Der Anaesthesist
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Randomized Controlled Trial
[Levobupivacaine for parturients undergoing elective caesarean delivery. A dose-finding investigation].
The optimum intrathecal dose of hyperbaric levobupivacaine for spinal anaesthesia during elective caesarean section has not yet been investigated. ⋯ Levobupivacaine 7.5 mg did not provide satisfactory intraoperative analgesia in all parturients. There were no statistically significant differences between 10 and 12.5 mg levobupivacaine with respect to analgesic, sensory and motor block characteristics. Therefore, based on these data, 10 mg levobupivacaine is recommended for parturients undergoing elective caesarean section with spinal anaesthesia.
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Review
[Determinants of insensible fluid loss. Perspiration, protein shift and endothelial glycocalyx].
Accurate perioperative fluid balance is the basis of a targeted infusion regimen. However, neither the initial status nor perioperative changes of the fluid compartments can be reliably measured in daily routine. In particular, insensible losses are not consistently assessed, so that substitution therapy is generally empirical. ⋯ An inconstant fluid and protein shift towards the interstitial space perioperatively seems to be associated with hypervolemia, which suggests it should be preventable. The decisive factor in this context seems to be deterioration of the endothelial glycocalyx, whose further patho-physiological impact is currently only partially known. Clinical studies have revealed a link between fluid restriction and improved outcome after major abdominal surgery.
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Demographic changes and aggressive medication with platelet aggregation inhibitors have resulted in a marked increase in blood and coagulation product expenditure and costs in cardiac surgery. We analyzed the bedside coagulation test (ROTEM) in order to verify clot forming quality and to find a cost-effective treatment algorithm. ⋯ Cumulative costs for treatment of perioperative coagulation disorders were reduced by bedside ROTEM analysis to achieve a selective substitution management. Saved costs for blood and coagulation products clearly outweighed the expenses of ROTEM. Adequate differential coagulation management can therefore be cost-effective.
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Patients with hypothermia are frequently encountered in emergency medicine. Particularly trauma patients, but also other predisposed persons, can be expected to suffer from hypothermia at any time of the year. ⋯ This paper first gives a brief overview of the typical clinical symptoms of hypothermia, before giving a detailed description of the preclinical and in-hospital management of the hypothermia patient. The various rewarming strategies are the subject of special attention and critical evaluation.