Der Anaesthesist
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Cerebral venous sinus thrombosis during pregnancy or puerperium is not a rarity. Nevertheless, it is often misdiagnosed. With the increasing use of regional anaesthesia in obstetrics the differential diagnosis of postdural puncture headache is often difficult. The case of a patient is reported who suffered from both intracranial hypotension and cerebral venous sinus thrombosis in the postpartum period.
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Randomized Controlled Trial Comparative Study
[Propofol administration systems. Handling, hemodynamics and propofol consumption].
During anaesthesia propofol is administered either by manual controlled infusion (MCI) or by target controlled infusion (TCI) techniques. In this study two different TCI systems for propofol administration were evaluated with regard to handling, patient safety, and costs and compared to administration of propofol by the MCI technique. ⋯ The investigated propofol administration procedures using the MCI or TCI techniques were safe and easy to handle under BIS monitoring. No differences were found concerning extubation times and time of awaking. During extended anaesthesia procedures (>60 min), propofol consumption was lower with both TCI techniques and thus costs could be saved.
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Palliative medicine has progressed during recent years to an independent medical faculty within the German health system. Despite this development palliative care systems for out-of-hospital and in-hospital palliative care are still insufficient in Germany so that the development of necessary resources must be considered as not yet completed. To support the further national development palliative medicine can be temporarily or permanently coupled to existing departments, which can be advantageous for all concerned and last but not least be profitable to patients and their relatives. ⋯ Part of the responsibility of most anaesthesia departments is to practice pain management and critical care medicine, which are reasons why anaesthesiologists are predestined to be part of the system for palliative care patients and their relatives. Anaesthesia departments can be responsible for the organization of in-hospital and out-of-hospital palliative medicine and palliative care. The integration of anaesthesiological expertise into palliative medicine departments and vice versa can be a great opportunity for both medical departments and therefore represents a worthwhile engagement.
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In order to provide early achievement of practical experience during medical education, the medical faculty of the university Aachen has developed a new medical school curriculum which was offered in 2003 for the first time. In this curriculum anaesthesiology became a compulsory subject with practical training both in the operation theatre and in emergency medicine. Accordingly, a practical course in the field of intensive care medicine has also been designed with respect to the planned schedule and personnel resources. This course was evaluated by both students and teaching staff in a written, anonymous form as a quality control. ⋯ According to the results, efficiency and acceptance of intensive care training courses were high. Major criteria for the high grading were a limited number of participants, the focus on few subjects, and a clear structural design. However, according to several personal notes from the students, simulation-based sessions and written teaching material might further improve success of this course.
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Delayed starts of operation room (OR) processes in the morning lead to suboptimal use of expensive OR personnel and resources. Therefore, the anaesthesiologist has to take care that anaesthesia preparation and induction are finished in time and the patients are ready for the surgical intervention according to the OR time schedule. However, if the anaesthesiologist starts too early, preincision waiting periods occur. ⋯ The results of a simulation model showed that in 100% of the cases finishing anaesthesia induction in time would only be feasible if anaesthesia processes started much earlier. However, this would lead to a sharp increase in preincision waiting time with the patient being under anaesthesia but surgeons not ready to start, therefore having only a minor effect on surgical waiting time. Subsequently, on-time anaesthesia induction in all cases is not a reasonable target in OR management.