Der Anaesthesist
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Postoperative pain therapy, i.e., the symptomatic treatment of acute post-surgical pain, is an interdisciplinary obligation of the anaesthesiologist and managing surgeon toward the patient. The failure to provide appropriate pain therapy, in particular withholding analgesic agents, can be regarded as malpractice and result in civil, criminal, and professional legal consequences. As with other medical treatments, the patient must be adequately informed about pertinent details prior to the use of pain therapy, particularly in regard to specific risks and feasible alternative measures. All pain therapy employed must be duly recorded.
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Unnoticed, minor damage to the unidirectional respiratory valves of the Draeger respiratory circuit may lead to intermittent and unpredictable malfunction, resulting in rebreathing and hypercapnia. The damage may be so minor that normal visual and functional test routines may be insufficient to detect it. We report one case of a potential life-threatening malfunction of the inspiratory valve and also propose economical solutions utilizing altered construction, modified machine-check procedures, or a simple instrument that adds only one step to the machine-check procedure. ⋯ This problem results in a significant but incalculable increased in risk to patients. Because of unclear reproduceability of intermittent malfunctions caused by borderline damage, there also is an increased forensic risk for the anaesthesiologist. The risk of mechanical malfunction might be displaced by software problems in new-generation ventilators in the market.