Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 2002
Case Reports[Accidental hypothermia--a challenge for rescue service and intensive care].
Accidental hypothermia is a rare clinical picture with different causes. Specific features are shown by patients who have accidents in water, due to rapid cooling. The SARRRAH project (Search and Rescue, Resuscitation and Rewarming in Accidental Hypothermia) was launched to secure fast and professional medical care right up to rewarming by extracorporal circulation. ⋯ Five of the non-survivors belonged to the group of eight patients who were rewarmed by extracorporal circulation. With one exception, they also had the lowest core temperatures. Only a homogeneous and up-to-date documentation will allow further conclusions to be made for improving the concept of therapy.
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Anaesthesiol Reanim · Jan 2002
Review[Etiology and sequelae of perioperative accidental hypothermia].
Accidental hypothermia is a frequent event during the perioperative period. Recent studies revealed a drop in core temperature of over 2 degrees C in more than 50% of all patients undergoing an operation. This drop in core temperature seems to be primarily due to the following factors. ⋯ On the other hand, there is accumulating evidence that accidental perioperative hypothermia may also adversely affect organ function and outcome. For example, unfavourable effects of perioperative hypothermia on the immune defence, on the function of the coagulation system, on cardiovascular performance, as well as on postoperative recovery have been reported. Consequently, measures should be taken to actively control the perioperative heat balance of patients.
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Myocardial ischaemia/reperfusion situations may occur during the perioperative period. The cardioprotective effects of anaesthetics have been known for a long time: volatile anaesthetics reduce the ischaemic cell damage and infarct development. Besides ischaemia, reperfusion itself can also lead to cellular damage, thereby further increasing the ischaemic injury (reperfusion injury). ⋯ The common pathway of the signal transduction cascade of both ischaemic and chemical preconditioning includes the sarcolemnal and/or mitochondrial ATP-sensitive potassium channel. Volatile anaesthetics can imitate the protective effects of a short ischaemia, thereby producing chemical preconditioning. This effect depends, at least in part, on anaesthetic-induced opening of ATP-sensitive potassium channels.
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Anaesthesiol Reanim · Jan 2002
Case Reports[Do position control methods for central venous catheters prevent complications? Hydromediastinum caused by an initially correctly placed tri-lumen subclavian catheter by using intra-atrial ECG recording--a case report].
Central venous catheters (CVCs) can be associated with various complications which arise during insertion, with the catheter in situ or upon its removal. Here we report a case of secondary CVC malposition that occurred despite checks of CVC position by different methods. A subclavian triple-lumen catheter was retracted until intra-atrial ECG indicated reversal to a normal P-wave. ⋯ Moreover, repeated chest radiographs are useful in verifying a correct CVC position and detecting late complications. In summary, CVC complications can occur with delay, are potentially life-threatening and may necessitate repeated checks of catheter position. This case report discusses different approaches to detecting malposition and reviews rare CVC complications.
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When caring for patients with an incurable progressive disease, the physician experiences a feeling of powerlessness because there is no curative treatment that he can offer. The reaction to this must not be resignation, but active palliative medicine to achieve the best possible quality of life for the remaining time. Palliative medicine is a holistic concept of treatment in an outpatient or inpatient setting, integrating physical, psychological, social and spiritual aspects. ⋯ The decision-makers in our health care system are called upon to support palliative medicine and ensure access to palliative care all over the country. Palliative medicine was started to ease suffering, preserve or restore autonomy and maintain dignity. As an active life aid it is, in our opinion, an alternative to any demand for euthanasia.