Der Anaesthesist
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Early defibrillation is the standard of care for patients with ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). Technical developments aim at further miniaturization and simplification of defibrillators as well as adaptation of energy requirements to the patient's needs. Implantable Cardioverter-Defibrillators (ICD) and automated external defibrillators (AED) are based upon the same technology. ⋯ Developments concerning the structure of in-hospital emergency systems or pre-hospital emergency medical services (EMS) aim at further reductions in time from collapse of a patient until first defibrillation. Such developments include early defibrillation programs for emergency medical technicians (EMT), nurses, and fire or police department first responders as well as wide distribution of easy-to-operate defibrillators in public areas, as discussed during the American Heart Association's Public Access Defibrillation conferences. All programs of that kind have to be organized and supervised by a physician who is responsible for training and supervision of the personnel involved.
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Randomized Controlled Trial Clinical Trial
[Randomized, double-blind study with ketoprofen in gynecologic patients. Preemptive analgesia study following the Brevik-Stubhaug design].
The clinical effect of ketoprofen is based not only on the inhibition of prostaglandin synthesis. Ketoprofen also acts through kynurenic acid as a central antagonist on the NMDA receptor. Due to this central analgesic mechanism of ketoprofen, we expected an analgesic preemptive effect. This study was carried out following the Breivik/Stubhaug preemptive effect study design. ⋯ We showed a preemptive effect with ketoprofen, which was expressed significantly both in terms of the time to first analgesic request and by the lower analgesic consumption in the first 24 hours after surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Can sevoflurane save time in routine clincal use? A comparison with halothane in pediatric anesthesia].
The volatile agent sevoflurane enables a rapid emergence from anaesthesia. The aim of this study was to investigate the possibility of increasing turnover in pediatric anaesthetic cases by use of sevoflurane in comparison with halothane. Often short cases or day cases need rapid turnover. ⋯ Sevoflurane offers the potential for shortening turnover in pediatric anaesthesia.
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In addition to renal elimination and gastrointestinal metabolism (amylase; splenic and hepatic dextranase) colloid plasma solutions like dextran and hydroxyethyl starch deposit in tissues, especially in the reticuloendothelial system (RES). This tissue storage is limited in time (weeks to months), is influenced by the employed solution and other factors (lysosomes) and has usually no clinical importance (no RES blockade). ⋯ This storage may have impaired ventilation, transport of bile acids and renal function. A possible role of tissue storage of colloids in organ failure is discussed.
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Turnaround time for analysis of prothrombin time (PT) and activated partial thromboplastin time (APTT) by standard laboratory methods ranges between 40 min and several hours. The delay in obtaining the test results limits their clinical utility for treatment of perioperative coagulation disorders and adequate anti-coagulation therapy. In this study, we compared on-site coagulation testing (OCT) of whole blood, which takes about 3 min, with standard laboratory plasma coagulation tests by our institutional laboratory (LAB) to assess the accuracy of the OCT in a clinical setting (abdominal and postcardiac surgery). ⋯ On-site coagulation monitoring provides a rapid, convenient, and accurate assessment of coagulation that can both guide specific anti-coagulation therapy and optimize therapy control of coagulation disorders after cardiac and abdominal operations. As a consequence, OCT offers a valuable tool to reduce the inappropriate use of fresh frozen plasma and to improve cost-effectiveness.