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Der Anaesthesist

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https://www.readbyqxmd.com/read/30406276/-prehospital-plasma-transfusion-in-civilian-trauma-patients-in-hemorrhagic-shock
#1
H Lier, O Grottke
No abstract text is available yet for this article.
November 7, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30406275/propofol-sparing-effect-of-different-concentrations-of-dexmedetomidine-comparison-of-gender-differences
#2
Ming Xiong, Zhao -Xin Zheng, Zu-Rong Hu, Jing He, Uchenna Madubuko, Dennis Grech, Xing-An Zhang, Bo Xu
BACKGROUND: The pharmacodynamics of propofol are closely linked to gender. Dexmedetomidine can decrease propofol needs during propofol anesthesia. The aim of this study was to compare the gender differences on the calculated effect site median effective concentration (EC50 ) of propofol for loss of consciousness (LOC) after pretreatment with different concentrations of dexmedetomidine. METHODS: In this study 60 male and 60 female patients were randomly allocated to receive dexmedetomidine at target plasma concentrations of 0...
November 7, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30377738/misleading-symptoms-and-successful-noninvasive-rewarming-of-a-patient-with-severe-hypothermia-23-1-%C3%A2-c
#3
T Woehrle, U Lichtenauer, A Bayer, S Brunner, M Angstwurm, S T Schäfer, H Baschnegger
Accidental severe hypothermia is a medical emergency in which symptoms may include coma, apnea, pulmonary edema, ventricular dysrhythmia or asystole. Despite optimal treatment, mortality remains high. This article reports a case of severe hypothermia in a geriatric hypothyroid patient, where despite a body core temperature of 23.1 °C the patient presented conscious and with stable vital signs, pronounced motor response, and a Glasgow Coma Scale score of 9. Blood gas analysis (alpha stat at 37 °C) indicated sufficient pulmonary function...
October 30, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30367211/-relevant-incidental-findings-and-iatrogenic-injuries-a-retrospective-analysis-of-1165-resuscitation-room-patients
#4
T Viergutz, T Terboven, T Henzler, D Schäfer, S O Schönberg, S Sudarski
BACKGROUND: Whole-body computed tomography (CT) is increasingly being used as the diagnostic modality of choice in patients admitted to the resuscitation room. Beyond findings related to the suspected diagnosis it often additionally reveals incidental findings. The aim of this investigation was the evaluation of these findings in patients admitted via the emergency room after suffering potential major trauma or life-threatening medical conditions. Furthermore, the number of iatrogenic injuries as well as misplaced catheters and endotracheal tubes was investigated...
October 26, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30361932/-reduction-of-treatment-time-for-children-in-the-trauma-room-care-impact-of-implementation-of-an-interdisciplinary-trauma-room-concept-itrap-s
#5
M Lehner, F Hoffmann, B Kammer, M Heinrich, L Falkenthal, D Wendling-Keim, M Kurz
INTRODUCTION: In addition to infrastructural and conceptual planning, smooth interdisciplinary cooperation is crucial for trauma room care of severely injured children based on time-saving management and a clear set of priorities. The time to computed tomography (CT) is a well-accepted marker for the efficacy of trauma management. Up to now there are no guidelines in the literature for an adapted approach in pediatric trauma room care. METHODS: A step-by-step algorithm for pediatric trauma room care (Interdisciplinary Trauma Room Algorithm in Pediatric Surgery, iTRAPS ) was developed within the framework of an interdisciplinary team: pediatric surgeons, pediatric anaethesiologists, pediatric intensivists and pediatric radiologists...
October 25, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30341447/-systematic-literature-search-in-pubmed-a-short-introduction
#6
A Blümle, W A Lagrèze, E Motschall
In order to identify current (and relevant) evidence for a specific clinical question within the unmanageable amount of information available, solid skills in performing a systematic literature search are essential. An efficient approach is to search a biomedical database containing relevant literature citations of study reports. In this article, we explain step by step how to perform a systematic literature search via PubMed (MEDLINE) by means of an example research question in the field of ophthalmology...
October 19, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30338337/epidural-needle-insertion-a-large-registry-analysis
#7
H Bomberg, N Paquet, A Huth, S Wagenpfeil, P Kessler, H Wulf, T Wiesmann, T Standl, A Gottschalk, J Döffert, W Hering, J Birnbaum, B Kutter, J Winckelmann, S Liebl-Biereige, W Meissner, O Vicent, T Koch, H Bürkle, D I Sessler, A Raddatz, T Volk
BACKGROUND: Dural puncture, paraesthesia and vascular puncture are the most common complications of epidural catheter insertion. Their association with variation in midline needle insertion depth is unknown. OBJECTIVE: This study evaluated the risk of dural and vascular punctures and the unwanted events paraesthesia and multiple skin punctures related to midline needle insertion depth. MATERIAL AND METHODS: A total of 14,503 epidural catheter insertions including lumbar (L1-L5; n = 5367), low thoracic (T7-T12, n = 8234) and upper thoracic (T1-T6, n = 902) insertions, were extracted from the German Network for Regional Anaesthesia registry between 2007 and 2015...
October 18, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30276418/ultrasound-guided-intermediate-cervical-plexus-and-additional-peripheral-facial-nerve-block-for-carotid-endarterectomy-a-prospective-pilot-study
#8
R Seidel, K Zukowski, A Wree, M Schulze
BACKGROUND AND OBJECTIVES: Ultrasound-guided intermediate cervical plexus block with perivascular local anesthetic infiltration is an established anesthetic procedure for carotid endarterectomy. In this prospective pilot study an additional subplatysmal block of the superficial ansa cervicalis is presented for the first time. The target structures are the anastomoses between the facial nerve (cervical and marginal mandibular branches) and cervical plexus. METHODS: An ultrasound-guided intermediate cervical plexus block (20 ml of ropivacaine 0...
October 1, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30209513/-non-beneficial-therapy-and-emotional-exhaustion-in-end-of-life-care-results-of-a-survey-among-intensive-care-unit-personnel
#9
Christiane S Hartog, F Hoffmann, A Mikolajetz, S Schröder, A Michalsen, K Dey, R Riessen, U Jaschinski, M Weiss, M Ragaller, S Bercker, J Briegel, C Spies, D Schwarzkopf
BACKGROUND: End-of-life care (EOLC) in the intensive care unit (ICU) is becoming increasingly more common but ethical standards are compromised by growing economic pressure. It was previously found that perception of non-beneficial treatment (NBT) was independently associated with the core burnout dimension of emotional exhaustion. It is unknown whether factors of the work environment also play a role in the context of EOLC. OBJECTIVE: Is the working environment associated with perception of NBT or clinician burnout? MATERIAL AND METHODS: Physicians and nursing personnel from 11 German ICUs who took part in an international, longitudinal prospective observational study on EOLC in 2015-2016 were surveyed using validated instruments...
September 12, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30206642/-transport-of-ventilated-emergency-patients-from-the-air-rescue-service-to-the-hospital-destination-hover-study-results-of-an-online-survey
#10
P Hilbert-Carius, M F Struck, V Hofer, J Hinkelbein, Th Wurmb, M Bernhard, B Hossfeld
BACKGROUND: In Germany more than 110,000 helicopter emergency medical service (HEMS) missions are carried out annually. A considerable number of patients are ventilated during the flight. So far, structured surveys with respect to the ground transport from the helipad to the hospital facility and handover of ventilated patients in the emergency room (ER) are not available in the German-speaking HEMS system. The handover of ventilated HEMS patients in the ER (HOVER I study) explored the use of the helicopter ventilator and medical equipment during the transport from the hospital landing site to the ER...
September 11, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30367210/-terminal-dehydration-part-2-medical-indications-and-therapeutic-approach
#11
U Suchner, C Reudelsterz, C Gog
The approach in the clinical fluid management of the dying is still controversially discussed in specialist circles and also in the general population. In this article the importance of establishing the therapeutic indications is emphasized against the background of a lack of evidence. Options to achieve noninvasive objectification of assumed dehydration as well as assessment of the reversibility of the symptoms are shown and the importance of monitoring of all therapeutic actions is discussed. The pathophysiological foundation of reversible disorders of fluid homoeostasis are described and distinguished from the irreversible disorders leading to terminal dehydration...
November 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30357447/-multiprofessional-management-of-delirium-a-challenge-not-only-for-intensivists
#12
EDITORIAL
Thomas Saller
No abstract text is available yet for this article.
November 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30341448/-correction-to-drugs-for-intravenous-induction-of-anesthesia-ketamine-midazolam-and-synopsis-of-current-hypnotics
#13
E Halbeck, C Dumps, D Bolkenius
No abstract text is available yet for this article.
November 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30315318/vocal-fold-paralysis-due-to-intracranial-hypotension-following-spinal-anesthesia
#14
H Gurbuz Aytuluk, O Aktas
Cranial nerve palsy is a rare neurological complication of epidural and subarachnoid blocks. Most of these complications are attributed to secondary intracranial hypotension due to cerebrospinal fluid leakage following dural puncture. Vocal fold paralysis (VFP) seems more likely to be overlooked and underreported due to delayed onset of symptoms and lack of attribution of dysphonia to spinal anesthesia. Therefore, VFP can often be missed and described as idiopathic. This article describes a case of VFP due to vagus nerve injury following subarachnoid block...
November 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30302517/-video-assisted-patient-education-in-anesthesia-how-do-medical-users-assess-the-procedure
#15
H Vogel, W Schaaf, M Jacob
BACKGROUND: Video-assisted patient education (VaPE) has in the past been a subject of many studies. Compared to conventional methods, most authors reported a better transfer of information, some found increased patient satisfaction and a time-sparing effect. There was no increase in anxiety caused by VaPE. Some authors even found a reduction of anxiety levels before anesthesia. All publications to date have focused on the patient's point of view. There have been no reports on how anesthetists as users assess VaPE...
November 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30298271/-positioning-of-external-pelvic-stabilization-devices-in-patients-with-multiple-injuries-retrospective-computed-tomographic-evaluation
#16
G Jansen, T Hefke, G Wittenberg, T Vordemvenne, F Mertzlufft
BACKGROUND: Severe hemorrhage is a dreaded complication of pelvic fractures. It has a significant impact on early trauma-associated mortality. Hemorrhage that is secondary to pelvic fractures can be reduced by external stabilization devices. Despite the commercial availability of many different systems, they are infrequently used. The aim of this computed tomography (CT) study was to examine the use of external pelvic stabilization devices. METHODS: Between 1 January 2011 and 31 December 2015 a total of 982 images produced in CT trauma scans at a level 1 trauma centre were retrospectively examined with respect to the presence of external pelvic stabilizers...
November 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30298270/-delirium-in-intensive-care-patients-a-multiprofessional-challenge
#17
REVIEW
N Zoremba, M Coburn, G Schälte
Delirium is the most common form of cerebral dysfunction in intensive care patients and is a medical emergency that must be avoided or promptly diagnosed and treated. According to current knowledge the development of delirium seems to be caused by an interplay between increased vulnerability (predisposition) and simultaneous exposure to delirogenic factors. Since delirium is often overlooked in the clinical routine, a continuous screening for delirium should be performed. Due to the close connection between delirium, agitation and pain, sedation and analgesia must be evaluated at least every 8 h analogous to delirium screening...
November 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30238129/-anesthesia-in-patients-with-nbia-neurodegeneration-with-brain-iron-accumulation
#18
REVIEW
T Warnecke, J Schmitz, S Kerkhoff, J Hinkelbein
BACKGROUND: Neurodegeneration with brain iron accumulation (NBIA) forms a group of rare hereditary diseases with rapid neurodegenerative progression due to an abnormal accumulation of iron in the basal ganglia. This causes extrapyramidal symptoms as well as dystonia and mental retardation. The most common form of NBIA is pantothenate kinase-associated neurodegeneration (PKAN, formerly Hallervorden-Spatz syndrome). There are multiple anesthesiological challenges with great implications for the clinical routine, particularly regarding the preparation for general anesthesia and the premedication visits...
November 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30225665/effect-of-prolonged-inspiratory-time-on-gas-exchange-during-robot-assisted-laparoscopic-urologic-surgery
#19
M Hur, S-K Park, D E Jung, S Yoo, J-Y Choi, W H Kim, J T Kim, J-H Bahk
BACKGROUND: Gas exchange disturbance may develop during urologic robotic laparoscopic surgery with the patient in a steep Trendelenburg position. This study investigated whether prolonged inspiratory time could mitigate gas exchange disturbances including hypercapnia. METHODS: In this randomized cross-over trial, 32 patients scheduled for robot-assisted urologic surgery were randomized to receive an inspiratory to expiratory time ratio (I:E) of 1:1 for the first hour of pneumoperitoneum followed by 1:2 for last period of surgery (group A, n = 17) or I:E of 1:2 followed by 1:1 (group B, n = 15)...
November 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/30291405/-management-of-the-difficult-airway-overview-of-the-current-guidelines
#20
REVIEW
J C Schäuble, T Heidegger
Several national airway task forces have recently updated their recommendations for the management of the difficult airway in adults. Routinely responding to airway difficulties with an algorithm-based strategy is consistently supported. The focus is increasingly not on tools and devices but more on good planning, preparation and communication. In the case of anticipated airway difficulties the airway should be secured when the patient is awake with maintenance of spontaneous ventilation. Unaltered a flexible bronchoscopic intubation technique is advised as a standard of care in such patients...
October 2018: Der Anaesthesist
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