Der Anaesthesist
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This special article for continued education begins with a broad definition of septic shock. The following section describes the fundamental organ dysfunctions and pathomechanisms. ⋯ The specific therapeutic interventions (only those which have been proven effective and recommendable for routine clinical use) will be presented. Monitoring of infection and organ function are discussed briefly.
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Many neurosurgeons prefer the sitting position for patients undergoing surgery in the posterior fossa because of the easier access and better conditions for haemostasis. Pneumatocephalus is a possible consequence of surgery in the posterior fossa with the patient in the sitting position. When this occurs air may enter the subarachnoid space, the cisternae, the ventricular system or the subdural space; it becomes more likely when any of the following is/are present: loss of CSF, a large cavity resulting from surgery, external or internal drainage of CSF, osmotic diuresis, and hyperventilation. ⋯ As complete skin had already been closure no explanation for the air embolism could be found. The patient was positioned supine, and air was no longer detectable in the right heart after 1 min. Approximately 1 h later both pupils were dilated and unreactive to light.(ABSTRACT TRUNCATED AT 250 WORDS)
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Although the incidence of difficult airway is very low, involving less than 1% of all patients, failed air-way management is the main cause of mortality or serious morbidity during anaesthesia. Successful management of a difficult airway starts with recognition of the potential problem. A careful preoperative history and clinical examination should elicit obvious problems to allow prediction of a potentially difficult airway. ⋯ The LMA is a new device developed to provide an airway for anaesthesia. However, since the LMA can be inserted quickly and blind, it can be used as an alternative airway in patients in whom the trachea is difficult to intubate. The lower incidence of post-operative complications than with endotracheal intubation is a further advantage, particularly during anaesthesia for day surgery.