Der Anaesthesist
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The long QT syndrome (LQTS) is a rare, congenital or acquired disease, which may lead to fatal cardiac arrhythmias (torsade de pointes, TdP). In all LQTS subtypes, TdPs are caused by disturbances in cardiac ion channels. Diagnosis is made using clinical, anamnestic and electrocardiographic data. ⋯ Propofol is safe for anaesthesia induction and maintenance. The acute therapy of TdPs with cardiovascular depression should be performed in accordance with the guidelines for advanced cardiac life support and includes cardioversion/defibrillation and magnesium. Torsades de pointes may be associated with bradycardia or tachycardia resulting in specific therapeutic and prophylactic measures.
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The treatment of acutely ill patients who presumably lack the insight or judgement to determine their need for medical treatment, is a difficult challenge for emergency physicians. We have carried out a study to assess the frequency and relevance of involuntary treatment and procedures in medical emergency services. ⋯ Involuntary inpatient commitment by emergency physicians was only necessary in relatively few cases. Nevertheless, in order to be able to correctly consider treatment and management options, emergency physicians should be aware of the basic conditions for treatment without a patient's consent.
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Review Meta Analysis
[Levobupivacaine for regional anesthesia. A systematic review].
Levobupivacaine [S(-)bupivacaine], the levorotatory S-enantiomer of racemic bupivacaine, is commercially available in the U. S. and in most European countries. We performed a systematic review (MEDLINE database) and identified 88 articles on the clinical application of levobupivacaine in more than 3,000 patients. ⋯ In these regional techniques, levobupivacaine was used for all common indications in a wide range of clinical settings. Epidural levobupivacaine was combined with fentanyl, morphine, sufentanil, epinephrine, and clonidine, spinal levobupivacaine was combined with sufentanil, fentanyl, and epinephrine. In most studies, levobupivacaine was compared to bupivacaine and/or ropivacaine.
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Comparative Study
[Psychological traits, course of surgery and recovery following hernia repair in patients preferring general or local anaesthesia].
This study addresses two questions concerning open inguinal hernia repair patients: (1) are there differences in psychological traits between patients opting for local vs. general anaesthesia and (2) assuming comparable operations, are there any differences between the two groups during surgery and postoperative recovery? ⋯ Psychological traits do not have a significant impact on the choice of either local or general anaesthesia. However, highly extraverted patients prefer local anaesthesia while extreme introverts prefer general anaesthesia. Our findings suggest that local anaesthesia will become more widely adopted for the repair of groin hernia. Future studies should focus on optimising the perioperative care for patients who choose local anaesthesia.
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The aim of this study was to demonstrate differences in structure and severity of pediatric emergencies treated by aeromedical (air rescue) or ground ambulances services. Conclusions for the training of emergency physicians are discussed. ⋯ Training of emergency physicians should include pediatric life support and specific information about frequent pediatric emergency situations. For emergency physicians in aeromedical services, an intensive training in pediatric trauma life support is also necessary.