Der Anaesthesist
-
The administration of paracetamol (in the US known as acetaminophen) to children and infants for postoperative pain after minor surgery is a well established and safe treatment option, if appropriately used. However, if paracetamol is dosed according to traditional recommendations (about 20 mg/kg body weight) frequently a sufficient analgetic effect cannot be achieved immediately after painful interventions. Recently, a higher initial dose (40 mg/kg body weight) was suggested for effective postoperative pain control, which seems especially important for children after ambulatory anesthesia, but may also be associated with certain risks to the patient. ⋯ In contrast, the risk for liver toxicity appears to be very low, if the daily paracetamol dose does not exceed 90 mg/kg body weight in otherwise healthy children, and if specific risk factors of the individual patient are always considered. This review discusses the recent publications on pharmacokinetics and -dynamics, the clinical use and dosing, as well as the risks and benefits of paracetamol for the treatment of postoperative pain in children and infants. Based on this information, specific dosing regimes for the postoperative period are suggested for neonates and infants, as well as for children in different age groups.
-
Correct indications are essential to perform surgical procedures. However, appropriate timing to achieve minimal rates of complications even in high-risk patients or major surgery is at the top of the priority list. Perioperative responsibility is divided between anaesthesiologists and surgeons. ⋯ Testing directed towards assessment of organ system functional reserve and identification of organs at risk rather than the diagnosis of a specific disease, is the primary goal of preoperative evaluation prior to surgery. These results are essential to prepare an effective anaesthetic plan. Along with increased patient comfort, the number of preoperative hospital days can be reduced by outpatient preoperative evaluation clinics.
-
Randomized Controlled Trial Clinical Trial
[Precurarization of succinylcholine with cisatracurium: the influence of the precurarization interval].
To determine the influence of two different pretreatment intervals, i.e. 3 and 6 min, on the efficacy of 0.01 mg/kg cisatracurium in preventing succinylcholine-induced fasciculations and myalgia. ⋯ Cisatracurium is only effective in preventing succinylcholine-induced fasciculations when a longer pretreatment interval, i.e. 6 min instead of 3 min, is chosen. Precurarization led to signs of paralysis in both pretreatment groups in the majority (75-80%) of patients without reducing the incidence or severity of postoperative myalgia.
-
The differential diagnosis of left-sided thoracic central venous catheters is discussed in context with the cannulation of a persistent left superior vena cava. In this case the catheter tip was seen lying to the left of the spine on frontal chest X-ray. In addition to the descending aorta, differential diagnoses are a persistent left-sided superior vena cava as well as other smaller veins such as the left internal thoracic vein, the left superior intercostal vein, or the pericardiophrenic vein. The misplacement of a venous catheter in a pericardiophrenic vein may result in a fatal pericardial tamponade.
-
The specialty of anesthesiology has made extraordinary advances in anesthesia safety. Yet, anesthetic mortality and morbidity continue to be far from tolerable. Efforts to enhance safety in anesthesia must include adherence to explicit and implicit safety standards, must make use of equipment that offers modern safety features, must seek to detect and correct developing safety threats as early as possible and must have a structured system to analyze problems and to institute remedies to prevent their recurrence.