Der Anaesthesist
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Nociception is a protective system of the body which prevents it from injury and tissue damage. Human beings respond to noxious stimuli by moving away. They learn by pain to avoid these situations in future. ⋯ Good antinociception may be even more important than it is assumed today. Anand demonstrated a lower morbidity and mortality in 45 newborns undergoing cardiothoracic surgery, when general anaesthesia was performed with high-dose sufentanil versus halothane supplementary doses of morphine. Anaesthesiologists have to reconsider the quality of general anaesthesia: the antinociception of their regimen.
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Although the need for the implementation of a quality management concept for the German emergency medical system (EMS) has been discussed for more than 10 years, such a concept has not been realised on a broad scale. Standardised national data sheets were developed many years ago. They are used by many local agencies, but a data-gathering system on a state or national basis is still lacking. ⋯ Quality control works on the basis that all EMS team members are motivated to perform on a professional level to ensure that each patient is treated adequately. It evaluates the system to create circumstances that enhance the achievement of this goal. Quality management is not only concerned with mishaps, because areas with documented good performance also provide important information.
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Clinical Trial
[Patient-controlled postoperative epidural analgesia. Prospective study of 1799 patients].
Side effects of postoperative epidural analgesia can be controlled by two strategies: Insertion of catheters into the center of the affected spinal segments and coadministration of local anesthetics and opioids. Both techniques will reduce single drug dosage. Additionally synergistic effects will result in excellent analgesia and the risk of side effects and complications will be minimized. ⋯ Mean VAS-scores during the postoperative observation-period were within the prior defined limits. On the morning after surgery, however, a reduction in pain relief was observed and analgesia on the first postoperative day could significantly be improved after a 24-h on call pain service has been introduced. Except urinary retention side effects are rare. Probability of motor-blockade is significantly lower in patients with thoracic compared to patients with lumbar catheters. Not any patient suffered from severe complications such as sedation or respiratory depression.de
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Pheochromocytomas are functionally active, catecholamine-secreting tumours of chromaffin tissue. The mainstay of pharmacological therapy is preoperative treatment with oral phenoxybenzamine. This drug irreversibly alkylates alpha-1-adrenergic receptors on vascular smooth muscle and renders them nonfunctional, thereby causing vasodilatation. ⋯ After complete resection of a total of three tumours, no further hypertensive crises occurred. The patient's postoperative course was uneventful. We conclude that in this patient presenting with an unsuspected multilocular pheochromocytoma, the lack of permanent alpha-blockade was probably helpful in allowing complete resection of all the tumours.