries are excluded. The mechanism and symmetry breaking elements underlying the electronic reconstruction thus remain to be identified. This situation resembles URu2Si2 that also undergoes an electronic transition without an identifiable symmetry breaking. As such our study positions Ca3Ru2O7 as another prominent hidden order parameter problem