Der Anaesthesist
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The aim of Evidence-based medicine (EBM) is the unbiased and systematic identification and synthesis of valid scientific data. These best-evidence data may then be used for clinical decision-making. The systematic review is the most important tool of EBM and gives a specific answer to a specific question. ⋯ They treat complications and risks related to anaesthesia, postoperative and labour analgesia, nausea and vomiting, regional anaesthesia, blood transfusion and fluids replacement, and resuscitation. The majority of these systematic reviews are of good quality. In the specific settings of perioperative medicine the number of systematic reviews has become so important that recommendations for evidenced-based strategies of prevention and therapy can be formulated.
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Recognized local and systemic complications of retrobulbar anaesthesia (RA) are well known. The purpose of this study was to determine which clinical signs predict the success of the RA technique. ⋯ The results of this study demonstrated that prognostic factors such as defined existing clinical signs, are early predictors of the success of the Atkinson RA.
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Case Reports
[The effect of volume status of the right-left shunt in a patient with a patent foramen ovale].
This is a description of the anaesthetic management of a patient with a flow patent foramen ovale undergoing intramedullary nailing of the femur. In order to detect the flow patent foramen ovale, we used transoesophageal echocardiography. ⋯ After the administration of 500 ml hydroxy-starch solution (6%) intravenously, detection of the right-to-left shunt flow was no longer possible. This case report shows that the volume status in a patient with a patent foramen ovale could influence the right to left interatrial shunt during general anaesthesia.
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Deficits in quality of postoperative pain management are not caused by the complexity of the medical problem or shortage of suitable drugs but by difficulties in organization and hospital structures. Moreover, there is no consensus on how to measure the quality of pain management. Quality management programs consist of strategies to overcome such difficulties and to increase quality continuously. This study reports the implementation of a quality management program to improve postoperative pain management at a university hospital. ⋯ Tools of quality management consisting of deficit analysis, definition of outcome parameters, implementation of improving strategies, post-intervention analysis and continuous feed-back may be successfully used to improve postoperative pain therapy. Changes in organization of medical management seem to be more important than medical or technical aspects. Similar strategies might be used to increase quality of other medical procedures.