Der Anaesthesist
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During the last decades anesthesia has developed into a wide ranging specialty in western countries, whereas in most developing and newly industrializing nations it still focuses on its core discipline, the perioperative care of the surgical patient. Poor socioeconomic status and inadequate financing of health systems result in a high burden of disease, a high rate of self-financing of healthcare costs by the patients, as well as insufficient personnel, infra-structural and material equipment of most healthcare facilities. Important limiting factors for anesthesia are low educational standards and a widespread lack of oxygen and medical gas supplies, as well as locally serviceable medical equipment. Studies evaluating the status of anesthesia in developing and newly industrializing nations in detail are urgently needed in order to provide aid on national and international as well as institutional and private levels for the development of anesthesia in poor countries.
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Pulmonary hypertension can arise in the presence of acute cardiopulmonary decompensation or develop as a chronic and progressive disease in association with connective tissue diseases, infectious diseases, or metabolic diseases, or in the form of idiopathic pulmonary hypertension. Impaired regulation of endogenous vasoactive mediators, growth factors, and thrombotic factors leads to pulmonary artery vasoconstriction, endothelial and epithelial proliferation, and thrombotic vascular obstruction, with resulting right heart failure. There is no curative treatment for chronic pulmonary hypertension, and the immediate objective of palliative treatment is to relieve right heart stress by reducing pulmonary arterial pressure with the aid of pulmonary vasodilators. ⋯ In the perioperative period, it is essential that anything that could lead to worsening of pulmonary hypertension is avoided, or at least recognized and treated at an early stage. Intraoperatively, imminent acute right heart decompensation is treated by improving right-ventricular contractility and reducing right-ventricular afterload. In the postoperative period, monitoring and optimization of the cardiopulmonary status, adequate analgesia and sedation, and careful anticoagulation must be ensured.
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Comparative Study
[Comparison between the laryngeal tubus S and endotracheal intubation. Simulation of securing the airway in an emergency situation].
The value of the laryngeal tube S (LTS) for emergency airway management was evaluated in comparison to endotracheal intubation (ETI). ⋯ The LTS represents a fast and reliable method to secure the airway and to achieve ventilation in the mannequin model described. The success rate, the time until successful ventilation and the rating by the participants indicates that the LTS is an important alternative to ETI. The LTS offers special benefits for the less experienced users.
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Two years ago we implemented a reporting system for critical incidents in the Department of Anaesthesiology and Intensive Care of the University Hospital Dresden. During the first 18 months 162 anonymous reports were registered. The most common errors involved airway and ventilation management, followed by errors in fluid and cardio-vascular management. ⋯ Over time, a change in the relative distribution of reported errors was observed. The article discusses the different kinds of errors and possible countermeasures. It also strengthens several aspects which are important to consider during the initial phase of a local critical incident reporting system.