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In order to evaluate the relation between costs and benefit of the use of a temporary shunt during surgery of the carotid artery, we analysed 356 patients undergoing 401 operations of the carotid artery in a period from January 1991 to August 1995 in a retrospective study. The morbidity and mortality during hospital stay were 1.75% respectively 0.75% referring to neurological outcome and death. The potential to economize surgery of the carotid artery by recording the somatosensory evoked potentials in order to select the patients requiring a temporary shunt would be 4.1% of the payment which will be payed from 1996 by the social insurance for carotid endarterectomy. These savings can be realized without loss of quality or higher risk for the patient.

The laryngeal mask which was developed by Brain in 1981 and described for the first time in 1983 has been employed worldwide a million times since 1989. Traditionally, all anaesthesiologists are oriented towards the techniques of conventional mask anaesthesia or endotracheal intubation. This new alternative, however, amazes by its easy handling and its concept: insertion of the mask directly onto the larynx without irritating it and sealing the pharynx at the same time thus allowing sufficient ventilation. On the one hand, the laryngeal mask does not even fail in desperate cases of "can't intubate-can't ventilate", on the other hand, the new "old" problem reappears to the anaesthesiologist used to endotracheal intubation: mask anaesthesia and aspiration--a discussion which needs to be continued in case of the laryngeal mask. This is also true for the use of the laryngeal mask in emergency medicine and resuscitation. However, cases of difficult intubation may be greatly facilitated. All users appreciate the reliability of the laryngeal mask in daily routine even though some fear that more difficult and safer techniques of anaesthesia might be forgotten. The indications of the laryngeal mask expand rapidly at the moment and the fast trend in its spread might continue if this method is not discredited by violations of its contraindications: full stomach, extreme obesity and low compliance of the lungs.