Der Anaesthesist
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Major incidents are high-profile events where many lives are at stake. The response of the health-care-related agencies has to be well-planned and co-ordinated, thus retaining the public's confidence in the emergency services whilst efficiently responding to those in need. The communication between supervising officers such as medical incident officer (MIO) and ambulance incident officer (AIO) with the ambulance personnel is vital for the proper employment of doctors and ambulance teams at the incident scene. In Germany the experience gained at such events has not yet been collected into a single coherent and comprehensive analysis. This study investigates the delivery of ambulance vehicles and personnel at major incidents. Was appropriate emergency treatment and transport for each seriously injured patient possible? Were the communication structures between the supervising officers and the ambulance teams sufficient to provide effective co-ordination and utilisation of the teams at the scene? ⋯ Quality assurance in emergency medicine can only be achieved by research and documentation. Analysis of the data for this study revealed a severe documentation gap. Only in Bavaria did a one-page documentation form for major incidents exist. For a comprehensive analysis of the health-care-related response to major incidents, a standardised and detailed documentation form should be introduced. According to the data from this study, ambulance staff and vehicles can be quickly and sufficiently provided for the vast majority of major incidents in Germany. For the optimal use of these resources, however, communication skills and knowledge and understanding of on-side supervision structures such as the MIO and AIO need to be promoted.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Single-dose spinal anesthesia with a mixture of isobaric bupivacaine 0.5% and hyperbaric mepivacaine 4%].
Single-dose spinal anaesthesia with hyperbaric local anaesthetic provides profound analgesia and motor blockade and allows exact assessment of the analgesic level. The present prospective, randomised study compares a mixture of plain 0.5% bupivacaine and hyperbaric 4% mepivacaine with hyperbaric 0.5% bupivacaine with regard to onset time of analgesia and duration of the sensory and motor blockade. ⋯ The local anaesthetic mixture may be preferred to hyperbaric 0.5% bupivacaine in patients requiring a fast onset of analgesia associated with a 2-3 h duration of sensory and motor block.
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Nociceptors can be defined as sensory receptors that are activated by noxious stimuli that damage or threaten the body's integrity. Nociceptors belong to the slowly conducting afferent A delta and C fibres. They are classified according to their responses to mechanical, thermal, and chemical stimuli. ⋯ Experimental and clinical progress has been achieved in using the nociceptor as a target for chemical anti-nociception and treatment of pain. Substances that act directly or indirectly on the nociceptor are steroidal and non-steroidal analgesics, capsaicin analogs, bradykinin antagonists, opioids, and (in the trigeminal system) 5-hydroxytryptamine agonists.
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In a recently published German multicenter study, 25% of the patients with witnessed cardiac arrest outside the hospital were resuscitated successfully and discharged from the hospital. Approximately 100,000 people suffer a fatal cardiac arrest in Germany annually, which is approximately tenfold the number of deaths from motor vehicle accidents. Cardiopulmonary resuscitation (CPR) performed by bystanders is an important part of the chain of survival to minimize the time interval without artificial circulation and ventilation in a cardiac arrest victim. ⋯ This strategy would decrease the inspiratory flow rate and, therefore, peak airway inflation pressure, which is associated with stomach inflation. Animal models indicate that lower esophageal sphincter pressure may decrease rapidly to 5 cm H2O during cardiac arrest, which may further increase the importance of a low peak airway pressure during ventilation with an unprotected airway. Gastric inflation may cause, besides regurgitation, aspiration, and pneumonia, an increased intragastric pressure, which may push up the diaphragm, decrease lung compliance, and induce a vicious circle of hypoventilation and stomach inflation.(ABSTRACT TRUNCATED)
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
[Neostigmine and edrophonium. Antagonism of profound and shallow mivacurium blockade].
Mivacurium has a short duration of action because it is rapidly hydrolysed by plasma cholinesterase. There is ongoing controversy concerning the antagonism of mivacurium-induced neuromuscular block, firstly because of its short spontaneous recovery time, and secondly because the metabolism of mivacurium may be inhibited by anticholinesterases. We therefore compared neostigmine and edrophonium reversal of deep and moderate mivacurium-induced blocks. ⋯ Two theoretical reasons, the very rapid onset time and the fact that it does not inhibit plasma cholinesterase, suggest edrophonium to be the preferred antagonist of a mivacurium-induced blockade. These two characteristics are reflected in our results: only edrophonium was able to shorten the recovery index significantly and, administered at a profound level of mivacurium-induced neuromuscular block, only edrophonium was successful in shortening recovery time significantly. Therefore, edrophonium should be the anticholinesterase of choice to antagonise a mivacurium-induced neuromuscular block.