Der Anaesthesist
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The localisation of the nerve to be blocked is one of the special challenges in local anaesthesia. Since the first time local anaesthesia procedures were carried out approximately 100 years ago, the basic limitations of this method have always been the unsatisfactory success rate and the specific risks involved. Even by variation of the access route to the various nerves and use of different identification methods, no ideal blockade technique has been found which allows a 100% success rate and at the same time reduces the risks to a minimum. ⋯ Organising committees have established that this method will be the future direction. Perhaps even the prediction of Alon P. Winnie for ultrasound-guided local anaesthesia will become true: "Sooner or later someone will make a sufficiently close examination of the anatomy involved, so that exact techniques will be developed."
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Review Case Reports
[Current aspects of the diagnosis of malignant hyperthermia].
The aim of this work was to give a survey of experiences and results obtained over a period of 15 years of diagnosis of malignant hyperthermia in the MH centre in Leipzig. The new branch of MH diagnosis, the molecular genetics and its general diagnostic potential will be presented in more detail. ⋯ The disposition to MH may be assessed by the IVCT, DNA analysis and with limitations by the clinical phenotype. The IVCT represents a highly specific method, the DNA analysis appears to be very specific. Under defined conditions an alternative use of the methods is possible. However, these methods should not be regarded as in competition but rather their potential should be complementary or used in specific situations in order to avoid non-detection of MH events in affected families.
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Herpes simplex infections are potentially a life-threatening situation for immunocompromised as well as critically ill patients. The correct diagnosis is made more difficult in comatose patients by the fact that the characteristic symptom of extreme pain cannot be registered. The clinical dermatological findings (polycyclic configuration, easily bleeding ulcers) are thus especially important in patients under intensive care conditions. ⋯ All patients subsequently died. These cases emphasize that patients in the intensive care unit are in danger of developing a chronic persistent Herpes simplex infection due to latent immunosuppression. Chronic persistent Herpes infections may be underrated in intensive therapy, and must always be ruled out in case of therapy-resistant erosions or ulcerations.
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The role or recognition of the anaesthetist as an independent medical specialist has been the subject of many studies. Since most of this work was performed in English speaking countries, only few data are available for Germany, Austria, or Switzerland. The goal of this study was to determine how much knowledge patients had of the training and activities of anaesthetists. The study included patients ( n=685) who underwent elective operations in all surgical subspecialties at the University Hospital of Basel. ⋯ Since other even more elaborate and expensive methods such as large exhibitions, national anaesthesia days, or increased coverage on radio and television also failed to enhance patients' knowledge, the focus is once again on the relationship between the patient and anaesthetist. If we wish to improve the role and recognition of anaesthetists for patients and/or the public, the anaesthetist must be visible for the patients as a true physician in the pre- and postoperative period. To improve this important patient-anaesthetist relationship, we have begun a training program in communication skills for all physicians in our department.