Der Anaesthesist
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Randomized Controlled Trial
[Intra-articular ketamine after arthroscopic knee surgery. Optimisation of postoperative analgesia].
Surgery of the knee can be very painful and sufficient postoperative pain treatment is often problematic. To optimize postoperative analgesia, application of local analgesics has been suggested. In the present study it was investigated whether intra-articular administration of ketamine reduces the level of pain after arthroscopic knee surgery. ⋯ The i.a. application of ketamine after arthroscopic knee surgery leads to a significant decrease of postoperative analgesic demand and decreases patients' subjective level of pain compared to i.a. application of bupivacaine or placebo. Likewise, the i.v. application of ketamine is similarly effective but the effect is of shorter duration.
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We have used the Stewart approach to typical acute and compensated acid-base disorders here. Dedicated software developed by the author is available with this article and will be of help to anyone considering analyzing his or her own patients using the Stewart approach. The Stewart approach shares analytical steps with the more traditional Siggard-Andersen method, and in most cases the two methods arrive at the same therapeutic solutions. The Stewart approach is, however, more than merely a biophysical appendix to the traditional clinical model, since metabolic acid-base disorders in particular are understood within a completely different pathophysiological framework; this results in a fresh and sometimes unexpectedly helpful perspective that highlights the functional relevance of seemingly forgotten components such as the chloride ion or albumin.
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Despite the increasing use of ultrasound, electrical nerve stimulation is commonly used as the standard for both plexus and peripheral nerve blocks. Several recent randomized trials have contributed to a better understanding of physiological and clinical correlations. Traditionally used currents and impulse widths are better defined in relation to the distance between needle tip and nerves. ⋯ Blockade of the femoral nerve can be performed without any nerve stimulation if the fascia iliaca block is used. Independently of the various approaches to the sciatic nerve, inversion and plantar flexion are the best options for single-shot blocks. Further clinical trials are needed to define the advantages of stimulating catheters in continuous nerve blocks.
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Over the last 30 years the Advanced Trauma Life Support (ATLS) course has become the most successful training program in the world for the early care of severely injured patients. It has shaped trauma care systems in many countries and is now on the verge of being introduced into Germany by the German Society of Trauma Surgery (DGU). However, after publication of the latest edition in 2004 there are rising concerns regarding the lack of multi-disciplinarity, out-dated contents and lack of adaptability to regional needs. This article questions the beneficial effect of ATLS on the advanced German trauma care system and concludes that ATLS is not likely to improve trauma care in Germany.
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Case Reports
[Application of the current resuscitation guidelines 2005. Case report of successful cardiopulmonary resuscitation].
The international guidelines for cardiopulmonary resuscitation are subject to continuous modification and were revised in November 2005. This report describes a case of an out-of-hospital cardiopulmonary resuscitation where the patient survived a cardiac arrest without neurological sequelae after chest compression (30:2), bag-mask ventilation and multiple biphasic defibrillation (single shocks). This article gives a practical review of the most important new recommendations in the current resuscitation guidelines. The accomplished measures are discussed on the background of the new recommendations.