Der Anaesthesist
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Biography Historical Article
[Beginning of continuous wound infusion with local anesthetics : With special emphasis on the contributions from Walter Capelle and Ewald Fulde].
Wound infusion with local anesthetics is a proven and safe analgesic procedure for modern perioperative patient care. Even the pioneers of local anesthesia practiced wound analgesia and emphasized the shortcomings of "single-shot" wound infusions. At the same time, they drew attention to the importance of long-lasting pain relief to prevent sequelae, especially after upper abdominal surgery with pneumonia, embolic events or postoperative ileus. ⋯ This measure was carried out to enable reduction in pain and allow early postoperative mobilization. The conceptual development of this pioneering analgesia method is closely connected with the names of the Berlin surgeons Walter Capelle and Ewald Fulde; however, their inaugurated and propagated therapy concept did not find the attention and dissemination that it deserved. This is a reason for us to remember their pioneering ideas on pain management in the context of current developments.
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We report an unusual complication following placement of a thoracic epidural catheter in a patient that had undergone surgery for pulmonary metastases of a malignant melanoma. The intra- and postoperative course was initially without complications. At 2 days, there was a small, conspicuous swelling above the site of epidural puncture, which was neither reddened nor painful. ⋯ Facklamia hominis was detected in the pure culture. To avoid bacterial infection, we treated the patient for 7 days with antibiotics. The clinical course was without further pathological findings.
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An impairment of cardiac function is a key feature of cardiovascular failure associated with sepsis; however, its clinical relevance is still underestimated. Recent advancements in echocardiography in patients with septic shock enable a better characterization of septic cardiomyopathy by unmasking a severe, cardiac dysfunction even in the presence of preserved left ventricular ejection fraction. ⋯ To date, the cornerstone of therapeutic management lies in control of the underlying infectious process and hemodynamic stabilization. This review summarizes the pathogenesis, diagnosis, and treatment of septic cardiomyopathy, and highlights the importance of further urgently needed studies aimed at improving diagnosis and treatment for septic cardiomyopathy.
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Even after many years of intensive research acute respiratory distress syndrome (ARDS) is still associated with a high mortality. Epidemiologically, ARDS represents a central challenge for modern intensive care treatment. ⋯ Lung protective mechanical ventilation and adjuvant therapies, such as the prone position and targeted extracorporeal lung support are of particular importance in the treatment of ARDS, depending on the severity of the disease. In order to guarantee an individualized and needs-adapted treatment, ARDS patients benefit from treatment in specialized centers.
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Editorial Comment
[Sharpen the classical view of septic cardiomyopathy].