Der Anaesthesist
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Growing attention has been drawn to patient safety during recent months due to media reports of clinical errors. To date only clinical incident reporting systems have been implemented in acute care hospitals as instruments of risk management. However, these systems only have a limited impact on human factors which account for the majority of all errors in medicine. ⋯ To reduce errors under such working conditions relevant processes should be standardized and trained for the emergency situation. Human performance can be supported by well-trained interpersonal skills which are evolved in CRM training. In combination these training programs make a significant contribution to maintaining patient safety.
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Randomized Controlled Trial
Hyperbaric levobupivacaine in anal surgery : Spinal perianal and spinal saddle blocks.
An ideal anesthetic technique for anal surgery on an outpatient basis should permit early mobilization without pain or residual complications of anesthesia. The aim of this study was to analyze the reliability and efficacy of spinal perianal and spinal saddle block by using two different doses of levobupivacaine for perianal surgery and their effects on voiding, first analgesic requirement and hospital discharge times. ⋯ The results of the study showed that the use of 1.5 mg hyperbaric levobupivacaine provides sufficient and satisfactory anesthesia in ambulatory perianal surgery.
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Review
[Acute renal failure and sepsis : Just an organ dysfunction due to septic multiorgan failure?].
Acute renal failure (ARF) is clinically defined as an abrupt, but in principle reversible deterioration of glomerular and tubular function. Regarding pathophysiology, ARF is caused by ischemic renal conditions and toxic mediators. Sepsis is the most common cause of ARF in the intensive care unit and ARF is an independent risk factor for lethality of septic patients. ⋯ Loop diuretics produce diuresis and can be beneficial to extrarenal organs by improving fluid homeostasis, however diuretics do not improve kidney function and outcome. Therefore, diuretics are not indicated for patients with imminent or existing ARF. Septic patients with ARF can be treated by intermittent and continuous forms of renal replacement therapy, whereas continuous convective and intermittent diffusive methods are equivalent when utilizing an ultrafiltration rate > or =20 ml/h*kg body weight or a therapeutic interval > or =3 times/week.
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The treatment of severely injured trauma patients (polytrauma) is one of the outstanding challenges in medical care. Early in the initial course the patient's diagnostics have to be scrupulously reevaluated by an interdisciplinary team (tertiary trauma survey) to reduce deleterious sequelae of missed injuries after the initial assessment. Severely injured patients stay in intensive care for an average of 11 days. ⋯ Because of the fact that the damage control strategy is gaining increasing acceptance, the intensive care unit plays a pivotal role in the critical time between emergency and elective surgery. Therefore a close cooperation between physicians of the intensive care unit and all surgical disciplines involved is essential to reach the aim of therapeutic efforts. After survival of emergency treatment patients with severe trauma should be reintegrated into social and occupational life as soon as possible.
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The case of 16-year-old, ASA I classified patient who suffered cardiac arrest during orthopedic surgery is reported. Return of spontaneous circulation was achieved with a precordial thump. The patient was discharged from hospital without any neurological deficits 10 days after the event.