Der Anaesthesist
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The perioperative risk for patients with obstructive sleep apnea syndrome and the optimal anaesthesiological management of these patients have not been well elucidated. The prevalence of obstructive sleep apnea with significant symptoms is estimated to be 4% in men and 2% in women. However, in 80-95% of patients this syndrome is not sufficiently diagnosed. ⋯ If ambulatory nasal continuous positive airway pressure (CPAP) therapy has been established preoperatively, this should be continued in the perioperative period. Postoperative monitoring should be performed in an intensive care or intermediate care unit. Controlled clinical studies on the best perioperative management of patients with obstructive sleep apnea are urgently required.
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In obese patients, perioperative pulmonary complications have an increased frequency and are associated with higher morbidity and mortality compared with non-obese patients. The management of surgical procedures in these patients is a challenge for the anaesthetist. Knowledge of pathophysiological and pharmacological aspects of the obese patients' condition is essential for their care during preoperative assessment, intra-operative management and, if necessary, postoperative intensive care. Special information on airway and lung protection as well as cases involving laparoscopic surgery, obstetric and paediatric anaesthesia in obese patients are also discussed.
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The Anaesthesiological Questionnaire (ANP) is a self-rating method for the assessment of postoperative complaints and patient satisfaction. The questionnaire was adapted for use in cardiac anaesthesia (ANP-KA). The study was conducted to show the value of ANP-KA as a practicable means of assessing the patient's state after cardiac anaesthesia and for its use in quality assurance. ⋯ The results demonstrate the practicability and validity of the ANP-KA for the assessment of postoperative complaints and patient satisfaction after cardiac surgery.
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Occupational exposure to volatile anaesthetics cannot be completely avoided even in modern operating theatres. In 1997, the staff exposure during balanced anaesthesia in our hospital was low (sevoflurane 0.49 ppm; N(2)O 11.5 ppm). In 1999, N(2)O was completely omitted at our hospital, therefore, exposure to volatile anaesthetics, namely sevoflurane, might have increased. ⋯ The occupational exposure to volatile anaesthetics is not higher using sevoflurane alone compared to the combination of sevoflurane and N(2)O. In addition, the data acquired from environmental and personal measurements showed similar results.