Der Anaesthesist
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Case Reports
[Chylothorax after central venous catheterization. Considerations to anatomy, differential diagnosis and therapy].
The authors report on a chylothorax, a rare, although classical complication of left internal jugular vein cannulation. The anatomy of major lymphatic vessels including variations is illustrated. The mechanisms of central venous catheter associated chylothorax are discussed. Likewise described are pathophysiology, signs, clinical features, and differential diagnosis with special consideration of the triglyceride content as well as treatment options.
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Since the term "complex regional pain syndromes" (CRPS) was introduced based on a revised taxonomy for disorders previously called reflex sympathetic dystrophy and causalgia in 1995, much knowledge grew up on the understanding and therapy of the disease. This review gives an overview on the clinical characteristics, pathophysiology, diagnostic tools and therapeutic options in CRPS. ⋯ Although there is no diagnostic gold standard, careful clinical evaluation and additional apparative test procedures are very helpful for the diagnosis. An early and interdisciplinary approach is the basis for an optimal and successful treatment.
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Whenever an anesthetic is needed during the breast feeding period, potential pharmacological side-effects imposed on the infant by any kind of anesthetic agent used during both general and regional anesthesia are in contrast to the potential beneficial effects of breast feeding for the infant and the mother. Despite an increasing knowledge and understanding of the mechanisms of excretion of drugs and their metabolites through breast milk, information about most anesthetic drugs are still either inconclusive or contradictory. Often it is impossible to decide whether a certain substance that is potentially excreted through breast milk might be harmless or harmful for the breast-fed infant. ⋯ Even planned elective surgical procedures do not need to be postponed. No scientifically based interval between surgery under general or regional anesthesia and resumption of breast feeding can be recommended. Instead current opinion is that breast feeding can be resumed as soon as the mother feels physically and mentally capable to do so.
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The operating unit is one of the cost-intensive facilities in a surgical clinic with a pacemaking function for most of the internal procedures. The power of performance of the operating unit is based on the cooperation of all disciplines and professions involved. The key to management of the operating unit is not only to coordinate the daily procedures, but also to interact with support personnel. ⋯ Better transparency of operations in the OR contributes to increased efficiency. Implementation of quality management is the foundation for a successfully operating surgical hospital. Not only the productivity of individual members of the staff, but also the precise documentation of the quality of results will become important parameters in a successful surgical hospital, whose nucleus is the OR.
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Randomized Controlled Trial Clinical Trial
[Haemodynamic effects following preoperative hypervolemic haemodilution with hypertonic hyperoncotic colloid solutions in coronary artery bypass graft surgery].
Using hyperoncotic colloids as volume replacement to provide haemodynamic stability appears to be a suitable approach to diminish fluid overload and subsequent interstitial edema during cardiac surgery. The aim of the present study was to investigate for the first time the haemodynamic effects following preoperative haemodilution with different hypertonic hyperoncotic colloid solutions in patients undergoing coronary artery bypass grafting. ⋯ Compared to isotonic saline solution, preoperative volume replacement with hyperoncotic colloids improves haemodynamic conditions during the pre-bypass period in patients with normal left ventricular function undergoing coronary artery bypass grafting. Additionally intraoperative crystalloid solution requirements are reduced. The volume saving effects are increased with administration of hyperoncotic colloids in a preparation with hypertonic saline solution, whereas the choice of the colloid, either hydroxyethyl starch or dextran seems to be of minor importance.