Der Anaesthesist
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Allowances have been made for surveillance as an essential component in the chain of anesthesiological care and the increasing importance of the recovery room by reformulation of the recommendations of the German Society for Anesthesiology and Intensive Care medicine (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI) and the Professional Association of German Anesthetists (Berufsverband Deutscher Anästhesisten, BDA) on surveillance following anesthesia procedures. These recommendations replace the previous guidelines on postoperative surveillance and the recommendations on organization and equipping of recovery units. In the following article the essential new aspects of the recommendations on surveillance following anesthesia procedures will be presented.
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Idiopathic orthostatic hypotension (formerly known as Shy-Drager syndrome) is a multiple system atrophy, which is characterized by autonomic dysregulation. Providing perioperative hemodynamic stability during narcosis is therefore a particular challenge. The effects of general anesthesia on systemic vascular resistance and cardiac output in a patient with idiopathic orthostatic hypotension undergoing retropubic prostatectomy will be reported. In the case presented perioperative hemodynamic stability was achieved by aggressive volume therapy guided by global end-diastolic volume measurement and low-dose catecholamine therapy.
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The outcome of cardiopulmonary resuscitation (CPR) depends on the quality of chest compressions. Current European Resuscitation Council (ERC) guidelines promote the development of feedback systems. However, no studies presenting satisfactory results of feedback use have been published. ⋯ With the AED real-time feedback technology used in this study standardized performance of chest compressions could be maintained in a professional ambulance service. Implementation of a feedback system requires training of ambulance staff.