Der Anaesthesist
-
Peripheral regional anesthesia is a commonly used and safe procedure and eneral complications or side effects are generally rare. Nerve damage has an incidence <0.1% depending on the definition and the prognosis is good. To avoid bleeding complications the national standards of block performance under antithrombotic therapy should be respected. ⋯ Potential infectious complications can occur mainly as a result of catheter techniques and require a strict aseptic approach. Further rare complications are allergies, dislocation of catheters and knotting or loops in catheters. Besides the general complications, there are some specific complications depending on the puncture site, such as pneumothorax or renal puncture.
-
Ambulatory surgery continues to grow and is slowly becoming routine in the majority of cases. Although the development of ambulatory surgery in Germany appears to be somewhat delayed, this is actually a chance to learn from worldwide experiences and avoid the mistakes others made earlier. This article investigates current trends and developments in day case surgery and discusses the extended role and influence of the anesthetist in the perioperative setting.
-
High risk pulmonary embolism commonly presents with a variety of symptoms and is an acute life-threatening event. In patients showing unclear acute circulatory distress, pulmonary embolism should be quickly ruled out by computed tomography or echocardiography. The diagnostic steps and surgical treatment of pulmonary embolism in a 25-year-old female patient suffering from acute circulatory insufficiency resulting in cardiac arrest within 11 min after emergency hospital admission are reported. ⋯ The patient was successfully extubated the following day and despite the long resuscitation time the outcome was excellent without any neurological deficit. Recent publications addressing the advantages of primary embolectomy versus intravenous thrombolysis in acute circulatory distress caused by pulmonary embolism are discussed. Primary surgical treatment including cardiopulmonary bypass for right ventricular relief and re-establishing of systemic perfusion is recommended for patients with pulmonary embolism undergoing cardiopulmonary resuscitation.
-
Patients with multiple trauma presenting with apnea or a gasping breathing pattern (respiratory rate <6/min) require prehospital endotracheal intubation (ETI) and ventilation. Additional indications are hypoxia (S(p)O(2)<90% despite oxygen insufflation and after exclusion of tension pneumothorax), severe traumatic brain injury [Glasgow Coma Scale (GCS)<9], trauma-associated hemodynamic instability [systolic blood pressure (SBP)<90 mmHg] and severe chest trauma with respiratory insufficiency (respiratory rate >29/min). The induction of anesthesia after preoxygenation is conducted as rapid sequence induction (analgesic, hypnotic drug, neuromuscular blocking agent). ⋯ Normoventilation should be the goal of mechanical ventilation. After arrival in the resuscitation room the ventilation will be controlled and guided with the help of arterial blood gas analyses. After temporary removal of a cervical collar, the cervical spine needs to be immobilized by means of manual in-line stabilization when securing the airway.
-
Intensive care medicine plays an important role in the medical care of patients as well as the economic success of hospitals. Knowledge and implementation of recent relevant scientific evidence are prerequisites for high quality care in intensive care medicine. ⋯ In 2010 and up to June 2011 many studies with high patient numbers have been published. The main topics were the treatment of respiratory failure, sepsis and investigations to improve analgosedation.