Der Anaesthesist
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Modern anesthesiology employs the combined administration of several drugs belonging to different pharmacological classes. Additionally, anesthesiologists are facing the challenge of polypharmacy regimens utilized by patients considered for surgical treatment When drugs are combined, the pharmacological effect may considerably differ from the individually expected properties. This may be beneficial or potentially lead to adverse drug reactions harming the patient. ⋯ Depending on the mechanism involved, drug interactions can be classified as pharmaceutical, pharmacodynamic, or pharmacokinetic. Although there are enormous possibilities for adverse drug reactions nd the complexity is hard to identify, prediction of drug interaction is possible. Besides recognizing the general risk factors, fundamental knowledge of basic and clinical pharmacology is important to prevent serious or fatal drug interactions before they occur.
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Clinical Trial
[Noninvasive determination of cardiac output in ventilated patients . Clinical evaluation of a simplified quick method].
This study was performed to evaluate a new simplified rebreathing method to determine cardiac output (CO) in mechanically ventilated patients. ⋯ The rebreathing system evaluated in the present study allows the noninvasive determination of cardiac output with rather high accuracy and good reproducibility. However, technical improvement and further investigation in patients with extremely high cardiac output and shunt values will be needed before its routine clinical use.
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A patient with Parkinson's disease refused both anti-Parkinson medication and general anaesthesia. Low dose remifentanil infusion suppressed her otherwise severe tremor, and the operation was performed uneventfully under local anaesthesia.
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In the current study a questionnaire was developed to evaluate the preanesthetic visit to prepare patients for general anesthesia with regard to the effects on in-hospital quality of care. The questionnaire consists of one part pertaining to patient satisfaction and one part pertaining to the information gained from the preanesthetic visit. In a first phase, the questionnaire was generated and then validated in 104 patients undergoing general or vascular surgery at the University of Heidelberg, Germany. ⋯ Analogous to the measurement of patient satisfaction, a total sum score can be calculated to evaluate the information gain after the preanesthetic visit. The present study shows the suitability of a questionnaire to evaluate the quality of health care after the preanesthetic visit with the parameters patient satisfaction and information gain. Such a questionnaire can be used to compare different premedication techniques and, thus, might contribute to improve the quality of health care.
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Recently, a controversy has arisen as to whether air or saline should be recommended for the correct localization of the epidural space with the loss of resistance technique. I report a case of a previously healthy parturient who developed pneumocephalus and severe headache following the use of the loss of resistance to air (LORA) technique to identify the epidural space. This case report raises one more time the question about the safety of the LORA technique for labor analgesia.