Der Anaesthesist
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The influence of Trendelenburg positions and variations in spinal canal configuration on the spread of hyperbaric spinal anesthetics was examined in two models of the subarachnoid space. ⋯ Diffusion processes represent the decisive factor for distribution patterns of hyperbaric anesthetics in the supine position. Only the 5° head-down tilt demonstrated an influence of specific gravity. When tilted 10° head-down gravitation prevailed over differences in density. A 15° head-down tilt is a precondition for the mobilization of sacrally pooled local anesthetic. Data comparison of both model investigations showed that the extent of spread depends more on initial bidirectional distribution of the local anesthetic than on increasing flow rate due to the slope of lumbar lordosis.
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Economic pressures are forcing German hospitals to take measures to secure the cost effectiveness of medical care. Surgical facilities are particularly affected as a high-cost segment. ⋯ With this in mind, the following article defines and comments on the most important aspects of OR managerial duties and responsibilities. The authors are experienced in OR management and are able to give the reader not only the theoretical fundamentals but also recommendations and guidelines which are particularly valuable to those contemplating a career as OR manager.
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Central venous line placement is a standard procedure in critical care and peri-operative medicine. This procedure can be associated with severe complications. In contrast to the landmark technique, ultrasound-guided punctures can significantly reduce the rate of complications. ⋯ In children and small infants central venous access can also be challenging due to the anatomical relationship in the head and neck region. Puncture techniques are explained briefly by means of ultrasound anatomy. Typical ultrasonographic images visualize pathological findings in order to identify dangers and complications in central venous catheterization.