Der Anaesthesist
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Case Reports
[The effect of volume status of the right-left shunt in a patient with a patent foramen ovale].
This is a description of the anaesthetic management of a patient with a flow patent foramen ovale undergoing intramedullary nailing of the femur. In order to detect the flow patent foramen ovale, we used transoesophageal echocardiography. ⋯ After the administration of 500 ml hydroxy-starch solution (6%) intravenously, detection of the right-to-left shunt flow was no longer possible. This case report shows that the volume status in a patient with a patent foramen ovale could influence the right to left interatrial shunt during general anaesthesia.
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Five months after the initial abdominal surgery, a female patient presented with a deep venous thrombosis of the right leg. A guide wire, lost during perisurgical insertion of a central venous catheter using Seldinger's technique, was identified and surgically removed. ⋯ The article presents details of the case together with a review of the literature regarding potential complications of Seldinger's technique. Common reasons and possible options for preventive and therapeutic strategies will be discussed.
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Deficits in quality of postoperative pain management are not caused by the complexity of the medical problem or shortage of suitable drugs but by difficulties in organization and hospital structures. Moreover, there is no consensus on how to measure the quality of pain management. Quality management programs consist of strategies to overcome such difficulties and to increase quality continuously. This study reports the implementation of a quality management program to improve postoperative pain management at a university hospital. ⋯ Tools of quality management consisting of deficit analysis, definition of outcome parameters, implementation of improving strategies, post-intervention analysis and continuous feed-back may be successfully used to improve postoperative pain therapy. Changes in organization of medical management seem to be more important than medical or technical aspects. Similar strategies might be used to increase quality of other medical procedures.