BackgroundThe use of cell salvage and autologous blood transfusion has become an important method of blood conservation. So far, there are no clinical data about the performance of the continuous autotransfusion device CATSmart.MethodsIn total, 74 patients undergoing either cardiac or orthopedic surgery were included in this prospective, bicenter and observational technical evaluation to validate red cell separation process and washout quality of CATSmart. The target of red cell separation process was defined as a hematocrit value in the packed red cell unit of 55–75% and of washout quality of 80–100% removal ratio.ResultsHematocrit values measured by CATSmart and laboratory analysis were 78.5% [71.3%; 84.0%] and 73.7% [67.5%; 75.5%], respectively. Removal ratios for platelets 94.7% [88.2%; 96.7%], free hemoglobin 89.3% [85.2%; 94.9%], albumin 97.9% [96.6%; 98.5%], heparin 99.9% [99.9%; 100.0%], and potassium 92.5% [90.8%; 95.0%] were within the target range while removal of white blood cells was slightly worse 72.4% [57.9%; 87.3%].ConclusionThe new autotransfusion device enables sufficient red cell separation and washout quality.

Over the last decades several indirect laryngoscopes have been developed to provide a significant better glottic view and improved the success rate in difficult intubations. Some case reports describe the use of indirect laryngoscopes for awake tracheal intubations under preserved spontaneous breathing. However, randomized clinical studies comparing indirect laryngoscopy to the standard of fiberoptic intubation under spontaneous breathing are rare. Therefore, we compared the intubation with the Airtraq® laryngoscope and the Bonfils endoscope, to the standard fiberoptic intubation in patients with an expected difficult intubation under local anesthesia and sedation. 150 patients with an expected difficult intubation were randomized to one of the three devices. All intubation attempts were performed under local anesthesia and sedation. We evaluated success rate, time for intubation and the satisfaction of anesthesiologists and patients. Fiberoptic intubation was significantly more successful (100%) than intubation with an Airtraq® laryngoscope (88%) or the Bonfils endoscope (88%). Time for intubation was quickest with the Airtraq® laryngoscope and significantly shorter than fiberoptic intubation (p=0.044). There was no difference in satisfaction of the anesthesiologists and none of the patients had a negative recall to one of the techniques. An expected difficult intubation can be managed using the Airtraq® laryngoscope or the Bonfils endoscope in 88% and shows the same satisfaction of anesthesiologists and patient. We conclude that these techniques represent an acceptable alternative for an awake tracheal intubation under sedation and preserved spontaneous breathing.

Postherpetic neuralgia can lead to therapy-resistant neuropathic pain. We report the case of a 74-year-old woman with postherpetic perineal neuralgia resistant to opioids and antiepileptic drugs who has been successfully treated with oral ketamine for 28 months. Pain scores were reduced by more than 50%, despite dose reduction of other analgetic drugs. Significant side effects have not yet been reported. Despite "off-label" use, ketamine is an important third line option in cases of therapy-resistant neuropathic pain.

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