Der Anaesthesist
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A survey was performed to obtain information on the organization and practice of postoperative pain management. ⋯ The number of departments with APS has increased over the last 10 years. Future decisions on reimbursement should consider this extensive service.
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Anaesthesia-related risk has been significantly reduced within the last decade. Nevertheless the risk and the possibility of dying or suffering permanent damage still exist. To improve patient safety, risk assessment and analysis must lead to the development of preventive strategies. ⋯ Human factors are responsible for individual mistakes as well as for organisational errors. Therefore besides traditional concepts of risk reduction (e.g. guidelines) new strategies (e.g. full-scale simulation) must be applied to minimise the negative impact of human factors on patient safety. Risk management has to consider technical, organisational and human factors to implement a higher standard of patient safety.
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Ventilatory control in humans depends on complex mechanisms which aim to maintain a cellular CO2-, O2- and H(+)-homeostasis under physiological conditions. This regulation is based on chemical control which predominantly acts via peripheral chemoreceptors in the carotid bodies and central chemoreceptors in the ventral medulla of the brainstem on the one hand, and behavioural control on the other, by which it is possible to adapt respiration to conditions of daily living. ⋯ This review will give an overview of ventilatory control and discuss the most relevant responses, describe the effects of pain, anaesthetics and opioids on ventilatory control and their interaction. The current body of knowledge is put into perspective to identify patients at risk for perioperative respiratory depression.
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The case of a 77-year-old woman is described, who was found unconscious, with decreased respiration and miotic pupils, having previously experienced dizziness, nausea and drowsiness before. In the emergency room a fentanyl patch was detected, which had obviously been mistakenly applied by the patient the day before. ⋯ The patient was supervised in an ICU for 24 h and sent home the next day without serious sequelae. The consequences following inappropriate use of transdermal fentanyl are discussed.