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Der Anaesthesist

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...
September 20, 2018: Der Anaesthesist
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)...
September 17, 2018: Der Anaesthesist
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
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
C R Behem, M F Gräßler, C J C Trepte
Central venous pressure (CVP) is deemed to be an important parameter of anesthesia management in liver surgery. To reduce blood loss during liver resections, a low target value of CVP is often propagated. Although current meta-analyses have shown a connection between low CVP and a reduction in blood loss, the underlying studies show methodological weaknesses and advantages with respect to morbidity and mortality can hardly be proven. The measurement of the CVP itself is associated with numerous limitations and influencing factors and the measures to reduce the CVP have been insufficiently investigated with respect to hepatic hemodynamics...
September 10, 2018: Der Anaesthesist
H Ilper, C Franz-Jäger, C Byhahn, M Klages, H H Ackermann, K Zacharowski, T Kunz
In 1985 Mallampati et al. published a non-invasive score for the evaluation of airways (Mallampati grading scale, MGS), which originally consisted of only three different classes and has been modified several times. At present it is mostly used in the version of Samsoon and Young consisting of four different classes. Class I: soft palate, fauces, uvula, palatopharyngeal arch visible, class II: soft palate, fauces, uvula visible, class III: soft palate, base of the uvula visible and class IV: soft palate not visible...
August 31, 2018: Der Anaesthesist
M Weitzel, P Hammels, C Schorer, H Klingler, A Weyland
BACKGROUND: There is insufficient knowledge about the hemodynamic effects of cafedrine/theodrenaline (caf/theo), a commercially available drug combination, to treat hypotension. METHODS: This prospective observational study investigated the hemodynamic effects of caf/theo on anesthesia-induced hypotension in 20 patients scheduled for elective major abdominal surgery. After induction of total intravenous anesthesia (TIVA) with propofol and remifentanil, a decrease in mean arterial blood pressure (MAP) below 60 mm Hg (n = 12) was treated with 60 mg/3 mg caf/theo...
August 21, 2018: Der Anaesthesist
M Bonsignore, C Alefelder, N Pausner, P Gastmeier, I Nachtigall
BACKGROUND: It is mandatory for hospitals in Germany to employ infection control physicians and have an external consultation. The recommended coverage has substantially increased in the last years. Typically, infection control physicians are specialists for hygiene and environmental medicine and/or for microbiology. As there is already a shortage of these specialists, a curricular educational program in infection control was developed by the German Medical Association in 2011. This program addresses specialists of different clinical disciplines...
August 13, 2018: Der Anaesthesist
C Vahldieck, M Lindig, C Nau, M Hüppe
BACKGROUND: The intensity of postoperative pain is characterized by large interindividual variability. Furthermore, strong postoperative pain is known to influence physical recovery after surgery. High (preoperative) pain expectation and pre-existing pain, which are associated with pain-related disability (impairing pain) are risk factors for strong postoperative pain. They can be determined with the Lübeck Pain Risk Questionnaire used for the first time in this study. The aim of this study was to explore the hypothesis that patients with a combination of the characteristics (1) preoperative impairing pain and (2) high pain expectation are more likely to have strong postoperative pain...
August 13, 2018: Der Anaesthesist
J Van Waesberghe, M Coburn
No abstract text is available yet for this article.
August 6, 2018: Der Anaesthesist
R Zimmermann, H Hackstein
No abstract text is available yet for this article.
September 2018: Der Anaesthesist
T S Becker, G Schuhmacher, R Stich, F Eyer, P Knuefermann
We present the case of a 31-year old male with ingestion of fire extinguisher powder in an attempted suicide. After consulting several poison information centres, the intoxication was initially classified as harmless; nevertheless, the patient was admitted to our intensive care unit for cardiopulmonary monitoring. Subsequently, due to the ingestion of ammonium sulphate and ammonium dihydrogen phosphate containing powder the patient developed severe metabolic acidosis with distinct electrolyte imbalance that required temporary haemodialysis...
September 2018: Der Anaesthesist
P Möhnle, A Humpe, G Wittmann
Correct blood group typing is a prerequisite for transfusion. In most cases blood group determination is without problems; however, in individual cases various factors can complicate blood group determination and sometimes lead to confusing findings. For a better understanding the clinician should have basic knowledge of blood typing. Blood group determination usually covers the AB0 blood groups, Rhesus and Kell systems; in addition, a direct Coombs test and an antibody screening test for the detection of irregular antibodies in the recipient are performed...
September 2018: Der Anaesthesist
U Suchner, C Reudelsterz, C Gog
Dehydration in palliative care patients can be associated with increased morbidity and mortality and is nevertheless therapeutically controversial. This article provides an overview of possible causes of dehydration at the end of life and places special emphasis on "terminal" dehydration in the dying. Empirical attitudes of healthcare professionals and persons concerned (patients and relatives) as well as evidence-based findings on "terminal" dehydration are elucidated and the limitations are described...
September 2018: Der Anaesthesist
F F Girrbach, F Hilbig, M Michael, M Bernhard
BACKGROUND: A myriad of publications have contributed to an evidence-based approach to airway management in emergency services and admissions in recent years; however, it remains unclear which international registries on airway management in emergency medicine currently exist and how they are characterized concerning inclusion criteria, patient characteristics and definition of complications. METHODS: A systematic literature research was carried out in PubMed with respect to publications from 2007-2017...
September 2018: Der Anaesthesist
C J Reuß, M Bernhard, C Beynon, A Hecker, C Jungk, C Nusshag, M A Weigand, D Michalski, T Brenner
No abstract text is available yet for this article.
September 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)...
September 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...
September 2018: Der Anaesthesist
K M Meggiolaro, H Wulf, C Feldmann, T Wiesmann, A-K Schubert, J Risse
One of the main tasks in every anesthetist's routine clinical practice is securing the airway. This also includes techniques for lung isolation and one-lung ventilation in thoracic surgery and in intensive care medicine. The anesthesiologist has various methods available to achieve one-lung ventilation. This article presents the most commonly used methods for lung isolation. These include the double lumen tube, the bronchus blockers by Arndt and Cohen, the EZ blocker, the Uniblocker, the Univent tube and the VivaSight-DL™...
August 2018: Der Anaesthesist
E Halbeck, C Dumps, D Bolkenius
Ketamine and midazolam form the endpoint of a series of articles about intravenous induction of anesthesia . Both substances can be used as single induction hypnotic drugs; however, in practice, this is unusual. Both substances, with the exception of a few very specific indications and clinical situations, are more frequently used in combination or with one of the more common alternatives propofol, barbiturates and etomidate. The reasons are the activity and side effects of both substances and their positive characteristics are used more as a supplement...
August 2018: Der Anaesthesist
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