Der Anaesthesist
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Abstract
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Review
Ventilator autotriggering : An underestimated phenomenon in the determination of brain death.
Ventilator autotriggering (VAT) may induce uncertainty in diagnosing brain death because it may falsely suggest a central respiratory drive in brain-dead patients where no intrinsic respiratory efforts exist. Since the lack of international standardization of brain death criteria contributes to the loss of potential donor organs, it is important to be aware of this phenomenon, which is a not well-known confounder in the process of diagnosing brain death. ⋯ The phenomenon of VAT is inconsistently addressed in the national guidelines and recommendations for the determination of brain death and should, therefore, be included in future harmonized brain death codes. Detection and correction of VAT should be implemented as early as possible by a structured procedure. Additional training and information on this phenomenon should be made available to the entire intensive care unit staff.
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Trauma-related deaths are not only a relevant medical problem but also a socioeconomic one. The care of a polytraumatized patient is one of the less commonly occurring missions in the rescue and emergency medical services. The aim of this article is to compare the similarities and differences between different course concepts and guidelines in the treatment of trauma-related cardiac arrests (TCA) and to filter out the main focus of each concept. Because of the various approaches in the treatment of polytraumatized patients, there are decisive differences between trauma-related cardiac arrests and cardiac arrests from other causes.
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Randomized Controlled Trial Clinical Trial
Efficacy of midazolam addition to local anesthetic in peribulbar block : Randomized controlled trial.
Peribulbar block is considered a safe option for patients undergoing cataract surgery. The limited duration of regional eye blocks was shown to be the main problem. The objective of this study was to evaluate the effects of adjuvant midazolam (in two concentrations) to lidocaine in the peribulbar block. ⋯ Addition of midazolam to local anesthetic significantly improved the quality of peribulbar block, hastened the onset of sensory anesthesia, lid and globe akinesia and increased the duration of analgesia without notable side effects.
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Working in anesthesiology is characterized by a complex environment in which effective teamwork with different disciplines as well as other professions (e. g. nursing staff and surgical assistants) is crucial. Clinical risk management includes all steps to prevent incidents and patient harm. An example for this is simulation training based on crisis resource management (CRM). ⋯ The decision to finance CRM-based simulation training remains a fundamental decision of the management of the respective hospital. In the near future, pressure from liability insurers to prevent incidents might increase. The inclusion of CRM-based simulation training as an integral component of clinical risk management could provide key benefits in contract negotiation.