Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Comparison of incomplete (135 degrees ) and complete prone position (180 degrees ) in patients with acute respiratory distress syndrome. Results of a prospective, randomised trial].
Ventilation in the prone position is carried out for improvement of pulmonary gas exchange in patients with acute respiratory distress syndrome (ARDS). We compared the effects of an incomplete prone position (IPP, 135( degrees )) with a complete prone position (CPP, 180( degrees )) in patients with ARDS. ⋯ Incomplete prone position improves oxygenation in ARDS patients, but less effectively than a "classic" CPP. In these patients the use of a CPP should be preferred.
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Sedation and analgesia are relevant aspects for the adequate treatment of patients in an intensive care unit. Recent drug developments and new strategies for ventilation provide improved sedation management allowing better adaptation to the clinical background and individual needs of the patient. ⋯ Another aspect is scoring system-related and EEG-based monitoring of depth of sedation. Modern concepts of analgesia and sedation for ICU patients have been developed based on the interaction of different parameters such as adaptive sedation and analgesia management (ASAM).
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More than 50% of all patients on intensive care units acquire a systemic inflammation such as systemic inflammatory response syndrome (SIRS) or sepsis. The development of hepatic microcirculatory failure with consecutive organ damage might occur during the course of the systemic inflammation. The liver microcirculation is regulated by a complex network of cellular components and specific mediators. ⋯ Some investigations aim to determine the impact of sedatives and analgesics on the hepatic microcirculation in sepsis and SIRS. Therefore, a decisive recommendation about the choice and dosage of sedatives and analgesics for these patients is not possible. Nevertheless, ketamine, midazolam and fentanyl with their potential anti-inflammatory properties seem to be suitable for patients with systemic inflammation.
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Case Reports
[Inadvertant epidural placement of a psoas compartment catheter. Case report of a rare complication].
Due to total knee replacement, a 67-year-old female patient had received a combination of general anesthesia and continuous psoas compartment block. An epidural block was detected postoperatively. An X-ray after the injection of contrast medium showed a typical epidurography with the catheter tip projecting into the epidural space. ⋯ We would recommend not to place the catheter further than 5 cm over the tip of the needle. After the first injection the quality of monitoring should correspond with that of an epidural anesthesia. In doubtful cases an injection of contrast medium and an X-ray can be performed.
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This prospective survey aimed at elucidating the patients' expectations and needs regarding the pre-anaesthetic visit and the forthcoming anaesthesia. The same questionnaire was answered by both patients and anaesthesiologists. ⋯ Anaesthesiologists tend to misinterpret many patients' expectations and attitudes. The results demonstrate the potential for quality improvement of the pre-anaesthetic visit.