[Out-of-hospital airway management : Five scenes of a tragedy.]
PMID: 24994015 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - July 5, 2014 Category: Anesthesiology Authors: Byhahn C, Schalk R, Russo SG Tags: Anaesthesist Source Type: research

[Anesthesia in a patient after endoscopic lung volume reduction : First anesthesiological experiences with implanted endobronchial valves.]
In conclusion the care of patients with implanted endobronchial valves after ELVR does not differ from COPD patients without ELVR. A close cooperation between surgeons, anesthesiologists and internists is mandatory in the care of these patients. PMID: 24994016 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - July 5, 2014 Category: Anesthesiology Authors: Hilbert P, Litwinenko KP, Niemann B, Zur Nieden K Tags: Anaesthesist Source Type: research

[Risks in pediatric anesthesia : Causes and prevention of complications.]
r M PMID: 24994017 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - July 5, 2014 Category: Anesthesiology Authors: Jöhr M Tags: Anaesthesist Source Type: research

[Application fields of intraoperative transesophageal 3D echocardiography.]
Abstract Intraoperative transesophageal echocardiography (TEE) is an established diagnostic tool and has to be regarded as the standard of care for intraoperative monitoring and cardiac surgical decision-making. Furthermore, intraoperative TEE is also used for monitoring and assessment of hemodynamic changes and the detection of previously unknown pathologies. In the past few years 3D-TEE has extended the spectrum of 2D-TEE by allowing pathomorphological features to be more easily and intuitively linked to the anatomy of the heart and the great vessels. Thus, a comprehensive 2D-TEE examination is favorably complem...
Source: Der Anaesthesist - July 3, 2014 Category: Anesthesiology Authors: Magunia H, Rosenberger P Tags: Anaesthesist Source Type: research

[Intubation with a tube exchanger on an intubation trainer : Influence of tube tip position on successful intubation.]
CONCLUSION: Tube insertion via an airway exchange catheter or a fiberoptic bronchoscope is a basic technique in anesthesia. Knowledge about the difficulties and their prevention are essential for every anesthetist. The gap between the airway exchange catheter, the fiber bronchoscope and the tube diameters is one of the major reasons for tube tip impingement. This investigation showed that intubation success via a tube exchange catheter, as investigated in an intubation mannequin, is considerably influenced by the tracheal tube tip position. A 90° anticlockwise rotation, placing the tracheal tube tip ventrally, consider...
Source: Der Anaesthesist - July 2, 2014 Category: Anesthesiology Authors: Kemper M, Haas T, Imach S, Weiss M Tags: Anaesthesist Source Type: research

[New KDIGO guidelines on acute kidney injury : Practical recommendations.]
s D Abstract The incidence of acute kidney injury (AKI) in critically ill patients is very high and is associated with an increased morbidity and mortality. In 2012 the Kidney Disease: Improving Global Outcome (KDIGO) guidelines were published in which evidence-based practical recommendations are given for the evaluation and management of patients with AKI. The first section of the KDIGO guidelines deals with the unification of earlier consensus definitions and staging criteria for AKI. The subsequent sections of the guidelines cover the prevention and treatment of AKI as well as the management of renal replacemen...
Source: Der Anaesthesist - July 2, 2014 Category: Anesthesiology Authors: Zarbock A, John S, Jörres A, Kindgen-Milles D Tags: Anaesthesist Source Type: research

Prehospital airway management using the laryngeal tube : An emergency department point of view.
CONCLUSION: Although the laryngeal tube is considered to be an effective, safe, and rapidly appropriable supraglottic airway device, it is also associated with adverse effects. In order to prevent tongue swelling, after initial prehospital or in-hospital placement of laryngeal tube and cuff inflation, it is important to adjust and monitor the cuff pressure. PMID: 24981153 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - July 2, 2014 Category: Anesthesiology Authors: Bernhard M, Beres W, Timmermann A, Stepan R, Greim CA, Kaisers UX, Gries A Tags: Anaesthesist Source Type: research

[On-scene times for helicopter services : Influence of central dispatch center strategy.]
ppe Abstract BACKGROUND: Previous studies have suggested that when using several emergency systems and air rescue prehospital and on-scene times are extended, depending on the dispatch strategy. Emergency medical services (EMS) in Germany are delivered by ambulances (AMB) staffed by paramedics alone or with physicians (EMD) and by helicopter emergency medical services (HEMS) always staffed by both. The advantages of HEMS in countries with short transport distances and high hospital density are controversial. The best dispatching strategy for HEMS has not been determined OBJECTIVE: The BoLuS study in the German sta...
Source: Der Anaesthesist - June 26, 2014 Category: Anesthesiology Authors: Gries A, Lenz W, Stahl P, Spiess R, Luiz T, für die BoLuS-Studiengruppe Tags: Anaesthesist Source Type: research

[German resuscitation registry : Science and resuscitation research.]
t J Abstract Sudden death due to cardiac arrest represents one of the greatest challenges facing modern medicine, not only because of the massive number of cases involved but also because of its tremendous social and economic impact. For many years, the magic figure of 1 per 1000 inhabitants per year was generally accepted as an estimate of the annual incidence of sudden death in the industrialized world, with a survival rate of 6 %. This estimate was based on large numbers of published reports of local, regional, national and multinational experience in the management of cardiac arrest. Measuring the globa...
Source: Der Anaesthesist - June 5, 2014 Category: Anesthesiology Authors: Gräsner JT, Seewald S, Bohn A, Fischer M, Messelken M, Jantzen T, Wnent J Tags: Anaesthesist Source Type: research

Erratum zu: neue orale Antikoagulanzien in der perioperativen Medizin.
r K PMID: 24895006 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - June 5, 2014 Category: Anesthesiology Authors: Giebl A, Gürtler K Tags: Anaesthesist Source Type: research

[German Resuscitation Register : Lots of quality management at low cost.]
PMID: 24851835 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - May 24, 2014 Category: Anesthesiology Authors: Kreutziger J, Wenzel V Tags: Anaesthesist Source Type: research

[Perioperative management of patients with obstructive sleep apnea : Update on the practice guidelines of the American Society of Anesthesiologists Task Force.]
This article gives a summary of the recommended approach for the perioperative treatment of patients with OSA given in the 2014 guidelines. PMID: 24851836 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - May 24, 2014 Category: Anesthesiology Authors: Fahlenkamp A, Rossaint R, Coburn M Tags: Anaesthesist Source Type: research

[Role of vasopressin in septic shock : Critical evaluation.]
r M Abstract Restoration of adequate tissue perfusion is the goal of resuscitation in septic shock. A growing understanding of microcirculatory dysfunction in sepsis led to a change in resuscitation practice away from targeting arterial and central venous pressures and towards tissue perfusion-guided protocols. This change in the approach to resuscitation was accompanied by a change in the role of vasoconstrictors. This review summarizes the pathophysiological and therapeutic mainstays of septic shock resuscitation and attempts to critically evaluate the scientific evidence on the use of vasopressin as a non-adren...
Source: Der Anaesthesist - May 18, 2014 Category: Anesthesiology Authors: Gradwohl-Matis I, Brunauer A, Dankl D, Dünser M Tags: Anaesthesist Source Type: research

[Customers who have bought a comfort alarm also bought wireless cable and volleyball rackets : Legal and medical aspects of so-called comfort alarms.]
This article summarizes in compact form what consequences this has for the user and what precautions should be taken when acquiring an alarm system. PMID: 24838481 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - May 18, 2014 Category: Anesthesiology Authors: Röhrig R, Kaiser J Tags: Anaesthesist Source Type: research

[Methohexital for analgosedation of ventilated intensive care patients : Prospective nonrandomized single center observational study on incidence of delirium.]
HB Abstract BACKGROUND: Delirium is defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) as a potentially reversible disturbance of consciousness and a change of cognition caused by a medical condition, drug intoxication, or medication side effect. Delirium affects up to 80 % of intensive care unit (ICU) patients and is associated with increased morbidity and mortality. One risk factor for development of delirium in ventilated intensive care unit patients is sedation. The German S3 guidelines on "Analgesie, Sedierung und Delirmanagement in der...
Source: Der Anaesthesist - May 14, 2014 Category: Anesthesiology Authors: Volz D, Vogt A, Schütz M, Hopf HB Tags: Anaesthesist Source Type: research

[Impact of acute normovolemic hemodilution on primary hemostasis.]
CF Abstract BACKGROUND: Acute normovolemic hemodilution (ANH) is performed with the intention to reduce the requirement for allogeneic blood transfusions. After preoperative withdrawal of whole blood, corresponding amounts of crystalloids and/or colloids are infused to maintain normovolemia. The main benefit of ANH is the availability of whole blood containing red blood cells, clotting factors and platelets for reinfusion after removal during the dilution process. Until retransfusion whole blood components are stored at the patient's bedside in the operating theatre. AIM: It was the aim of the present invest...
Source: Der Anaesthesist - May 14, 2014 Category: Anesthesiology Authors: Reyher C, Bingold TM, Menzel S, Zacharowski K, Müller M, Pape A, Weber CF Tags: Anaesthesist Source Type: research

[Ethical case discussions in the intensive care unit : From testing to routine.]
CONCLUSION: A methodically structured ethical decision-making process can and should be integrated into the clinical routine. This process requires a fixed place in everyday practice and the defined responsibility for the actual organization and performance. Support by medical and nursing management personnel is also essential for the implementation. The regular occurrence of ethical case discussions among the care team relieves the participants and improves collaboration between nurses and physicians. PMID: 24820357 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - May 14, 2014 Category: Anesthesiology Authors: Meyer-Zehnder B, Barandun Schäfer U, Albisser Schleger H, Reiter-Theil S, Pargger H Tags: Anaesthesist Source Type: research

[Comments on: perioperative administration of clonidine or aspirin.]
PMID: 24820358 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - May 14, 2014 Category: Anesthesiology Authors: Treschan TA, Kienbaum P Tags: Anaesthesist Source Type: research

[Guidance of axillary multiple injection technique for plexus anesthesia : Ultrasound versus nerve stimulation.]
CONCLUSION: Nerve stimulation-guided axillary plexus blocks performed by trained anesthesiologists may result in similar onset times and success rates compared to ultrasound-guided blocks. PMID: 24805282 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - May 9, 2014 Category: Anesthesiology Authors: Meierhofer JT, Anetseder M, Roewer N, Wunder C, Schwemmer U Tags: Anaesthesist Source Type: research

[Update on intensive care medicine : Most important publications from 2012-2014.]
PMID: 24805283 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - May 9, 2014 Category: Anesthesiology Authors: Knapp J, Bernhard M, Hofer S, Popp E, Weigand MA Tags: Anaesthesist Source Type: research

[Primary treatment of penetrating injuries : Part 1: blast trauma.]
[Primary treatment of penetrating injuries : Part 1: blast trauma.] Anaesthesist. 2014 May 9; Authors: Hossfeld B, Holsträter T, Holsträter S, Rein D, Josse F, Lampl L, Helm M Abstract Blast injuries may result from a variety of causes but the biomechanical impact and pathophysiological consequences do not differ between domestic or industrial accidents or even terrorist attacks. However, this differentiation relevantly affects the tactical procedures of the rescue teams. Focusing on further detonations, top priority is given to the personal safety of all rescue workers. The rareness of...
Source: Der Anaesthesist - May 9, 2014 Category: Anesthesiology Authors: Hossfeld B, Holsträter T, Holsträter S, Rein D, Josse F, Lampl L, Helm M Tags: Anaesthesist Source Type: research

[Local anesthetic agents : More and more not only sodium channel blockers.]
PMID: 24800884 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - May 8, 2014 Category: Anesthesiology Authors: Graf BM Tags: Anaesthesist Source Type: research

[Localization of peripheral nerves : Success and safety with electrical nerve stimulation.]
Abstract Peripheral electrical nerve stimulation is one of the standard applications in peripheral regional anesthesia in addition to the ultrasound technique. Among other findings, the visualization of needle and nerve during ultrasound-guided blockade caused a change in clinical practice of peripheral nerve stimulation in the last decade. In the present article old and new aspects of principles and clinical practice of the nerve stimulation technique are presented and summarized in a total clinical concept in order to achieve safe and successful peripheral regional anesthesia using electrical peripheral nerve st...
Source: Der Anaesthesist - April 10, 2014 Category: Anesthesiology Authors: Neuburger M, Schwemmer U, Volk T, Gogarten W, Kessler P, Steinfeldt T Tags: Anaesthesist Source Type: research

[Modified McPeek score in multiple trauma patients : Prospective evaluation of a points system for recording follow-up factors.]
Abstract BACKGROUND: Many commonly available trauma scores predict mortality, but to evaluate the success of a certain therapy or for difficult scientific and epidemiological purposes this may be insufficient in the face of improved survival rates. For outcome analysis of multiple trauma patients, the extent of medical resources needed could be an additional outcome measurement. McPeek et al. developed a potential scoring system for elective surgery patients, which was recently modified for multiple trauma patients. AIM: The current study investigated if the McPeek score could be prospectively used in multipl...
Source: Der Anaesthesist - April 10, 2014 Category: Anesthesiology Authors: Mathis S, Kellermann S, Schmid S, Mutschlechner H, Raab H, Wenzel V, El Attal R, Kreutziger J Tags: Anaesthesist Source Type: research

[New oral anticoagulants in perioperative medicine.]
r K Abstract New oral anticoagulants (NOAC) inhibit factor Xa (Stuart-Prower factor) or factor IIa (thrombin) and are alternatives to vitamin K antagonists. Perioperative indications are deep vein thrombosis prophylaxis for prosthetic hip and knee replacement, therapeutic anticoagulation for deep vein thrombosis as well as the prophylaxis of stroke for patients with atrial fibrillation. Patients on NOACs pose multiple perioperative challenges for all medical disciplines involved. For non-emergency surgery, patients should be evaluated by an anesthesiolgist as early as possible to assess an optimal appointment for ...
Source: Der Anaesthesist - April 4, 2014 Category: Anesthesiology Authors: Giebl A, Gürtler K Tags: Anaesthesist Source Type: research

[Update on the pharmacology and effects of local anesthetics.]
Abstract Local anesthetics (LA) are broadly used in all disciplines and it could be considered that relatively little is reflected on the mechanisms of action of this old substance group. However, several molecular mechanisms of LAs mediating wanted and unwanted effects remain to be explored. Furthermore, the number of indications for application of LAs seems to be expanding. The local anesthetic effect of LAs is primarily mediated by a potent inhibition of voltage-gated sodium channels. However, this effect is due to much more than the interaction of LAs with one single molecule. Most recent studies indicated tha...
Source: Der Anaesthesist - April 3, 2014 Category: Anesthesiology Authors: Ahrens J, Leffler A Tags: Anaesthesist Source Type: research

[Prediction of further hospital treatment for emergency patients by emergency medical service physicians.]
CONCLUSIONS: Prehospital NACA scores indicate the need for inpatient treatment, but neither hospital discharge or admission nor need of IMC or ICU admission after initial ED treatment could be sufficiently predicted by EMS physicians. Thus, hospital prenotification in order to predispose IMC or ICU capacities does not seem to be useful in cases where an ED can reassess admitted EMS patients. PMID: 24691947 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - April 3, 2014 Category: Anesthesiology Authors: Bernhard M, Trautwein S, Stepan R, Zahn P, Greim CA, Gries A Tags: Anaesthesist Source Type: research

[Prewarming : Yesterday's luxury, today's minimum requirements.]
r M Abstract Prewarming is a useful and effective measure to reduce perioperative hypothermia. Due to §23(3) of the German Infektionsschutzgesetz (Gesetz zur Verhütung und Bekämpfung von Infektionskrankheiten beim Menschen, Infection Act, act on protection and prevention of infectious diseases in man) and the recommendations of the Hospital Hygiene and Infection Prevention Committee of the Robert Koch Institute, implementation of prewarming is clearly recommended. There are several technically satisfactory and practicable devices available allowing prewarming on the normal hospital ward, in the preo...
Source: Der Anaesthesist - April 3, 2014 Category: Anesthesiology Authors: Bräuer A, Brandes IF, Perl T, Wetz AJ, Bauer M Tags: Anaesthesist Source Type: research

[A guide to successful public relations for hospitals and emergency medical services.]
Abstract Tragic accidents, e.g. involving celebrity patients or severe incidents in hospital occur suddenly without any advance warning, often produce substantial interest by the media and quickly overburden management personnel involved in both hospitals and emergency medical services. While doctors, hospitals and emergency medical services desire objective media reports, the media promote emotionalized and dramatized reports to ensure maximum attention and circulation. When briefing the media, the scales may quickly tilt from professional, well-deliberated information to unfortunate, often unintended disinformat...
Source: Der Anaesthesist - March 30, 2014 Category: Anesthesiology Authors: Ausserer J, Schwamberger J, Preloznik R, Klimek M, Paal P, Wenzel V Tags: Anaesthesist Source Type: research

[Mirror, mirror on the wall or writing on the wall? : Publication performance of university anesthesiology departments.]
PMID: 24668267 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - March 27, 2014 Category: Anesthesiology Authors: Peters J Tags: Anaesthesist Source Type: research

[Anesthesia and analgesia in the lactation period : Criteria for drug selection.]
e P Abstract There is no sound information concerning the safe and correct use of analgesics and anesthetics during the lactation period based on studies with a large sample size. Available information is limited to case studies and small sample observations. As a result, information given by the drug manufacturers about the use of drugs during the lactation period is often restrictive or contains contraindications for the lactation period. Although some drugs are not officially licensed for use during lactation they need to be administered in daily (off-label) use. This review gives an overview about the recent k...
Source: Der Anaesthesist - March 12, 2014 Category: Anesthesiology Authors: Nassen CA, Schaefer C, Wirbelauer J, Hönig A, Kranke P Tags: Anaesthesist Source Type: research

[Rocuronium and sugammadex in emergency medicine : Requirements of a muscle relaxant for rapid sequence induction.]
Conclusion: rocuronium used in hospital is a very good substitute for succinylcholine as a neuromuscular blocker during RSI as long as sugammadex is at hand for reversal. It remains to be considered that in a situation with severe problems of the airway and breathing, which are the main preclinical indications for intubation, a forward strategy for ventilation of the patient is the only acceptable way in most cases and the return to spontaneous breathing is not an alternative. Therefore, the value of sugammadex and also of succinylcholine is limited for these situations. Additionally, economic factors such as storage condi...
Source: Der Anaesthesist - March 6, 2014 Category: Anesthesiology Authors: Luxen J, Trentzsch H, Urban B Tags: Anaesthesist Source Type: research

[Quo vadis, preclinical emergency physician? : Results of a survey of emergency medical services in Rhineland-Palatinate (Germany).]
CONCLUSION: The described problems are complex. Besides financial incentives, they necessitate greater general appreciation of the preclinical work of emergency physicians. Further studies including the emergency physicians concerned are necessary. The low percentage of female emergency physicians requires special consideration. PMID: 24595443 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - March 6, 2014 Category: Anesthesiology Authors: Luiz T, Jung J, Flick S Tags: Anaesthesist Source Type: research

[Pneumocephalus as a rare complication of general anesthesia.]
This article reports a case of massive postoperative pneumocephalus in a patient following general anesthesia for a urological procedure. The patient had sustained a severe head injury more than 10 years ago with long-term treatment in an intensive care unit (ICU) including decompressive craniectomy, tracheostomy followed by rehabilitation, decanulation and cranioplasty. The patient recovered but suffered severe hemiparesis and mild neurocognitive deficits. Immediately after the current operation the patient was disoriented and did not recover in an appropriate interval. A cranial computed tomography (CT) scan revealed mas...
Source: Der Anaesthesist - March 2, 2014 Category: Anesthesiology Authors: Welschehold S, Wegermann P, Reuland A Tags: Anaesthesist Source Type: research

[Hypoxic gas mixture delivery due to a defective vaporiser manifold : Case report, review of the literature and suggested emergency management algorithm.]
Abstract A case of delivery of a hypoxic gas mixture to a patient during total intravenous anesthesia is described. A progressive fall in inspiratory oxygen concentration followed by a drop in oxygen saturation below 90 % occurred during the advanced stages of a hitherto uneventful general anesthesia of a female patient undergoing anterior cervical fusion surgery. A malfunctioning defective rubber seal of a vaporizer manifold was identified as the cause of the gas leak. The leak had not been detected during the preanesthesia leak test. The problem of hypoxic gas mixtures and uncommon leaks in modern anesthe...
Source: Der Anaesthesist - March 2, 2014 Category: Anesthesiology Authors: Berlet T Tags: Anaesthesist Source Type: research

[Interaction of anesthetics and analgesics with tumor cells.]
Abstract The results of preclinical and clinical studies indicate that the perioperative period is a vulnerable period for cancer progression and metastasis. The risk of cancer cell dissemination is enhanced by the combination of surgical manipulation and perioperative immunosuppression. Whether the oncological outcome of cancer patients can be influenced by the choice of anesthetic techniques is still a matter of debate. This review summarizes the molecular characteristics of cancer and interaction of anesthetic and analgesic drugs with cancer cells. PMID: 24584840 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - March 2, 2014 Category: Anesthesiology Authors: Bundscherer A, Malsy M, Bitzinger D, Graf BM Tags: Anaesthesist Source Type: research

[Management of postpartum hemorrhage (PPH) : Algorithm of the interdisciplinary D-A-CH consensus group PPH (Germany - Austria - Switzerland).]
immermann R Abstract Postpartum hemorrhage (PPH) is one of the main causes of maternal deaths even in industrialized countries. It represents an emergency situation which necessitates a rapid decision and in particular an exact diagnosis and root cause analysis in order to initiate the correct therapeutic measures in an interdisciplinary cooperation. In addition to established guidelines, the benefits of standardized therapy algorithms have been demonstrated. A therapy algorithm for the obstetric emergency of postpartum hemorrhage in the German language is not yet available. The establishment of an international (...
Source: Der Anaesthesist - March 2, 2014 Category: Anesthesiology Authors: Schlembach D, Mörtl MG, Girard T, Arzt W, Beinder E, Brezinka C, Chalubinski K, Fries D, Gogarten W, Hackelöer BJ, Helmer H, Henrich W, Hösli I, Husslein P, Kainer F, Lang U, Pfanner G, Rath W, Schleussner E, Steiner H, Surbek D, Zimmermann R Tags: Anaesthesist Source Type: research

[Acute pancreatitis.]
Abstract Acute pancreatitis is a potentially fatal disease with individually differing expression of systemic involvement. For this reason early diagnosis with subsequent risk stratification is essential in the clinical management of this frequent gastroenterological disorder. Severe forms of acute pancreatitis occur in approximately 20 % of cases often requiring intensive care monitoring and interdisciplinary therapeutic approaches. In the acute phase adequate fluid replacement and sufficient analgesic therapy is of major therapeutic importance. Concerning the administration of antibiotics and the nutritio...
Source: Der Anaesthesist - March 2, 2014 Category: Anesthesiology Authors: Hecker M, Mayer K, Askevold I, Collet P, Weigand MA, Krombach GA, Padberg W, Hecker A Tags: Anaesthesist Source Type: research

[Awake ECMO therapy in airway stenosis : Bronchoscopic treatment using laser resection.]
This article presents the case of a 62-year-old patient with cancer in the left upper pulmonary lobe who underwent lobe resection with postoperative respiratory insufficiency. The right upper lobe had already been resected 5 years earlier because of an adenocarcinoma. Prior to the present surgery a computed tomography scan detected a narrow stenosis at the former resection site; however, both pulmonary lobes beyond this stenosis appeared to be sufficiently ventilated. After resection of the left upper lobe attempted extubation was unsuccessful due to insufficient global gas exchange as the stenosis prevented ventilation of...
Source: Der Anaesthesist - March 2, 2014 Category: Anesthesiology Authors: Duru JA, Menges T, Bodner J, Degen ME, Greifenberg D, Gehron J, Weigand MA, Henrich M Tags: Anaesthesist Source Type: research

[Mechanical resuscitation assist devices.]
Abstract In Germany 100,000-160,000 people suffer from out-of-hospital cardiac arrest (OHCA) annually. The incidence of cardiopulmonary resuscitation (CPR) after OHCA varies between emergency ambulance services but is in the range of 30-90 CPR attempts per 100,000 inhabitants per year. Basic life support (BLS) involving chest compressions and ventilation is the key measure of resuscitation. Rapid initiation and quality of BLS are the most critical factors for CPR success. Even healthcare professionals are not always able to ensure the quality of CPR measures. Consequently in recent years mechanical resuscitation d...
Source: Der Anaesthesist - February 27, 2014 Category: Anesthesiology Authors: Fischer M, Breil M, Ihli M, Messelken M, Rauch S, Schewe JC Tags: Anaesthesist Source Type: research

[Augmented spontaneous breathing in the weaning process : Technical gimmick or enrichment of intensive care medicine?]
PMID: 24569932 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - February 27, 2014 Category: Anesthesiology Authors: Ragaller M Tags: Anaesthesist Source Type: research

[Parental presence during induction of anesthesia in children : Pros and cons.]
This article explains the grounds and the premises for this practice and describes those factors which might be important to support parental presence during induction of anesthesia in children. Some practical advice and tips on how parental presence in the clinic can be practically implemented are given at the end of the article. PMID: 24569933 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - February 27, 2014 Category: Anesthesiology Authors: Machotta A Tags: Anaesthesist Source Type: research

[Overwhelming postsplenectomy infection syndrome.]
SO Abstract The overwhelming postsplenectomy infection syndrome (OPSI) is a fulminant sepsis that is mainly caused by Streptococcus pneumoniae and is characterized by a particular high mortality. Patients whose spleen was removed due to a hematological disease are at special risk. Even after the recommended immunization against Streptococcus pneumoniae 20-30 % of these patients do not develop an adequate level of antibody response. Therefore, this particular group of patients must be trained how to behave in case of fever and need to obtain immediate specific sepsis therapy with antibiotic prophylaxis. ...
Source: Der Anaesthesist - February 27, 2014 Category: Anesthesiology Authors: Fuchs C, Scheer C, Schulz K, Dombrowski F, Brückmann S, Kuhn SO Tags: Anaesthesist Source Type: research

[Prehospital non-invasive ventilation in Germany : Results of a nationwide survey of ground-based emergency medical services.]
CONCLUSION: Prehospital NIV in Germany was used by only one third of all respondents by the end of 2008. Based on the clinical data a growing application for pNIV is expected. Controlled prehospital studies are needed to enunciate evidence-based recommendations for pNIV. PMID: 24569935 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - February 27, 2014 Category: Anesthesiology Authors: Sellmann T, Conty C, Treschan T, Kindgen-Milles D Tags: Anaesthesist Source Type: research

[Placement of a central venous catheter in cases of persistent left superior vena cava.]
This article presents a case report on the placement of a central venous catheter (CVC) in a patient with an unknown persistent left superior vena cava (PLSVC). Normally, PLSVCs remain asymptomatic but can be associated with disastrous consequences for the patient during placement of a CVC particularly due to vascular perforation and pulmonary injury. A PLSCV is particularly common in association with congenital heart defects; however, otherwise healthy patients can also be affected. As the presence of a PLSCV is normally unknown special attention must be paid in every patient during placement of a CVC. PMID: 24566941...
Source: Der Anaesthesist - February 26, 2014 Category: Anesthesiology Authors: Seemann M, Zech N, Kieninger M, Graf B, Künzig H Tags: Anaesthesist Source Type: research

[Prehospital analgesia performed by paramedics : Quality in processes and effects under medical supervision.]
This study specifically focused on the medical results and associated processes and not on the legal aspects. MATERIALS AND METHODS: In a retrospective analysis analgesia performed by paramedics who had undergone standardized training with annual controls and under medical supervision was investigated with regard to administration processes and efficacy. Analysis endpoints included vital signs at baseline and on transfer to the emergency department, pain score as defined by a numeric rating scale (NRS 0-10), the amount of ketamine administered and the occurrence of side effects (e.g. respiratory and circulatory disord...
Source: Der Anaesthesist - February 23, 2014 Category: Anesthesiology Authors: Häske D, Schempf B, Gaier G, Niederberger C Tags: Anaesthesist Source Type: research

[Current concepts of augmented spontaneous breathing : New modes of effort-adapted weaning.]
Abstract The use of augmented spontaneous breathing is an important component in a bundle concept of weaning from mechanical ventilation as it was demonstrated that controlled ventilation with diaphragmatic underuse induces rapid muscle atrophy and impairs successful weaning. On the other hand spontaneous breathing is often associated with disturbed patient-ventilator interaction resulting in asynchrony (e.g. ineffective triggering, early termination of inspiration and overflow or underflow). It was shown that asynchrony can impair gas exchange, increase work of breathing and enhance deleterious aspects of mechani...
Source: Der Anaesthesist - February 19, 2014 Category: Anesthesiology Authors: Bein T Tags: Anaesthesist Source Type: research

[Preoperative risk evaluation of adult patients prior to elective non-cardiac surgery : Follow-up survey of the recommendations published in 2010.]
CONCLUSION: The joint recommendations are well known and positively rated among anesthetists in Germany responding to the questionnaire reflecting an effective implementation process over the last 2 years. The anesthetists who completed the questionnaire stated that the use of the recommendations leads to a more reasonable approach in preoperative risk evaluation which contributes to an increase in patient safety and satisfaction. PMID: 24535688 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - February 19, 2014 Category: Anesthesiology Authors: Böhmer AB, Defosse J, Geldner G, Mertens E, Zwissler B, Wappler F Tags: Anaesthesist Source Type: research

[Keep on pumping : Importance of mechanical resuscitation aids.]
PMID: 24531735 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - February 16, 2014 Category: Anesthesiology Authors: Helm M Tags: Anaesthesist Source Type: research

[Patients rights act : Consequences for medical treatment.]
Abstract With the justification that the treatment and medical liability act suffers from a lack of transparency and reliability due to being characterized by many isolated decisions, in 2013 this was made into statute law in the form of the patients rights act in the German Civil Code (BGB). It was considered that "currently existing comprehensive rights of patients" would be strengthened through clarity and "legal transparency" and that the practical "implementation" would be improved. That this target will be achieved with these new statutory provisions is doubtful. Instead of more...
Source: Der Anaesthesist - February 7, 2014 Category: Anesthesiology Authors: Ulsenheimer K Tags: Anaesthesist Source Type: research