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Der Anaesthesist

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https://www.readbyqxmd.com/read/29159491/-algorithm-for-securing-an-unexpected-difficult-airway-user-analysis-on-a-simulator
#1
T Ott, K Truschinski, M Kriege, M Naß, S Herrmann, V Ott, S Sellin
BACKGROUND: Critical incidents in difficult airway management are still a main contributory factor for perioperative morbidity and mortality. Many national associations have developed algorithms for management of these time critical events. For implementation of these algorithms the provision of technical requirements and procedure-related training are essential. Severe airway incidents are rare events and clinical experience of the individual operators is limited; therefore, simulation is an adequate instrument for training and evaluating difficult airway algorithms...
November 20, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29159490/-prewarming-according-to-the-awmf-s3-guidelines-on-preventing-inadvertant-perioperative-hypothermia-2014-retrospective-analysis-of-7786-patients
#2
R Grote, A J Wetz, A Bräuer, M Menzel
BACKGROUND: Inadvertent perioperative hypothermia, which is defined as a core body temperature of less than 36.0 °C, can have serious consequences in surgery patients. These include cardiac complications, increased blood loss, wound infections and postoperative shivering; therefore, the scientific evidence that inadvertent perioperative hypothermia should be avoided is undisputed and several national guidelines have been published summarizing the scientific evidence and recommending specific procedures...
November 20, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29147790/-etomidate-for-intravenous-induction-of-anaesthesia
#3
C Dumps, D Bolkenius, E Halbeck
The pharmacological and historical knowledge about the currently available intravenous induction hypnotics form the basis for the daily work of anesthetists. Side effects of using hypnotic induction agents must be anticipated and adequately treated. Decades of experience with using intravenous induction hypnotics have led to theoretical requirements for an ideal narcotic agent with a best possible side effect profile. In the absence of this optimal hypnotic induction agent, a careful selection of one or a combination of narcotic drugs is necessary to meet the needs of the respective risk constellation of the patient...
November 16, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29143074/-additional-emergency-medical-measures-in-trauma-associated-cardiac-arrest
#4
B Ondruschka, C Baier, J Dreßler, A Höch, M Bernhard, C Kleber, C Buschmann
INTRODUCTION: More than half of all traumatic deaths happen in prehospital settings. Until now, there have been no long-term studies examining the actual additive treatment during trauma-associated cardiopulmonary resuscitation (tCPR), including pleural decompression, pericardiocentesis, tourniquets and external stabilization of the pelvis. The present cohort study evaluated forensic autopsy reports of trauma deaths occurring at the scene with respect to additive actions in preclinical tCPR as well as the potentially preventable nature of the individual death cases...
November 15, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29134257/-regional-anesthesia-tradition-and-innovation
#5
EDITORIAL
U Schwemmer
No abstract text is available yet for this article.
November 13, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29119207/anesthesia-in-a%C3%A2-child-with-suspected-peroxisomal-disorder
#6
J S Englbrecht, M Maas
We present the case of an 8‑year-old female child with suspected peroxisomal disorder requiring general anesthesia for adenotomy, paracentesis and brainstem-evoked response audiometry. Peroxisomes are small intracellular organelles that catalyse key metabolic reactions. Peroxisomal disorders are a heterogeneous group of rare genetic diseases. Anesthesia can be challenging as adrenal insufficiency, mental retardation, muscle weakness, risk of pulmonary aspiration, airway complications, seizure disorders and altered pharmacokinetics and pharmacodynamics can occur in these patients but guidelines for anesthesia do not exist due to the heterogeneity and rarity of these diseases and case reports are rare...
November 8, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29098342/preoperative-evaluation-of-adult-patients-before-elective-noncardiothoracic-surgery-joint-recommendation-of-the-german-society-of-anesthesiology-and-intensive-care-medicine-the-german-society-of-surgery-and-the-german-society-of-internal-medicine
#7
REVIEW
B Zwissler
Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery, and may help to optimize the patient's preoperative medical condition and guide perioperative management. Whether performance of additional technical tests (e. g., blood chemistry, electrocardiography, spirometry, chest x‑ray) can contribute to reduction of the perioperative risk is often not well known or controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists, and surgeons with respect to perioperative management of the patient's long-term medication...
November 2, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29085962/-role-specific-targets-and-teamwork-in-the-operating-room
#8
REVIEW
K Hoeper, M Kriependorf, C Felix, P Nyhuis, A Tecklenburg
BACKGROUND: The primary goal of a surgical team is the successful performance of an operation on a patien; however, this primary goal can show discrepancies from the goals of individual team members. The main causes for differences of interests can be variations in subjective preferences and organizational differences. Subjective preferences are due to the values held by those involved. These values are of an intrinsic nature and therefore difficult to change. Another reason for individual goals is that hospitals and universities are professional bureaucracies...
October 30, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29071370/determination-of-the-median-effective-dose-ed50-of-bupivacaine-and-ropivacaine-unilateral-spinal-anesthesia-prospective-double-blinded-randomized-dose-response-trial
#9
WeiBing Wang, YuanHai Li, AiJiao Sun, HongPing Yu, JingChun Dong, Huang Xu
BACKGROUND: Unilateral spinal anesthesia (USpA) has been reported to potentiate spinal anaesthesia and is used in geriatric patients. The purpose of this study was to determine the median effective dose (ED50) of 0.5% hypobaric bupivacaine and 0.5% hypobaric ropivacaine USpA for geriatric patients (age ≥ 70 years) undergoing elective hip replacement surgery. METHODS: A total of 60 geriatric patients (age ≥ 70 years) undergoing elective hip replacement surgery were enrolled in this study...
October 25, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29046933/-regional-anesthesia-are-the-standards-changing
#10
REVIEW
T Volk, C Kubulus
Regional anesthesia has undergone many changes over the years and the increasing use of ultrasound has certainly played an important role in this. Apart from individual case reports in the literature of very different blocking options, some new procedures seem to have become established and can be broadly applied. Among these are blockades, by which ultrasound-guided injection of local anesthetics is carried out in fascial or muscular layers rather than around target nerves (e.g. cervical plexus blocks and truncal blocks)...
October 18, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28971216/-does-annual-simulation-training-influence-the-safety-climate-of-a-university-hospital-prospective-5%C3%A2-year-investigation-using-dimensions-of-the-safety-attitude-questionnaire
#11
M St Pierre, C Gall, G Breuer, J Schüttler
BACKGROUND: Simulation-based training with a focus on non-technical skills can have a positive influence on safety relevant attitudes of participants. If an organization succeeds in training sufficient staff, it may experience a positive change in the safety climate. As the effects of a single training are of a transient nature, annual training sessions may lead to an incremental improvement of safety relevant attitudes of employees over time. In spring 2012 the Department of Anesthesia at the University Hospital of Erlangen established an annual simulation-based training for staff members (e...
October 2, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28956075/-polytrauma-following-a-truck-accident-how-to-save-lives-by-guideline-oriented-emergency-care
#12
M Kippnich, Y Jelting, C Markus, M Kredel, T Wurmb, P Kranke
BACKGROUND: Identification and immediate treatment of life-threatening conditions is fundamental in patients with multiple trauma. In this context, the S3 guidelines on polytrauma and the S1 guidelines on emergency anesthesia provide the scientific background on how to handle these situations. CASE STUDY: This case report deals with a seriously injured driver involved in a truck accident. The inaccessible patient showed a scalping injury of the facial skeleton with massive bleeding and partially blocked airway but with spontaneous breathing as well as centralized cardiovascular circulation conditions and an initial Glasgow coma scale (GCS) of 8...
September 27, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28936539/-cave-interscalene-catheters
#13
P Gaus, Ph Kutz, J A Bachtler, R Lindner, P Saur
Interscalene regional anesthesia is an established and highly effective procedure; however, it represents an increased level of risk due to the close proximity of anatomical structures, such as the cervical spinal cord and many vessels. Furthermore, due to inadvertent placement of a catheter close to the cervical spinal cord or into a vessel, as opposed to a single shot injection technique, it remains a latent danger until it is removed. This article describes seven  cases of misplaced catheters. The etiology and symptoms are discussed as well as recommendations regarding the prevention of catastrophic complications...
September 21, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28914331/-the-ideale-handover
#14
LETTER
W Hölz, T Zinsmeister, H Forst
No abstract text is available yet for this article.
September 15, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29046934/-knowledge-of-the-population-about-leading-symptoms-of-cardiovascular-emergencies-and-the-responsibility-and-accessibility-of-medical-facilities-in-emergencies-results-of-the-kzen-study-in-western-palatinate
#15
T Luiz, S Dittrich, G Pollach, C Madler
BACKGROUND: The Westpfalz is a mainly rural region in the southwestern part of the German state of Rhineland-Palatinate with 527,000 inhabitants and demonstrates a higher than average cardiovascular mortality compared to the rest of Germany. The reasons are not known. Our study attempted to investigate whether significant deficits in knowledge of the population on cardiovascular emergencies, the accessibility of emergency medical services (EMS) or the different responsibilities and abilities of the medical facilities could be held responsible for this...
November 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29030648/-interprofessional-symptom-management-at-the-end-of-life
#16
S Frankenhauser, M J P Geist, M A Weigand, H J Bardenheuer, J Keßler
At the end of life patients often show distressful symptoms which significantly reduce their quality of life. The goal of all healthcare professionals should be to recognize the beginning of this end of life period in order to provide good symptom management. For this purpose, existing symptoms have to be recorded, suitable therapeutic goals have to be defined for the current situation and potential therapeutic strategies have to be individually formulated. Besides the identification of underlying causes with the possibility of causal treatment, a symptom-based therapy is often necessary...
November 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28993842/-the-right-opioid-for-my-patient
#17
EDITORIAL
M Schäfer
No abstract text is available yet for this article.
November 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28980031/-use-of-near-infrared-spectroscopy-for-control-of-limb-perfusion-during-venoarterial-ecmo-treatment-application-and-limitations
#18
T Werner, D Lunz, A Philipp, B Flörchinger, B M Graf, Y A Zausig
Patients undergoing peripheral venoarterial extracorporeal membrane oxygenation have a high risk of lower limb ischemia. In general, regular controls are carried out based on clinical and laboratory parameters in order to quickly detect and treat complications. These controls are challenging due to states of shock, nonpulsatile flow and vasopressor therapy. As additional monitoring the use of near-infrared spectroscopy (NIRS) is described in the literature as being very successful in detecting ischemia. The present article describes the use and possible limitations of NIRS for the diagnostics of peripheral ischemia...
November 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28971215/-differential-indications-of-opioids-in-pain-therapy
#19
REVIEW
J Heyn, S C Azad
Due to their strong analgesic potency opioids are highly effective in the therapy of acute and particularly cancer-induced chronic pain; however, the individual opioids differ considerably with respect to their pharmacokinetic and physicochemical properties and may therefore not be equally applicable for every patient. Caution should be taken especially in patients with impaired organ function. Furthermore, the metabolism of opioids leads to active or inactive metabolites. This process can be substantially influenced by genetic polymorphisms or drug interactions...
November 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28914332/-comment-on-ketamine-for-prevention-of-postoperative-delirium-and-pain
#20
S Ziemann, M Coburn
No abstract text is available yet for this article.
November 2017: Der Anaesthesist
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