Der Anaesthesist
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To compare the effects of total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) used in lumbar disc herniectomy on postoperative cognitive recovery based on the mini-mental state examination (MMSE) score and neuron-specific enolase (NSE) levels. ⋯ The use of IA may result in higher cognitive dysfunction 1h after the operation compared to TIVA. The effects of both methods on cognitive functions were similar at 24 h postoperatively.
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Increasing requirements for documentation, cross-sectoral communication and quality management are leading to increased organizational effort in emergency medical services (EMS). On the one hand, the use of digital information systems in prehospital settings can help to support emergency physicians and paramedics in these tasks and on the other hand, it opens new treatment options such as telemedical care for patients. This work attempts to provide a comprehensive picture of the current use of digital systems for ambulance services in Germany. To do so, the study investigated how widespread various information and communication systems currently are at local EMS stations and ambulances, how they are used by emergency personnel, how they are assessed by users and what challenges currently exist for further expansion and greater acceptance of the users. ⋯ Although information technology systems in German EMS are no longer in their infancy, there is still a long way to go before prehospital emergency care can be considered as extensively and adequately digitalized. A more holistic perspective and networked implementation of all systems and processes involved in emergency response operations can help improve and further spread digital solutions for prehospital emergency care. Incorporating field experience into the development process could contribute to increasing functionality and user acceptance.
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Review
[Intensive Care ventilation-New norm establishes a uniform nomenclature for ventilation modes].
The current naming of ventilation modes in anesthesiology and critical care is characterized by manufacturer-specific inconsistent acronyms. This is confusing for users and potentially life-threatening for patients. The standard, published in August 2021 in its German version as DIN EN ISO 19223:2021, aims to introduce a uniform classification with corresponding nomenclature. ⋯ Standardized terminology and semantics in respiratory care are necessary and desirable for error reduction. However, the recently presented standard fulfils these expectations only to some extent and in its current form will probably lead to further ambiguities and problems in the clinical routine. Accordingly, it is imperative that this first version of DIN EN ISO 19223:2021 be understood as the starting point for a discussion of its content, even outside the standards committees, so that its obvious weaknesses can be eradicated and the nomenclature made suitable for everyday use.
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Emergency medical care for critically ill nontrauma patients (CINT) varies between different emergency departments (ED) and healthcare systems, while resuscitation of trauma patients is always performed within the ED. In many ED CINT are treated and stabilized while in many German smaller hospitals CINT are transferred directly to the intensive care unit (ICU) without performing critical care measures in the ED. Little is known about the resuscitation room management of CINT regarding patient characteristics and outcome although bigger hospitals perform ED resuscitation of CINT in routine care. Against this background we conducted this retrospective analysis of CINT treated by an ED resuscitation room concept in a German 756 bed teaching hospital. ⋯ The observed mortality was high and was comparable to patient collectives with septic shock. Nonsurvivors showed significantly more impaired vital parameters and blood gas analysis parameters. Vital parameters together with blood gas analysis might enable ED risk stratification of CINT. Resuscitation room management enables immediate stabilization and diagnostic work-up of CINT even when no ICU bed is available. Furthermore, optimal allocation to specialized ICUs can probably be enabled more accurately after a first diagnostic work-up; however, although a first diagnostic work-up including laboratory tests and computed tomography in many cases was performed, ED admission and hospital discharge diagnoses matched only in 78%.