Articles: function.
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In Germany approximately 3000 body organs are transplanted annually. In general, all artificially ventilated patients with diagnosed brain death are potential organ donors. All German hospitals are obliged to report potential organ donors and be actively involved in the organ donation process. ⋯ Brain death is associated with complex pathophysiological changes in cardiopulmonary function as well as fluid, electrolyte and metabolic homeostasis. In the case of diagnosed brain death and with permission for organ donation, a precise organ-protective therapy is initiated, essentially focussing on optimal organ perfusion and oxygenation. The quality of organ protection has a direct influence on the outcome of transplantation.
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Review Case Reports
Lower urinary tract dysfunction in the neurological patient: clinical assessment and management.
Lower urinary tract (LUT) dysfunction is a common sequela of neurological disease, resulting in symptoms that have a pronounced effect on quality of life. The site and nature of the neurological lesion affect the pattern of dysfunction. The risk of developing upper urinary tract damage and renal failure is much lower in patients with slowly progressive non-traumatic neurological disorders than in those with spinal cord injury or spina bifida; this difference in morbidity is taken into account in the development of appropriate management algorithms. ⋯ Intradetrusor injections of onabotulinumtoxinA have transformed the management of neurogenic detrusor overactivity. Neuromodulation offers promise for managing both storage and voiding dysfunction. An individualised, patient-tailored approach is required for the management of LUT dysfunction associated with neurological disorders.
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Anesthesia and analgesia · Jul 2015
ReviewA Quantitative Approach to the Intraoperative Echocardiographic Assessment of the Mitral Valve for Repair.
Intraoperative echocardiography of the mitral valve has evolved from a qualitative assessment of flow-dependent variables to quantitative geometric analyses before and after repair. In addition, 3-dimensional echocardiographic data now allow for a precise assessment of mitral valve apparatus. Complex structures, such as the mitral annulus, can be interrogated comprehensively without geometric assumptions. ⋯ Given this context, echocardiographers may be expected to diagnose and quantify valvular dysfunction, assess suitability for repair, assist in annuloplasty ring sizing, and determine the success and failure of the repair procedure. As a result, anesthesiologists have progressed from being mere service providers to participants in the decision-making process. It is therefore prudent for them to acquaint themselves with the principles of intraoperative quantitative mitral valve analysis to assist in rational and objective decision making.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2015
Review[Epidural analgesia in combination with general anesthesia].
Epidural anaesthesia is a widely used and accepted technique for perioperative analgesia in different kinds of surgery. Apart from analgetic effect and due to wide positve effects on patients outcome epidural analgesia is often used with general anaesthesia. ⋯ Further, a benefit is expected in patient's mortality. This article summarizes and critically discusses the current knowledge on the effects of epidural anaesthesia on pain management, cardiopulmonary as well as gastrointestinal functions and patient's outcome.
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Minerva anestesiologica · Jun 2015
ReviewOptimal technique for deep breathing exercises after cardiac surgery.
Cardiac surgery patients often develop a restrictive pulmonary impairment and gas exchange abnormalities in the early postoperative period. Chest physiotherapy is routinely prescribed in order to reduce or prevent these complications. Besides early mobilization, positioning and shoulder girdle exercises, various breathing exercises have been implemented as a major component of postoperative care. ⋯ Arbitrary instructions are given, and recommendations on performance and duration vary between hospitals. Deep breathing exercises are a major part of this therapy, but scientific evidence for the efficacy has been lacking until recently, and there is a lack of trials describing how postoperative breathing exercises actually should be performed. The purpose of this review is to provide a brief overview of postoperative breathing exercises for patients undergoing cardiac surgery via sternotomy, and to discuss and suggest an optimal technique for the performance of deep breathing exercises.