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Der Anaesthesist

G Michels, T Wengenmayer, C Hagl, C Dohmen, B W Böttiger, J Bauersachs, A Markewitz, A Bauer, J-T Gräsner, R Pfister, A Ghanem, H-J Busch, U Kreimeier, A Beckmann, M Fischer, C Kill, U Janssens, S Kluge, F Born, H M Hoffmeister, M Preusch, U Boeken, R Riessen, H Thiele
Extracorporeal cardiopulmonary resuscitation (eCPR) may be considered as a rescue attempt for highly selected patients with refractory cardiac arrest and potentially reversible etiology. Currently there are no randomized, controlled studies on eCPR, and valid predictors of benefit and outcome which might guide the indication for eCPR are lacking. Currently selection criteria and procedures differ across hospitals and standardized algorithms are lacking. Based on expert opinion, the present consensus statement provides a proposal for a standardized treatment algorithm for eCPR...
July 16, 2018: Der Anaesthesist
C Raspé, M Bucher
No abstract text is available yet for this article.
July 4, 2018: Der Anaesthesist
T Warnecke, M Dobbermann, T Becker, M Bernhard, J Hinkelbein
BACKGROUND: The goal of rapid sequence induction (RSI) in cases of emergency situations is to secure the airway as quickly as possible to prevent pulmonary aspiration of gastric contents; however, the technique itself is not standardized. For example, the choice of drugs, application of cricoid pressure and the patient position remain controversial. A survey of emergency medical services (EMS) physicians throughout Germany was carried out to assess the different RSI techniques used and with respect to complying with the national guidelines for emergency airway management anesthesia and local standard operating procedures (SOP)...
June 29, 2018: Der Anaesthesist
C Eichelsbacher, H Ilper, R Noppens, J Hinkelbein, T Loop
BACKGROUND: Induction of general anesthesia in patients with risk for aspiration needs special considerations to avoid the incidence and severity of complications. Since no evidence-based guidelines support the challenge for anesthesiologists various practical recommendations exist in clinical practice for rapid sequence induction and intubation (RSI). The aim of this systematic review is, to summarize the evidence and recommend a decision making process. MATERIAL AND METHODS: Multilevel RAND-delphi-method (RAND: Research and Development) combined with systematic literature research, individual assessment and evaluation, consensus conferences and final common sequence...
June 29, 2018: Der Anaesthesist
U Keppler, T Schmoch, B H Siegler, M A Weigand, F Uhle
BACKGROUND: The old definition of sepsis was replaced by Sepsis-3 in February 2016. The new screening diagnostic tools sequential organ failure assessment (SOFA) score and quick SOFA (qSOFA) score were incorporated into the definition. The resulting scientific controversy led to several retrospective and prospective evaluations. In contrast no evaluation of the state of play of national implementation of Sepsis-3 has been conducted so far. OBJECTIVE: The aim of this study was to capture the current situation in German academic intensive care units 1 year after the implementation of Sepsis-3...
June 26, 2018: Der Anaesthesist
F Wappler
The prevalence of malignant hyperthermia (MH) in Germany is 1:2000-1:3000 and therefore more common than previously assumed, so that anesthesia personnel will more often be confronted with susceptible patients in the clinical setting. After the initial treatment with 2.5 mg/kg body weight dantrolene, further therapy using up to 10 mg/body weight dantrolene can be indicated for 24 h. Under these circumstances it is important to have a sufficient amount of water available for injection purposes. For outpatient anesthesia a stockage of dantrolene is not necessary as long as the use of MH trigger substances in general is strictly avoided...
June 26, 2018: Der Anaesthesist
S M Schellong, H Riess, M Spannagl, H Omran, M Schwarzbach, F Langer, W Gogarten, P Bramlage, R M Bauersachs
Approximately 30% of patients receiving oral anticoagulation using vitamin K antagonists (VKA) require surgery within 2 years. In this context, a clinical decision on the need and the mode of a peri-interventional bridging with heparin is needed. While a few years ago, bridging was almost considered a standard of care, recent study results triggered a discussion on which patients will need bridging at all. Revisiting the currently available recommendations and study results the conclusion can be drawn that the indications for bridging with heparin must nowadays be taken more narrowly and considering the individual patient risk of bleeding and thromboembolism...
June 20, 2018: Der Anaesthesist
M Kippnich, F Wallström, M Kolbe, H Erhard, U Kippnich, T Wurmb
BACKGROUND: In the case of a mass casualty incident an advanced medical post (AMP) plays a central role in the medical care by ambulance service and civil protection units. Besides the traditional organization with one triage category per medical services tent, it can also be structured in a mixed form (i.e. a defined number of patients with different triage categories are assigned to each medical services tent). To date it remains unclear which organization format is better in order to rapidly evacuate those patients with the highest priority...
June 8, 2018: Der Anaesthesist
M Hellmund, J Bajorat, S Machmüller, M Sauer, A Zitzmann, D A Reuter, T Mencke
BACKGROUND: Mask ventilation could improve after administration of muscle relaxants if there is a functional obstruction of the airway, such as laryngospasm, vocal cord closure or opioid-induced muscle rigidity. On the other hand, muscle relaxants could worsen mask ventilation because they induce upper airway collapse; however, clinical studies showed that rocuronium (Roc) improved mask ventilation or it remained unchanged. In most cases Roc 0.06 mg/kgBW was used. OBJECTIVE: The optimal dose of Roc has not been studied; therefore, we studied the quality of mask ventilation with three different doses of Roc (0...
May 25, 2018: Der Anaesthesist
C Metelmann, B Metelmann, C Scheer, M Gründling, B Henkel, K Hahnenkamp, P Brinkrolf
BACKGROUND: Sepsis is associated with a high mortality, which can be reduced by starting screening, diagnostics and treatment as early as possible. Due to multiple educational programs and increased awareness, a decreased sepsis mortality on intensive care units has been achieved. Many patients with sepsis are admitted by the prehospital emergency service to hospital emergency departments. Thus, prehospital emergency services and emergency departments provide an opportunity to start screening, diagnosis and treatment earlier...
May 25, 2018: Der Anaesthesist
K Lange, A Brinker, M Nowak, C Zöllner, W Lauer
BACKGROUND: The Federal Institute for Drugs and Medical Devices (BfArM) was notified of an event in which it was not possible to sufficiently ventilate a patient suffering a severe asthma attack. It turned out that the ventilation pressures used by the device for pressure-controlled ventilation were below the values set by the user, which the user was not aware of. The ventilation pressures chosen by the user exceeded the preset alarm limits of the ventilator. This pressure and alarm management significantly differed from that of other ventilators used in the hospital...
May 25, 2018: Der Anaesthesist
K Lewandowski
No abstract text is available yet for this article.
May 25, 2018: Der Anaesthesist
T Piegeler, R Werdehausen
Besides the well-known analgesic effects of amide-linked local anesthetics exerted via the inhibition of the voltage-gated sodium channel, these substances also possess a certain number of properties, which bear the potential to positively influence the outcome after surgery. The results of several experimental as well as clinical studies suggest the possibility of an enhanced recovery after surgery, reduction in the incidence of chronic pain, preservation of endothelial barrier function during acute lung injury and the prevention of metastasis of solid tumors by systemic effects of local anesthetic administration...
May 25, 2018: Der Anaesthesist
C Klein, C Wittmann, K N Wendt, C Ostgathe, S Stiel
BACKGROUND: Palliative sedation (PS) serves as a therapeutic option in cases of otherwise intractable suffering. As the use of sedative and hypnotic medication in many diverse situations is a core competency of anesthesiology, anesthesiologists are confronted with questions of sedative therapy at the end of life in institutions for specialized palliative care, in intensive care units and intermediate care wards. In recent years a number of guidelines have been published internationally but so far no official guidelines exist in Germany...
May 16, 2018: Der Anaesthesist
I Kezze, N Zoremba, R Rossaint, A Rieg, M Coburn, G Schälte
Surgically induced fire is a life-threatening hazard; this topic has received little attention, although only 3 factors, the so-called fire triad, are needed for surgical fires to occur: an oxidizer, fuel and an ignition source. This systematic review aims to determine the impact of each component and to delegate every staff member an area of responsibility, thus ensuring patient health through prevention or protection. The trial was registered in Prospero CRD42018082656. A database search of eligible, preferably evidence-based studies was conducted...
May 15, 2018: Der Anaesthesist
C Benstoem, R Wübker, M Lüngen, T Breuer, G Marx, R Autschbach, A Goetzenich, H Schnoering
BACKGROUND: For cardiac surgery patients who were employed prior to surgery, the return to their professional life is of special importance. In addition to medical reasons, such as pre-existing conditions, the success of the operation or postoperative course and patient-intrinsic reasons, which can be assessed with the Sense of Coherence (SOC) scale by Antonovsky, may also play a role in the question of a possible return into working life. METHODS: In this study 278 patients (invasive coronary artery bypass graft surgery and/or surgery on heart valves, age < 60 years, employed) were questioned postoperatively via post with the SOC questionnaire...
May 14, 2018: Der Anaesthesist
A E Goetz
No abstract text is available yet for this article.
May 14, 2018: Der Anaesthesist
C Dumps, E Halbeck, D Bolkenius
The discovery of barbituric acid and research on its derivatives have long been of importance in advancements in modern anesthesia. Decades of clinical use of barbiturates worldwide and their abuse has led to an enormous amount of knowledge. Thiopental and methohexital are ultra-short acting derivatives of barbiturates. Their clinical application has been accompanied by an enormous increase in the knowledge of the pharmacology of cerebrally active drugs, in particular gamma-aminobutyric acid (GABAA ) receptor and GABA-induced effects on nerve cell membranes...
May 9, 2018: Der Anaesthesist
C Cleff, M Boensch, F Eifinger, J Hinkelbein
BACKGROUND: Correct positioning of a central venous catheter (CVC) tip in pediatric patients is very important. Malpositioning may lead to direct complications, such as arrhythmia and increase the risk of thrombosis, infections, valve failures or pericardial tamponade. OBJECTIVE: The aim of this review was to identify and summarize published formulae for the correct positioning of the CVC tip in children and to discuss the benefits of these formulae for the daily routine...
May 7, 2018: Der Anaesthesist
M Jöhr
No abstract text is available yet for this article.
May 7, 2018: Der Anaesthesist
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