Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative pain management and respiratory depression after thoracotomy: a comparison of intramuscular piritramide and intravenous patient-controlled analgesia using fentanyl or buprenorphine.
To compare the analgesic efficacy of fentanyl, buprenorphine, and piritramide and to define the respiratory risk during conventional postoperative pain management and patient-controlled analgesia (PCA). ⋯ Opioid-induced respiratory depression occurred infrequently during postoperative pain management whether by conventional means or using PCA, even though high doses of opioid analgesics were required intermittently for adequate postoperative pain relief by either technique.
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Randomized Controlled Trial Comparative Study Clinical Trial
Adaptive feedback-controlled infusion versus repetitive injections of vecuronium in patients during isoflurane anesthesia.
To compare vecuronium requirements using repetitive injections and a model-based, closed-loop, feedback-controlled infusion during isoflurane anesthesia. ⋯ The model-based adaptive feedback system proved to be useful in maintaining a stable degree of paralysis, adjusting relaxant input to individual demand, and minimizing drug requirement, as compared with repetitive injections.
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The specialty of anesthesia was established in German medicine in 1953 with the founding of the Germany Society of Anaesthesia and the inclusion of a "specialist in anesthesia" as part of the German medical training requirements. Anesthesia training is offered to students and residents and as a part of continuing education. ⋯ Of those, about 320 are fully accredited. Continuing education in West German anesthesia is very similar to that offered in the United States.
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As of 1991, intensive care medicine in Germany is not an independent medical specialty but a part of other main medical specialities such as anesthesiology, internal medicine, surgery, and pediatrics. Accordingly, there is neither formal training nor a separate board examination in intensive care medicine. ⋯ Surgical (or operative) ICUs predominantly are operated by anesthesiology departments, as anesthesiologists' expertise in respiratory and hemodynamic support qualifies them for the management of the critically ill patient in the perioperative phase. This article gives a brief review of the development of intensive care medicine in Germany, thereby providing the historical background for its present national and regional organization, facilities, and education and training programs.
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A 25-year-old healthy patient developed bilateral tension pneumothorax during general endotracheal anesthesia due to a defective anesthesia breathing circuit filter. Prompt diagnosis and treatment of the pneumothorax was facilitated by the use of capnography and pulse oximetry. The manufacturing process of the breathing circuit and filter that made this accident possible has since been corrected by the manufacturer. Anesthesiologists must be alert to the possibility of such accidents with any breathing system using bacterial filters.