Der Anaesthesist
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Comparative Study Observational Study
[Methohexital for analgosedation of ventilated intensive care patients : Prospective nonrandomized single center observational study on incidence of delirium.]
Delirium is defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) as a potentially reversible disturbance of consciousness and a change of cognition caused by a medical condition, drug intoxication, or medication side effect. Delirium affects up to 80 % of intensive care unit (ICU) patients and is associated with increased morbidity and mortality. One risk factor for development of delirium in ventilated intensive care unit patients is sedation. The German S3 guidelines on "Analgesie, Sedierung und Delirmanagement in der Intensivmedizin" (analgesia, sedation and delirium management in intensive care medicine) of the DGAI (German Society for Anesthesiology and Intensive Care Medicine) and the DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine) recommend midazolam and propofol for sedation, although both drugs are associated with a high incidence of delirium. ⋯ Sedation with methohexital compared to midazolam or propofol reduced the incidence of delirium by more than 50 % in ventilated ICU patients.
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Practice Guideline
[Perioperative management of patients with obstructive sleep apnea : Update on the practice guidelines of the American Society of Anesthesiologists Task Force.]
Obstructive sleep apnea (OSA) is a widespread disease which is associated with many cardiovascular diseases and can have health-related consequences for affected patients if untreated. It is known that perioperative airway complications occur more often in OSA patients during general anesthesia. ⋯ These guidelines have now been revised and updated. This article gives a summary of the recommended approach for the perioperative treatment of patients with OSA given in the 2014 guidelines.
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The word "secondary alarm" also sometimes known as "comfort alarm" means that a system indicates a critical situation (alarm condition) but this does not happen with the safety of an alarm system. A closer inspection of the small print reveals that the comfort alarm is in reality not an alarm but only additional information. This article summarizes in compact form what consequences this has for the user and what precautions should be taken when acquiring an alarm system.
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Transoral laser surgery has become a standard procedure in the treatment of benign and malignant neoplasms of the upper aerodigestive tract. As the laser cuts and coagulates simultaneously, intraoperative bleeding is reduced, thus improving visualization of the operative field. ⋯ Although potentially fatal complications are rare, surgeon and anesthesiologist need to be aware of the dangers at all times and have exact knowledge of emergency measures. The use of suitable laser-resistant endotracheal tubes, total intravenous anesthesia and an optimized breathing gas mixture can contribute to minimize the occurrence of complications in otorhinolaryngology laser surgery.