Background. There is little information about the anesthesiologic management of lung transplantation. Therefore, we characterized intraoperative variables and their impact on survival in dependence to preoperative characteristics of recipients and donors. Methods. We analyzed 808 lung transplantations performed at our institution between 1987 and 2006, described patients in relation to the use of cardiopulmonary bypass (CPB), and used both recursive-partitioning and multivariate analyses to examine patients, donors, anesthesiologic management (e.g. gas exchange, hemo-dynamics, transfusions), extracorporeal life support (e.g. unplanned/planned CPB), and other variables. Results. Compared with off-pump transplantations (n = 389), unplanned CPB (n = 216) resulted in more transfusions and both doubled duration of postoperative ventilation (7.2 +/- 16.5 vs. 16.5 +/- 23.7 days, p<0.001) and hospital mortality (10 vs. 19%, p = 0.006) ; after planned CPB (n = 88), mortality doubled again (42%, p<0.001). Pulmonary diseases, their severity and comorbidities differed between groups, but pulmonary diseases were similar between patients with unplanned and planned CPB. According to recursive-partitioning analyses postoperative ventilation of < 4 days 10h discriminated best between survivors and non-survivors, and the duration of postoperative ventilation was also predictive for survival (odds ratio (OR), 1.02 ; 1-day increments). Intraoperative independent risk factors were transfusions of packed red blood cells (OR, 1.10 ; 10-unit increments), planned CPB (OR 2.4) and donors at least 20 cm taller than the recipient (OR 6.0). Conclusions. Apart from avoiding CPB, further efforts towards shorter postoperative ventilation and avoiding the intraoperative need for excessive transfusions may have the potential to improve outcomes as these were identified as important risk factors and were associated with CPB use.

The i‐scoop is an intubation device with a curved guiding bar with laterally located lenses at its tip, rather than a blade. Twenty‐five anaesthesiologists intubated a manikin that simulated first a normal and then a difficult airway. All participants were able to intubate the difficult airway with a good view of the glottis using the i‐scoop. None was able to intubate using seven other laryngoscopes (Macintosh laryngoscope, GlideScope® GVL and AVL, McGrath® (Series 5/MAC), C‐MAC®, A.P. Advance™). Intubation was successful only with the Airtraq® (n = 10), the Airway Scope (n = 5), the C‐MAC D‐Blade (n = 2), the A.P. Advance DAB (n = 1) and the GlideScope DL Trainer (n = 1) (p < 0.001, success rate of i‐scoop vs all 12 laryngoscopes combined). In contrast to all other videolaryngoscopes, intubation of the normal airway with the i‐scoop was achieved even faster than with the Macintosh laryngoscope (p < 0.02). The i‐scoop outperformed all other laryngoscopes in both difficult and normal airways, and therefore has potential as an easier and safer alternative to present devices.

BACKGROUND Mivacurium is widespread used because it is the non-depolarizing muscle relaxant with the shortest duration time. Therefore, it seems to be ideal for fast track or ambulatory surgery. However, especially in combination with propofol and remifentanil onset time remains unclear and incidence of poor intubating conditions seems to be higher than in other regimes of anesthesia. METHODS We included 35 ear, nose and throat (ENT) patients in this study. Muscle relaxation was measured by acceleromyograhpy at the adductor pollicis muscle (a.p.m.) and intubating conditions were evaluated. Anesthesia was induced with 2.5 mg kg-1 propofol and 1 µg kg-1 remifentanil and intubation was performed three minutes after the administration of 0.2 mg kg-1 mivacurium. Open vocal cords conjoined with full relaxation of the a.p.m., easy mouth opening and prevention of coughing and bucking represented the primary endpoint in this study. RESULTS Only 20% of patients (N.=7) had optimal intubating conditions and achieved the primary endpoint. In 21 patients (60%) a complete block of the a.p.m. could not be achieved and in six patients (17%) the vocal cords were closed. In seven patients (20%) we observed difficult mouth opening and in 11 patients (31%) coughing and bucking. In addition, we found a prolonged onset time of 228±95 seconds (mean±SD). CONCLUSION In combination with propofol and remifentanil the muscle relaxant agent mivacurium led to uncertain muscle relaxation and to poor intubating conditions. Therefore the study was aborted after 35 patients. Probably mivacurium is not a useful muscle relaxant agent if fast and deep muscle relaxation is needed. The advantage of a short duration time is foiled by intubation complications due to insufficient muscle relaxation.