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Der Anaesthesist

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https://www.readbyqxmd.com/read/27924353/-the-old-man-and-the-i-sea-u-essay-on-faith-fate-and-evidence-after-the-manner-of-hemingway
#1
K Lewandowski, R H Bartlett
Robert Bartlett, emeritus Professor of surgery at the University of Michigan in Ann Arbor, USA, transformed classical works of world literature (Charles Dickens: A Christmas Carol, Lewis Carroll: Alice in Wonderland) into teaching aids for advanced training in intensive care medicine. He recently turned his hand to the well-known work of Ernest Hemingway: the Nobel Prize winning novel The Old Man and the Sea. Subsequent to Robert Bartlett's essay this article provides background information and comments on the current problems in modern intensive care medicine addressed in his essay...
December 6, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27900416/-intensive-care-treatment-after-aneurysmal-subarachnoid-hemorrhage
#2
U Jaschinski
Aneurysmal subarachnoid hemorrhage (SAH) is a devastating disease and nearly one third of patients die in the acute phase. Due to the bleeding event, a hyperactive sympathetic nervous system and an uncontrolled inflammatory response have a profound local and systemic impact on other organ functions. Neuroendocrinological disorders and cardiopulmonary morbidity are dominant. Despite a decrease in hospital mortality for high volume centers, a high proportion of survivors suffer from neurological deficits. Knowledge of the pathophysiology of vasospasms in the later stages of the disease has increased...
November 29, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27900415/-management-of-anesthesia-in-endovascular-interventions
#3
T Rössel, R Paul, T Richter, S Ludwig, T Hofmockel, A R Heller, T Koch
Cardiovascular diseases are one of the leading causes of morbidity and mortality in Germany. In these patients, the high-risk profile necessitates an interdisciplinary and multimodal approach to treatment. Endovascular interventions and vascular surgery have become established as an important element of this strategy in the past; however, the different anatomical localizations of pathological vascular alterations make it necessary to use a wide spectrum of procedural options and methods; therefore, the requirements for management of anesthesia are variable and necessitate a differentiated approach...
November 29, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27900414/-comment-on-dexmedetomidine-for-delirium-prophylaxis-in-elderly-patients-after-non-cardiac-surgery-in-the-intensive-care-unit
#4
J Van Waesberghe, A Eisert, M Coburn
No abstract text is available yet for this article.
November 29, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27900413/recommendations-of-the-german-association-of-anesthesiology-and-intensive-care-medicine-dgai-on-structured-patient-handover-in-the-perioperative-setting-the-sbar-concept
#5
V von Dossow, B Zwissler
Teamwork in the operating room and in the intensive care unit necessitates clear and precise communication; however, interruptions in communication frequently occur, especially in the perioperative phase. Patients are particularly susceptible to deficits in communication, e.g. due to higher stress peaks, simultaneous admission of several patients and concomitant treatment of emergency cases. The German Society of Anesthesiology and Intensive Care Medicine (DGAI) therefore recommends the implementation of the so-called SBAR concept (S situation, B background, A assessment, R recommendation) for standardization of patient handover...
November 29, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27896375/-extracorporeal-co2-removal-as-an-alternative-to-tracheotomy-in-a%C3%A2-patient-with-extubation-failure
#6
A Redel, M Ritzka, S Kraus, A Philipp, H-J Schlitt, B Graf, T Bein
We report a patient with chest trauma who was admitted to the ICU after surgery. As he fulfilled protocol-based criteria, he was extubated 7 days after admission. However, despite intermittent non-invasive ventilation, the patient had to be re-intubated on day 10 owing to progressive hypercapnia. We decided to support the patient with a mid-flow veno-venous extracorporeal carbon dioxide removal (ECCO2‑R) system instead of a tracheotomy. Sufficient CO2 removal was established with a blood flow of 1.5 l/min and the patient was successfully extubated within a few hours...
November 28, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27882390/-highest-level-of-clinical-competence-for-endovascular-interventions
#7
EDITORIAL
Gunther Pestel
No abstract text is available yet for this article.
November 23, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27832294/-the-basis-for-well-founded-simulations
#8
O Meyer, M Rall, H Baschnegger, M Lazarovici, B Urban
In medical education, simulation is gaining increasing importance for teaching a variety of subjects. A well-founded educational approach is necessary for effective use. In addition to material aspects, simulation environment, curriculum, learning environment, and methods of debriefing have to be considered. The role of a competent instructor should be emphasized and the importance of an elaborate change management process to implement a good concept should not be underestimated.
November 10, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27812729/-under-scrutiny-by-the-state-prosecutor-legal-pitfalls-in-emergency-medicine
#9
P Schelling
Physicians who allow a suicide attempt to happen, which from an ex ante viewpoint was completely voluntary, cannot be held punishable for homicide or failing to provide medical assistance when the suicide corresponds to the putative will of the patient according to plausible information supplied by an authorized person with healthcare proxy. Guidelines for resuscitation also play a central role in the forensic practice for assessment of whether and when resuscitation can be terminated; therefore, it is urgently advised to follow and implement these guidelines: deviations are possible if they can be factually justified...
November 3, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27787572/-comment-on-decompressive-craniectomy-after-traumatic-brain-injury
#10
A Höllig, M Coburn
No abstract text is available yet for this article.
October 27, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27787571/-anesthesia-for-medical-students-a-brief-guide-to-practical-anesthesia-in-adults-with-a-web-based-video-illustration
#11
S Mathis, O Schlafer, J Abram, J Kreutziger, P Paal, V Wenzel
In Germany, Austria and Switzerland, anesthesiologists are the second largest group of physicians in hospitals, but this does not correspond to the amount of anesthesiology teaching that medical students receive in medical schools. Accordingly, the chances of medical students recognizing anesthesiology as a promising personal professional career are smaller than in other disciplines with large teaching components. Subsequent difficulties to recruit anesthesiology residents are likely, although many reasons support anesthesiology as a professional career...
October 27, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27778056/-unilateral-spinal-anesthesia-literature-review-and-recommendations
#12
B Büttner, A Mansur, M Bauer, J Hinz, I Bergmann
Unilateral spinal anesthesia is a cost-effective and rapidly performed anesthetic technique. An exclusively unilateral block only affects the sensory, motor and sympathetic functions on one side of the body and offers the advantages of a spinal block without the typical adverse side effects seen with a bilateral block. The lack of hypotension, in particular, makes unilateral spinal anesthesia suitable for patients with cardiovascular risk factors e. g. aortic valve stenosis or coronary artery disease. Increasing numbers of surgical procedures are now being performed on an outpatient basis...
October 24, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27778055/-necessitas-not-habet-legem-the-physician-s-tension-between-professional-ethics-and-patient-wishes
#13
E Biermann
No abstract text is available yet for this article.
October 24, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27778054/-comment-on-andexanet-alfa-for-acute-major-bleeding-associated-with-factor-xa-inhibitors
#14
H Lier, O Grottke
No abstract text is available yet for this article.
October 24, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27752712/erratum-zu-geschichte-der-an%C3%A3-sthesie-%C3%A2-%C3%A2-vom-narkotiseur-zum-perioperativen-hom%C3%A3-ostatiker%C3%A2
#15
H Petermann, M Goerig
No abstract text is available yet for this article.
October 17, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27742969/stress-coping-styles-of-459%C3%A2-emergency-care-physicians-in%C3%A2-germany-a%C3%A2-pilot-study
#16
M Sand, S Hessam, D Sand, F G Bechara, C Vorstius, M Bromba, E Stockfleth, I Shiue
AIM: In addition to assessing stress-coping strategies in patients, equal attention should be paid to health-care professionals. The literature on the stress-coping strategies of emergency physicians - health-care professionals who are frequently subject to stress in a fast-paced clinical setting - is scant. Therefore, we aimed to investigate the stress-coping strategies of emergency-care physicians (ECPs) in Germany. METHODS: We conducted a cross-sectional study by approaching German Associations of Emergency Medicine Physicians and the two largest ECP recruitment agencies in Germany to invite their members to participate...
October 14, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27742968/ultrasound-guided-intermediate-cervical-plexus-block-and-perivascular-local-anesthetic-infiltration-for-carotid-endarterectomy-a%C3%A2-randomized-controlled-trial
#17
R Seidel, K Zukowski, A Wree, M Schulze
BACKGROUND AND OBJECTIVE: Ultrasound-guided blocks of the cervical plexus are established anesthetic procedures for carotid endarterectomy. This randomized, double-blind, placebo-controlled study tested the hypothesis that an additional ultrasound-guided periarterial injection of local anesthetic leads to a lower frequency of periarterial supplementation by the surgeon. METHODS: A total of 40 patients were randomly assigned to 1 of 2 groups. In both groups an ultrasound-guided intermediate cervical plexus block (20 ml of 0...
October 14, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27726001/-perioperative-adverse-respiratory-events-in-overweight-and-obese-children
#18
J Ulrici, G Hempel, M Sasse, J Vollrath, C Höhne
BACKGROUND: Overweight and obesity are increasing problems in pediatric anesthesia. This observational study was designed to examine how airway-related complications occur in overweight children and adolescents during general anesthesia and if this is a relevant problem in Germany. METHODS: From October 2008 until August 2009, at the university clinic in Leipzig, 504 in- and outpatients, aged 2-18 years, ASA I-III, undergoing elective procedures (ENT and pediatric surgery), were observed...
October 10, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27709275/-impairment-of-oxygenation-of-patients-in-surgical-intensive-care-early-symptom-of-severe-sepsis
#19
M Hückstädt, G O Hofmann, T Mendel, R Stuttmann, P Hilbert-Carius
BACKGROUND: Sepsis and septic shock are major contributors to morbidity and mortality in intensive care patients. Early identification and adequate therapy are of utmost importance to reduce the still high mortality in patients with severe sepsis. Many of the pathophysiologic changes are nonspecific. Thus, a combination of symptoms and laboratory results are necessary to confirm the diagnosis. Impairment of the Horovitz index is identified as being a primal prognostic criterion for early diagnosis in serious progression of sepsis, after exclusion of a few differential diagnoses...
October 5, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27709274/-injuries-to-blood-vessels-near-the-heart-caused-by-central-venous-catheters
#20
J Abram, J Klocker, N Innerhofer-Pompernigg, M Mittermayr, M C Freund, N Gravenstein, V Wenzel
Injuries to blood vessels near the heart can quickly become life-threatening and include arterial injuries during central venous puncture, which can lead to hemorrhagic shock. We report 6 patients in whom injury to the subclavian artery and vein led to life-threatening complications. Central venous catheters are associated with a multitude of risks, such as venous thrombosis, air embolism, systemic or local infections, paresthesia, hemothorax, pneumothorax, and cervical hematoma, which are not always immediately discernible...
October 5, 2016: Der Anaesthesist
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