Der Anaesthesist
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Editorial Biography Historical Article
[The perfect mixture is the clue: the honorary editorship of Prof. Dr. med. Dr. med. h.c. Klaus Peter].
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Preoperative fasting aims at minimizing the risk of pulmonary aspiration. However, perioperative safety does not directly increase with the duration of total abstinence from food and liquids. The traditional principle "nil per os from midnight on", is based on insufficient data, overinterpretation and expert opinion. ⋯ This lack of knowledge is reflected by national and international guidelines concerning preoperative fasting, which mention the "patient at risk" without defining it exactly. Abstention from clear liquids 2 h before and of solids 6 h before induction of anesthesia, is becoming increasingly more accepted. Feeding babies with breast milk appears to be tolerated 4 h before anesthesiological procedures.
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Severe burn injuries are rare and represent less than 1% of all medical emergencies. At the scene of the accident self-protection is important. The progress of thermal injury should be stopped, while cold water therapy is usually not indicated as the resulting hypothermia severely reduces the prognosis. ⋯ Local or systemic administration of corticosteroids is not indicated. Transfer to a specialized burn unit depends on burn size and depth. Emergency room management includes stabilization of vital functions, evaluation of co-injuries and initiation of the specific surgical and intensive care therapy.
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The new index "degree of operation room (OR) utilization" describes the ratio between possible and actual OR utilization with purely surgical time. The possible OR utilization with purely surgical time was calculated by eliminating the time necessary for induction and emergence from anaesthesia, the time necessary for surgical measurements directly before the first incision (i.e. skin disinfection) and directly after the last suture (i.e. wound dressing) of an operation from the time an operating room could theoretically be used with purely surgical times (the theoretical block time). The possibility of distributing block time based on the effectiveness of surgeons and to reduce costs by identifying waste of block time was investigated using the "degree of OR utilization" method. ⋯ The application of the new index "degree of OR utilization" enables the OR manager to distribute OR capacities to surgeons with effective use of block time. This leads to cost reduction without minimizing surgical productivity or income and therefore to a higher level of OR efficiency.
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In 2003 an anonymous reporting system for critical incidents was implemented in the Department of Anaesthesiology and Intensive Care Medicine of the University Hospital Dresden. This reporting system was modified to an intranet-based version and extended to the intensive care unit (ICU). ⋯ The main causes were lack of attention, missing check of measures, work load of nurses, experience and communication deficits. The article discusses the incidence of errors in the ICU setting and their potential effects.