Der Anaesthesist
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Review Meta Analysis
[Current concepts of augmented spontaneous breathing : New modes of effort-adapted weaning.]
The use of augmented spontaneous breathing is an important component in a bundle concept of weaning from mechanical ventilation as it was demonstrated that controlled ventilation with diaphragmatic underuse induces rapid muscle atrophy and impairs successful weaning. On the other hand spontaneous breathing is often associated with disturbed patient-ventilator interaction resulting in asynchrony (e.g. ineffective triggering, early termination of inspiration and overflow or underflow). ⋯ It was shown in some smaller clinical investigations that these newer modes are able to improve patient-ventilator interaction, to reduce the burden on respiratory muscles and to increase ventilation comfort. Although large randomized controlled studies are lacking, effort-adapted modes of augmented breathing will become a routine part in the management of weaning from mechanical ventilation.
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Tragic accidents, e.g. involving celebrity patients or severe incidents in hospital occur suddenly without any advance warning, often produce substantial interest by the media and quickly overburden management personnel involved in both hospitals and emergency medical services. While doctors, hospitals and emergency medical services desire objective media reports, the media promote emotionalized and dramatized reports to ensure maximum attention and circulation. When briefing the media, the scales may quickly tilt from professional, well-deliberated information to unfortunate, often unintended disinformation. ⋯ Each hospital or emergency medical service should have a professional department for public relations, an exact knowledge of the regional and national media and strategies how to handle an incident that is of interest for the media. The media should be provided with information not only when a negative incident has happened but should be provided with regular positive messages as well. An interview must be carefully prepared to achieve a good image.
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A case of delivery of a hypoxic gas mixture to a patient during total intravenous anesthesia is described. A progressive fall in inspiratory oxygen concentration followed by a drop in oxygen saturation below 90 % occurred during the advanced stages of a hitherto uneventful general anesthesia of a female patient undergoing anterior cervical fusion surgery. A malfunctioning defective rubber seal of a vaporizer manifold was identified as the cause of the gas leak. ⋯ The problem of hypoxic gas mixtures and uncommon leaks in modern anesthesia equipment is discussed. The importance of locating a leak in the high or low pressure circuits is explained. An algorithm for the management of an unexpected decrease of inspiratory oxygen concentration or any other manifestation of a gas leak along with a systematic approach to locating the source of a gas leak is presented.
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There is a high level of evidence that parental presence during induction of anesthesia in children does not lead to a reduction of fear and better cooperation of the child. However, pediatric anesthetists often encounter the request of parents to be present during the induction of anesthesia which is current practice in many countries. This article explains the grounds and the premises for this practice and describes those factors which might be important to support parental presence during induction of anesthesia in children. Some practical advice and tips on how parental presence in the clinic can be practically implemented are given at the end of the article.
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The results of preclinical and clinical studies indicate that the perioperative period is a vulnerable period for cancer progression and metastasis. The risk of cancer cell dissemination is enhanced by the combination of surgical manipulation and perioperative immunosuppression. Whether the oncological outcome of cancer patients can be influenced by the choice of anesthetic techniques is still a matter of debate. This review summarizes the molecular characteristics of cancer and interaction of anesthetic and analgesic drugs with cancer cells.