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Der Anaesthesist

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https://www.readbyqxmd.com/read/29335823/-drugs-for-intravenous-induction-of-anesthesia-propofol
#1
D Bolkenius, C Dumps, E Halbeck
In a series of articles dealing with hypnotics for induction of anesthesia, this article describes the development and current value of propofol. Its significance far exceeds that of a pure induction hypnotic (sedation in diagnostic and therapeutic procedures and on the intensive care unit). Propofol is also used for sedation in diagnostic and therapeutic procedures and on the intensive care unit. In the field of induction of anesthesia, the alternatives are barely used. Some contraindications are still controversial whereas others are no longer sufficiently anchored in the users' awareness (widespread off-label use)...
January 15, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29313072/-antibiotic-stewardship-measures-for-optimizing-prescription-of-anti-infective-agents
#2
REVIEW
C Lanckohr, H Bracht
Antibiotic stewardship (ABS) comprises a bundle of different interventions to improve anti-infective treatment in a hospital setting. An important component of ABS interventions is the interdisciplinary approach to infection management. Besides improving infrastructural aspects on a hospital level, including surveillance of the use of anti-infective agents and nosocomial infections, collation and interpretation of statistics on resistance and formulation of local treatment guidelines, ABS teams go to the wards and advise treating physicians on antibiotic therapy...
January 8, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29302698/out-of-hospital-airway-management-during-manual-compression-or-automated-chest-compression-devices-a%C3%A2-registry-based-analysis
#3
M Bernhard, N H Behrens, J Wnent, S Seewald, S Brenner, T Jantzen, A Bohn, J T Gräsner, M Fischer
BACKGROUND: Airway management during resuscitation is pivotal for treating hypoxia and inducing reoxygenation. This German Resuscitation Registry (GRR) analysis investigated the influence of the type of airway used in patients treated with manual chest compression (mCC) and automated chest compression devices (ACCD) after out-of-hospital cardiac arrest (OHCA). METHODS: Out of 42,977 patients (1 January 2010-30 June 2016) information on outcome, airway management and method of chest compressions were available for 27,544 patients...
January 4, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29294162/-antibiotic-stewardship-in-a-basic-care-hospital-a-retrospective-observational-study
#4
REVIEW
M Bonsignore, E Balamitsa, C Nobis, S Tafelski, C Geffers, I Nachtigall
BACKGROUND: In response to the global increase in antibiotic resistance, the concept of antibiotic stewardship (ABS) has become increasingly important in recent years. Several publications have demonstrated the effectiveness of ABS, mainly in university facilities. This retrospective observational study describes the implementation of ABS in a basic care hospital. MATERIAL AND METHODS: Following existing national guidelines, an ABS team was set up and measures were launched...
January 2, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29294161/-perioperative-bleeding-in-a%C3%A2-jehovah-s-witness
#5
S Heschl, M Schörghuber, W Kröll
Perioperative bleeding in Jehovah's Witnesses leaves physicians with difficult medical and ethical decisions. We report the case of a 45-year-old man, who refused to accept red blood cell concentrates by a patient directive. A postoperative bleeding occurred after removal of a transplanted kidney. Despite critically low hemoglobin (3.1 g/dl) and hematocrit (9.5%) levels, the case was managed without red blood cell transfusions. The patient showed an amazingly quick recovery and was discharged from hospital after 24 days without any sequelae...
January 2, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29270666/-acute-perioperative-right-heart-insufficiency-diagnostics-and-treatment
#6
B Schäfer, C-A Greim
Acute right heart failure is often overlooked as a cause of cardiopulmonary insufficiency. The various pathologies underlying right heart failure at the level of afterload, preload and contractility, make rapid, targeted diagnostics necessary. In addition to clinical symptoms and laboratory chemical parameters, echocardiography in particular is relevant for making a diagnosis. Symptomatic treatment of the endangered patient is essential. The focus is on a reduction of right ventricular pressure and afterload, a correction of systemic hypotension and positive inotropic support of the right ventricle...
December 21, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29270665/-intramedullary-injection-with-tethered-cord-case-report-of-a-rare-complication-during-spinal-anesthesia
#7
L Vogt, B Rodermond, P Post, S Iborra, E Stickeler, J Schiefer, J P Alt, R Rossaint, A Röhl
Although very rare, severe neurological complications can occur when undergoing spinal anesthesia. This report describes and analyses a case of spinal injury due to an undiagnosed tethered cord (TC) during spinal anesthesia for a cesarean section of a 31-year-old woman expecting twins. As a consequence of spinal dysraphism during embryogenesis, an atypically low conus level can occur and increase the risk of injury during neuraxial anesthesia, especially in the absence of symptoms. Injuries can be caused by mechanical trauma from direct needle injury, hematoma or neurotoxicity from local anesthetics...
December 21, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29234824/-comments-on-daytime-variation-of-perioperative-myocardial-injury-in-cardiac-surgery
#8
Gereon Schälte, Christian Stoppe
No abstract text is available yet for this article.
December 12, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29230502/-acceptance-of-post-mortem-organ-donation-in-germany-representative-cross-sectional-study
#9
E Tackmann, S Dettmer
BACKGROUND: The German post-mortem organ donation rate has dropped by one third since 2010. Furthermore, 958 patients died in 2015 in Germany while waiting for an organ. To decrease organ shortage, an amendment of the transplantation law was established in 2012. An information package including an organ donor card is sent to all German citizens via the postal service. A voluntary national transplantation register was introduced in 2016 to improve transparency in the organ donation process...
December 11, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29230501/-development-of-ground-based-physician-staffed-emergency-missions-in-the-city-of-leipzig-from-2003-to-2013
#10
K Bader, M Bernhard, A Gries, M Kaul, R Schröder, A Ramshorn-Zimmer
BACKGROUND: The annual number of physician-based emergency missions reported is continuously increasing. Data from large cities concerning this development over long periods is sparse. MATERIAL AND METHODS: In this retrospective study the charts of all ground-based physician-staffed emergency missions in the city of Leipzig for the first quarters of 2003 and 2013 were analyzed. Patient characteristics, injury and illness severities, mission location, hospital admission rate, as well as emergency interventions were collated...
December 11, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29230500/-analysis-and-options-for-optimization-of-preoperative-assessment-for-anesthesia-at-a%C3%A2-university-hospital
#11
M Kieninger, C Eissnert, M Seitz, K Judemann, T Seyfried, B Graf, B Sinner
BACKGROUND: Risk assessment prior to elective surgery is an important tool in the context of perioperative patient care; however, only a few studies have been carried out to address the processes and problems during preoperative assessment for anesthesia. AIM: Over a period of several weeks all preoperative anesthesia evaluations prior to elective surgery were prospectively recorded in order to generate a data pool with a view to identifying options for process optimization...
December 11, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29230499/-fulminant-sepsis-after-capnocytophaga-canimorsus-infection
#12
K Feige, Pia Hartmann, J T Lutz
Capnocytophaga canimorsus is a Gram-negative bacterium present in the oral cavities of cats and dogs. It is known for its capability to cause life-threatening sepsis following a dog bite, especially in immunocompromised patients. We report the case of a 67-year-old man who suffered from septic shock and multiorgan failure presumably following contamination of a pre-existing minor skin lesion by canine saliva. The purpose of this report is to raise awareness of Capnocytophaga canimorsus among physicians when faced with a patient presenting with fulminant septic shock and Gram-negative bacteremia, who has been exposed to dogs...
December 11, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29209790/-delegation-of-medical-activities-in-acute-pain-therapy
#13
REVIEW
J Erlenwein, A Moroder, E Biermann, F Petzke, A P F Ehlers, H Bitter, E Pogatzki-Zahn
Acute pain management is an interprofessional and interdisciplinary task and requires a good and trustful cooperation between stakeholders. Despite provisions in Germany according to which medical treatment can only be rendered by a formally qualified physician ("Arztvorbehalt"), a physician does not have to carry out every medical activity in person. Under certain conditions, some medical activities can be delegated to medical auxiliary personnel but they need to be (1) instructed, (2) supervised and (3) checked by the physician himself; however, medical history, diagnostic assessment and evaluation, indications, therapy planning (e...
December 5, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29209789/-novel-aspects-of-the-guidelines-for-hemotherapy-2017-implications-for-anesthesiology
#14
REVIEW
I Pekrul, G Wittmann, P Möhnle
Based on the German Transfusion Law, the periodically updated guidelines "Richtlinien zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten" ("Hämotherapierichtlinien") are intended to provide the current knowledge and state of the art of blood transfusion practice in Germany. The novel update 2017 contains relevant changes for blood donation, especially the extension of the exclusion period of persons at risk for sexually transmitted HBV, HCV and HIV diseases to 12 months. Moreover, the guidelines provide several changes relevant to blood transfusion practice in anesthesiology, such as: all autologous hemotherapy procedures including normovolemic hemodilution, cell saver, and autologous blood donation and transfusion require formal registration at the regulatory authority...
December 5, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29209788/-reform-of-emergency-physician-training-in-austria-finally-up-to-date
#15
REVIEW
H Trimmel, M Baubin, J Kreutziger, G Frank, G Prause
During the last 20 years Austrian prehospital emergency medical services (EMS) have significantly improved. The structure and organization of Austrian EMS comply with European standards but training requirements for prehospital EMS physicians are insufficient when compared with other countries. Although some EMS systems follow the German or Swiss postgraduate training concepts, the legal requirements in Austria defining the scope of mandatory training for physicians in the prehospital setting are only minimal...
December 5, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29209787/-different-levels-of-experience-with-anesthetic-agents-of-german-emergency-physicians-results-of-an-online-survey
#16
A Luckscheiter, M Fischer, W Zink
BACKGROUND AND OBJECTIVE: In 2015 practice management guidelines on prehospital emergency anesthesia in adults were published in Germany. The aim of the present study was to evaluate whether emergency physicians follow these guidelines in daily practice and to assess their level of experience with the use of anesthetic agents. MATERIAL AND METHODS: In an online survey the way of induction of preclinical anesthesia (including preoxygenation time and applied monitoring techniques) was assessed with the help of virtual scenarios based on the guidelines...
December 5, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29159491/-algorithm-for-securing-an-unexpected-difficult-airway-user-analysis-on-a-simulator
#17
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
#18
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
#19
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
#20
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
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