Der Anaesthesist
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Myocardial ischemia is a major cause of perioperative morbidity and mortality. Because of a growing expectancy of lives, the prevalence of cardiovascular diseases is increasing, and thus the number of surgical patients presenting with a cardiovascular risk profile. Based upon pathophysiological considerations, different interventions to lower perioperative cardiovascular risk have been evaluated. ⋯ Another cardioprotective option is the use of statins. Besides their lipid-lowering properties, so called pleiotropic effects are believed to decrease cardiac risk. Furthermore, different interventions can be used in addition to or as an alternative to perioperative beta-blocker therapy, such as alpha-2 agonists, thoracic epidural analgesia or coronary revascularization.
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Electroconvulsive therapy (ECT) is used in the therapy of severe psychiatric disorders. The treatment, in which a generalized epileptic seizure is provoked by electrical stimulation of the brain, is performed under anaesthesia and muscle relaxation. Considering careful previous clinical examination and anaesthesiological and internal contraindications, ECT is a safe form of treatment. The following review is intended to familiarize with ECT and to provide advice for the anaesthesiological management.
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A coagulopathy is an independent predictor of perioperative mortality. Therefore, maintenance of a functional coagulation system is an essential precondition to reduce morbidity and mortality in the perioperative setting. Sound coagulability also depends on prerequisites such as body temperature, acid-base balance, plasma calcium concentration and haematocrit. ⋯ According to the current literature, an increased risk for clinically significant coagulopathy exists with a body temperature
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In an extensive project intensive care units (ICUs) of the Charité University Hospital were reorganized. The aim of this investigation was to determine if staff costs after this reorganization are financed by modular profits of diagnosis-related groups (DRGs). ⋯ The spectrum of intensive care medicine at the Charité University Hospital covers the maximum range of operative and non-operative medicine. After an extensive reorganization of the ICUs under the aspect of staff costs, intensive care medicine can become profitable under the 4.0 G-DRG system. With consequent reorganization the cost efficiency of staff can be optimized, particularly in the setting of high-end intensive care medicine.