Der Anaesthesist
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Fast-track rehabilitation refers to an interdisciplinary multimodal procedure to improve and accelerate recovery and avoid perioperative complications. The concept aims at reducing morbidity and discharging patients faster. It includes preoperative patient information, atraumatic surgical technique, stress reduction, pain therapy mostly via regional anesthetic techniques (frequently, thoracic epidural anesthesia), optimized fluid and temperature management, early enteral feeding, prophylaxis of gastrointestinal atony and postoperative nausea and vomiting, fast postoperative patient mobilization, and earlier hospital discharge. Fast-track protocols exist for all kind of surgical procedures but are best established for colon surgery.
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Randomized Controlled Trial
[Non-invasive extended hemodynamic monitoring. Reduction of circulatory risk situations].
Cardiac output and the cardiac index (CI) are not routinely monitored during major abdominal surgery for economic as well as medical reasons. This practice, however, might be changed by the application of newer non-invasive technologies like the partial CO(2) rebreathing method based on the inverse Fick's principle. In this prospective randomized study we investigated the impact of a non-invasive monitoring of CI on the incidence of hemodynamic instability and interventions by the attending anesthesiologist during major abdominal surgery. ⋯ The incidence of hemodynamic instability was significantly reduced during major abdominal surgery when anesthesiologists were aware of the measurement results of extended hemodynamic monitoring.
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Review
[Ultrasound-guided anaesthesia of peripheral nerves. The new challenge for anaesthesiologists].
Ultrasound-guided anaesthesia of peripheral nerves is a new challenge for anaesthesiologists. The number of ultrasound users in this field has increased over the last 10 years because of improved high frequency ultrasound technology and increased mobility of machines. ⋯ Basic knowledge in ultrasound technology and image characteristics and a defined approach to blocking procedures to ensure sterile working conditions are necessary to guarantee optimal safety of patients. Furthermore economic questions and the implementation of a standardised education program are very important.
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The rule of three describes three steps which are needed for an optimal control of postoperative nausea and vomiting (PONV). Firstly, patients at high risk of PONV need to be identified. Knowledge about predictive factors may help to identify patients who may best profit from prophylaxis and those where prophylaxis is not worthwhile since the baseline risk is too low. ⋯ Risk scores have been proposed and have been widely implemented in clinical practice. The sensitivity and specificity of such scores, however, remain particularly unsatisfactory. Unless more reliable risk scores are developed, aggressive treatment of established PONV symptoms may be more useful and more cost-effective than prophylaxis for many patients.
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Comparative Study
[Infrastructure of emergency medical services. Comparison of physician-staffed ambulance equipment in the state of Baden-Wuerttemberg in 2001 and 2005].
A survey amongst emergency physician bases in the federal state of Baden-Wuerttemberg in 2001 concerning equipment available for airway management and the treatment of acute coronary syndromes showed striking differences with respect to implementation of European norms and international recommendations. The survey was repeated in 2005 to evaluate the development of the equipment in physician-staffed ambulance systems. ⋯ A favourable trend could be found concerning the equipment of physician-staffed ambulances state-wide. Further efforts must be undertaken to ensure the complete implementation of legal requirements and international recommendations concerning provision of medical equipment.