Der Anaesthesist
-
A regular hydration status and compensated vascular filling are targets of perioperative fluid and volume management and, in parallel, represent precautions for sufficient stroke volume and cardiac output to maintain tissue oxygenation. The physiological and pathophysiological effects of fluid and volume replacement mainly depend on the pharmacological properties of the solutions used, the magnitude of the applied volume as well as the timing of volume replacement during surgery. In the perioperative setting surgical stress induces physiological and hormonal adaptations of the body, which in conjunction with an increased permeability of the vascular endothelial layer influence fluid and volume management. ⋯ The objective of this article is to review the monitoring devices that are currently used to assess haemodynamics and filling status in the perioperative setting. Methods and principles for measuring haemodynamic variables, the measured and calculated parameters as well as clinical benefits and shortcomings of each device are described. Furthermore, the results for monitoring devices from clinical studies of goal-directed fluid and volume therapy which have been published will be discussed.
-
Comparative Study
[Evaluation of the new supraglottic airway devices Ambu AuraOnce and Intersurgical i-gel. Positioning, sealing, patient comfort and airway morbidity].
Supraglottic airway devices (SGAD) have become more important in airway management over the past years and an objective comparison of the available devices is in order. ⋯ The tested SGADs were comparable with regard to ease of insertion, insertion times and airway morbidity. Considering leak tightness and patient comfort the PLMA and the AuraOnce fared better with regard to tightness of seal and patient comfort.
-
In the present study the efficacy of subcutaneous tunneling and a 10 min disinfection time with a 70% alcoholic solution to reduce the infection rate in continuous interscalene plexus anesthesia were examined. In a prospective study 1,134 continuous interscalene plexus anesthesias were included. In group 1 (473 catheters) a cotton swab was soaked with the alcoholic solution and swabbed 3 times at the puncture site in the classical manner. ⋯ The difference between the groups in the infection rate is statistically significant (p<0.002). The practicability of the 10 min disinfection time in the clinical routine was excellent. A 10 min disinfection time with a 70% alcoholic solution combined with subcutaneous tunneling led to a significantly lower infection rate in continuous peripheral regional anesthesia in the neck of the patient.
-
Patients with solid tumors and hematological neoplasia can be a special challenge for anesthetists with their multilayered core competences (induction of anesthesia, intensive care, emergency medicine, pain therapy and palliative medicine) due to the systemic manifestation of the disease especially in metastatic stages, to complex sequelae of toxic oncologic therapy especially in curatively intended treatment concepts, to difficult ethical decision-making especially in acute situations and to the special emotional state of the patient which can extend throughout the complete course of the disease. In addition there are many new developments in modern oncology, which complicate the special characteristics of oncology patients, can have a direct influence on the anesthesiologic approach and will, therefore, be presented in this article.