Anaesthesiologie und Reanimation
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Skilful analgesia is self-explanatory and needs no justification. In contrast to this, preclinical general anaesthesia is of relative value and depends, in part, on the professional qualities of the emergency physician. Analgesic and anaesthestic drugs should be administered via a safe intravenous line. ⋯ Butylscopolamin is used in colic pain, either alone or in combination with analgesic drugs. Haloperidol is indicated in acute psychotic syndromes as well as psychomotoric and alcohol-dependent excitation. On the whole, profound pharmacological and practical knowledge is necessary, although restricting oneself to just a few drugs increases the depth of one's personal experience.
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Anaesthesiol Reanim · Jan 2004
Clinical Trial[Remifentanil analgesia for aspiration of follicles for oocyte retrieval].
Remifentanil is an esterase-metabolized ultra-short acting mu-agonist opioid with a rapid clearance. The aim of this study was to determine the efficacy of remifentanil infusion for the short-lasting, but painful, transvaginal puncture for oocyte retrieval. Eighty consenting adult women (ASA I and II) aged 30.5 +/- 5 years and with a body weight of 69.1 +/- 9.1 kg were enrolled in this prospective study. ⋯ Some patients, however, showed motoric reactions to vaginal puncture, while in other cases significant and clinical relevant decreases in Hb-oxygen saturation occurred. Therefore, we no longer carry out remifentanil infusion for transvaginal oocyte retrieval. We now prefer a remifentanil infusion of 0.2 microg/kg/min and propofol (1 mg/kg initially with intermittent doses of 0.5 mg/kg) combined with assisted ventilation by mask.
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Anaesthesiol Reanim · Jan 2004
Review[What is anaesthesiology worth in the German DRGs?--First experience with German DRGs].
This overview reports on first experience with German DRGs version 1.0 from 2003, with special regard to relevant procedures and diagnoses of anaesthesiology. Basically, the G-DRGs are a translation of the AR-DRGs 4.1. Only the 2004 version represents a first "real" German DRG system. ⋯ The correct documentation and transfer of ASA classifications is necessary for additional charges in external quality management and to avoid financial sanctions. In our experience, regarding operated patients, anaesthetists can contribute a lot to enquiries by health insurance companies, e.g. whether the payment code for an in- or an out-patient should be used. Departments of anaesthesia should appoint an anaesthetist as DRG representative to supervise anaesthesiological coding and DRG-relevant procedures.
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As a basis for quality assurance measures, we analysed over a period of three years all iatrogenic tracheobronchial injuries that had to be repaired operatively at a university hospital. Twelve patients were affected. In most of these cases, the injuries were the result of an intubation during resuscitation attempts prior to or after admission to hospital (6 patients; 4 of them died later). ⋯ No such serious tracheal injuries were observed. The cause of death in the patients with tracheal injuries was mainly the underlying disease (resuscitation after myocardial infarction; tracheostomy because of pulmonary failure in septic disorders); however, it is likely that the injuries or the surgical intervention played an additional role in the negative outcome of the patients. The conclusion is that this complication rate must be reduced by in-service training and alteration of the procedures.