Der Anaesthesist
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Comparative Study
[Intended and actual paths of epidural needles. Investigations with a test tissue model].
Peridural anaesthesia needles (PDA) do not only differ in calibre or gauge but also vary in the design of the needle tip, which shows a special configuration to place a catheter in the epidural space. A laboratory model was performed to determine the influence of different types of virgin epidural needles concerning their path through tissue. In an additional test run we analysed the influence of a previous use on the path through tissue. ⋯ As expected, the average deviation of PDA needles depended on the diameter. No differences in the degree of deviation for virgin needles compared to previously used needles could be found. Thus, more than one application of the same needle in one patient is considered to be safe as long as the needle is not deformed in any way.
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Induction areas (IA) can lead to more efficient operating sessions through shortening the changeover time between patients. To date IAs have always required additional staff members, whose cost was only partly covered by improvements in productivity. The objective of this project was to demonstrate that a reduction in non-operative time through a newly introduced induction area can be achieved without a need for extra personnel. ⋯ An induction area can be established and can reduce non-operative time and improve operation theatre throughput without the need for extra personnel. The efficiency of these measures will be increased when the relevant surgical organizational measures are taken to adjust to the faster anesthesiology workflow. The induction area does not lead to a higher rate of critical incidents. To what extent the induction area can be used for structured training of doctors and nurses, remains to be investigated.
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Randomized Controlled Trial
[Non-invasive extended hemodynamic monitoring. Reduction of circulatory risk situations].
Cardiac output and the cardiac index (CI) are not routinely monitored during major abdominal surgery for economic as well as medical reasons. This practice, however, might be changed by the application of newer non-invasive technologies like the partial CO(2) rebreathing method based on the inverse Fick's principle. In this prospective randomized study we investigated the impact of a non-invasive monitoring of CI on the incidence of hemodynamic instability and interventions by the attending anesthesiologist during major abdominal surgery. ⋯ The incidence of hemodynamic instability was significantly reduced during major abdominal surgery when anesthesiologists were aware of the measurement results of extended hemodynamic monitoring.
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Review
[Ultrasound-guided anaesthesia of peripheral nerves. The new challenge for anaesthesiologists].
Ultrasound-guided anaesthesia of peripheral nerves is a new challenge for anaesthesiologists. The number of ultrasound users in this field has increased over the last 10 years because of improved high frequency ultrasound technology and increased mobility of machines. ⋯ Basic knowledge in ultrasound technology and image characteristics and a defined approach to blocking procedures to ensure sterile working conditions are necessary to guarantee optimal safety of patients. Furthermore economic questions and the implementation of a standardised education program are very important.