Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 2005
Case Reports[Severe ARDS following perioperative aspiration of gastric content associated with the use of a "ProSeal" laryngeal mask airway].
A ProSeal laryngeal mask airway was used for anaesthesia for laparoscopic surgery in a 26 y old male patient with acute appendicitis. Perioperative aspiration of gastric contents resulted in severe ARDS. Invasive therapeutic options including ECMO had to be used to obtain full recovery. ⋯ Further risk factors were a long period of fasting, untimely removal of the mask before the patient regained full consciousness, the late confirmation of the diagnosis and the hesitant initial therapy. Since PLMA provides a higher airway occlusion pressure compared to the classic laryngeal mask airway (CLMA), the use of this device may be justified for elective laparoscopic surgery. In emergency patients with increased risk of regurgitation endotracheal intubation still remains the gold standard.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2005
Randomized Controlled Trial Clinical Trial[Obturator nerve block for transurethral surgery. comparing ropivacaine 0.75 % vs. prilocaine 1 %].
Obturator nerve block is used for transurethral resection of lateral bladder wall tumors to prevent adductor muscle spasm and associated complications. Therefore, the local anesthetic applied should provide an adequate motor blockade. Ropivacaine 0.75 % was compared to prilocaine 1 % and motor blockade assessment performed by the Medical Research Council (MRC)-scale. ⋯ Ropivacaine 0.75 % is a more appropriate agent for direct obturator nerve block than prilocaine 1 %, providing a faster onset and a more intense and longer-lasting motor blockade. This may reduce surgical complications and facilitate early surgical re-intervention. In this study, MRC-scale was appropriate for motor blockade assessment in a peripheral nerve block.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2005
Review[Catecholamine-resistant hypotension -- an update].
Vasoplegia as catecholamine resistent hypotension occurs in severe hemorrhagic or septic shock and post cardiopulmonary bypass. The entire rational behind this phenomenon is still unclear. An ATP-shortage in the vascular musculature, disregulation of vasopressin release, and the activation of ATP-dependent potassium-channels are discussed. ⋯ Concerning the side effects, vasopressin and methylenblue, like most vasopressors, can cause gastrointestinal ischemia, but with the small number of patients enrolled so far, further major side effects can not be ruled out. Accordingly, the identification of risk factors for the development of vasoplegia and the prediction of the extent of the response or the rate of non-responders to these treatments are widely unknown. However, although the administration of vasopressin and methylenblue can not be recommended as a standard treatment it provides an additional option in individual cases of life threatening vasoplegia.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2005
[Implementation of modern operating room management -- experiences made at an university hospital].
Caused by structural changes in health care the general need for cost control is evident for all hospitals. As operating room is one of the most cost-intensive sectors in a hospital, optimisation of workflow processes in this area is of particular interest for health care providers. While modern operating room management is established in several clinics yet, others are less prepared for economic challenges. ⋯ In addition, experiences made with implementation of new management structures are described and results obtained over the last 5 years are reported. Whereas the total number of operation procedures increased by 15 %, the operating room utilization increased more markedly in terms of time and cases. Summarizing the results, central operating room management has been proved to be an effective tool to increase the efficiency of workflow processes in the operating room.