Der Anaesthesist
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Every action taken by a physician comes under the jurisdiction of the courts. The physician is sentenced when he offends against the duties of care, set down by the respective standard, or when he carries out treatment without having first obtained the patient's consent. Using the examples of many decisions made by the chief justice and the supreme court relating to the field of anaesthesia, this paper sets out to indicate which rules on diligence apply in this area. ⋯ The burden of proof for fulfillment of this obligation lies with the physician. The final part of the paper is a discussion of the documentational obligations, which are important for litigation on the physician's liability. A description of a variety of topics from a physician's everyday work is also given.
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Impaired pulmonary gas exchange can result from lung parenchymal failure inducing oxygenation deficiency and fatigue of the respiratory muscles, which is characterized by hypercapnia or a combination of both mechanisms. Contractility of and coordination between the diaphragm and the thoracoabdominal respiratory muscles predominantly determine the efficiency of spontaneous breathing. Sepsis, cardiac failure, malnutrition or acute changes of the load conditions may induce fatigue of the respiratory muscles. ⋯ As with APRV, alveolar ventilation is maintained even if the spontaneous breathing efforts of the patient cease, which improves the safety of both modes of respiratory therapy. The contribution of spontaneous breathing to total minute ventilation may be important, since a decreased shunt and improved VA/Q relationship have been observed in experimental non-cardiogenic lung oedema. These data give support to the concept that spontaneous breathing should be maintained and augmented in the setting of acute respiratory failure.
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Randomized Controlled Trial Clinical Trial
[Perioperative physiological and cognitive functions following oral premedication with 3.75 mg midazolam in operations with retrobulbar anesthesia].
The number of surgical procedures performed as day surgery has significantly increased in recent years. Therefore, a safe and short postoperative recovery period has become increasingly important. The aim of the present study was to investigate perioperative cognitive and physiological function after oral premedication with low-dose midazolam (3.75 mg), especially during the postoperative period. ⋯ Oral administration of low-dose midazolam (0.049 +/- mg/kg) seems to be appropriate for premedication before ambulatory surgical procedures in elderly patients. In the interest of patient safety, standardised oral premedication with 3.75 mg midazolam may not be sufficient for some of the patients.
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Randomized Controlled Trial Clinical Trial
[The effect of a heat and moisture exchanger (HME) on bronchial mucus transport in a closed inhalation anesthesia system].
The administration of dry anaesthetic gases for ventilation leads to morphological changes of the tracheobronchial epithelium that may cause postoperative pulmonary complications. Therefore, additional humidification with a heat and moisture exchanger (HME) is suggested for ventilation during anaesthesia, particularly when using semi-open breathing systems. Recommendations concerning the use of a HME in the semi-closed system are controversial. There are no data in the literature as to whether a HME improves mucociliary transport under these conditions. We therefore studied bronchial mucus transport velocity (BTV) with and without the use of a HME in the semi-closed circle system in humans. ⋯ BTV does not improve with the use of a HME in the semi-closed circle system with a fresh gas flow of 31. With modern anaesthesia machines lower fresh gas flows should be administered, whereby the humidity and temperature of the inspired gases are further increased.
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Randomized Controlled Trial Clinical Trial
[The interaction of nitrous oxide and enflurane on the EEG median of 2-3 Hz is additive, but weaker than at 1.0 MAC].
The aim of this study was to quantify the interaction of enflurane and nitrous oxide at a constant median EEG frequency. ⋯ The interaction of enflurane and nitrous oxide in the dose range from 0 to 75 vol.-% on median EEG frequency is compatible with additivity. The potency of nitrous oxide as a substitute for enflurane is less than might be expected when adding up the MAC values.