Der Anaesthesist
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Historical Article
[Nitrous oxide production by the German Armed Forces in the 20th century : History of medicine and pharmacy in the Armed Forces].
The nitrous oxide production unit of the German Armed Forces was a worldwide unique facility which was only employed in the former main medical depot at Euskirchen (nitrous oxide: medical gas which is now obsolete). The last unit was phased out in 2002 and brought to the main medical depot at Blankenburg. Unfortunately the unit is now no longer in the depot and seems to have disappeared. This article describes the nitrous oxide production process and the use of the production unit which was designed by the Socsil company of Switzerland.
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In extreme situations, for example during emergencies or when facing surgery, patients exhibit heightened and focused attention and increased susceptibility to suggestion. In this trance-like state negative suggestion, usually spoken unintentionally can aggravate anxiety, stress and pain. On the other hand words can offer an opportunity to benefit the patient via positive suggestion. ⋯ Indications for such approaches are the preoperative visit, induction of anaesthesia, as well as operations under local or regional anaesthesia. An extreme example of the latter is awake craniotomy employing cranial nerve blocks and an awake-awake technique avoiding centrally acting drugs. Such hypnotic communication can help the patient to regain self-control and access to inner resources.
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The difficult airway remains a challenge especially in emergencies. ⋯ The laryngeal tube allows rapid oxygenation in emergency patients with a difficult airway until a secure airway can be established. In cases of potentially life saving operations successful ventilation via the laryngeal tube might allow the priority of establishing a secure airway to be deferred.
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In-hospital emergencies can lead to unexpected admission to the ICU, cardiac arrest or even death. Therefore, hospitals have to implement an adequate in-hospital emergency management. The results of the deployment of the in-hospital emergency team of a hospital providing maximum medical care will be presented. ⋯ The high proportion of patients in a life-threatening condition and cardiac arrests indicates the necessity for closer patient monitoring, more intensive emergency training including early defibrillation and continuing education of hospital staff in the prevention and early detection of emergencies, in addition to the provision of an emergency team.
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While guidelines represent systematically developed aids for decision-making on appropriate courses of action, recommendations should focus the attention of the medical profession on noteworthy circumstances which are in need of amendment. The new recommendations on the "Execution of analgesia and anesthesia procedures in obstetrics" 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) in cooperation with the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) comprehensively fulfill these requirements. The new recommendations include not only revisions in the form of updating but also supplementations in the form of the new chapters "Initial care of newborns", "Postpartum hemorrhaging" and "Morbid obesity". In the following article relevant alterations to newly formulated or completely amended sections with consequences for the clinical practice will be discussed.