Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2008
ReviewThe anesthesiologist in prehospital and hospital emergency medicine.
The German emergency medical system is different from the Anglo-American system. Emergency medicine is no distinct specialty in Germany. Physicians are involved in prehospital emergency medicine. This review highlights the historic development of prehospital and hospital emergency medicine in Germany and describes future trends. ⋯ Economic and quality arguments have initiated the development of departments for emergency medicine in Germany. In the future, this will lead to new qualification criteria for physicians working in these departments.
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This review summarizes the knowledge of error and of critical incident reporting systems in general and especially in emergency medicine. ⋯ The first step in avoiding fatalities in emergency medicine is to accept that errors do occur. The next question is how to prevent errors in medicine and not to search for personal mistakes. We need a culture of error and not a culture of blame. Critical incidents occur in all ranges of medical hierarchical structures. We have to accept the presence of mistakes and we need to recognize them every day to protect our patients.
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Curr Opin Anaesthesiol · Feb 2008
ReviewAnesthetic management of patients undergoing extrapleural pneumonectomy for mesothelioma.
Extrapleural pneumonectomy is a radical and aggressive surgery that presents a great challenge to the thoracic anesthesiologist. This surgery is performed routinely by only a few centers in the world and this review represents our institution's experience in anesthetic care. ⋯ Anesthetic management importantly contributes to containment of the perioperative complications of extrapleural pneumonectomy. An appreciation of the technical aspects and physiologic disruptions associated with extrapleural pneumonectomy is critical to effective management. While data on this relatively uncommon surgical procedure are scarce, some referral centers have accumulated extensive experience. This review summarizes relevant surgical aspects and anesthetic insights from the Brigham and Women's Hospital experience. Included are the anesthetic implications of intraoperative intracavitary hyperthermic chemotherapy in combination with extrapleural pneumonectomy - an emerging therapeutic option in the treatment of malignant pleural mesothelioma.
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The management of patients with recent coronary artery stents presenting for noncardiac surgery has become a major topic of interest and concern for all perioperative caregivers. This review will update recent reports and particularly new guidelines as well as recommendations. ⋯ Anaesthesiologists may understand the specific problem of drug-eluting stents, the recent debate among cardiologists and the implications for the perioperative scenario.