Der Anaesthesist
-
Case Reports
[Sheared catheter in regional anaesthesia : causes and follow-up of an axiallary plexus catheter].
In the past years intoxication with local anesthetics, damage to nerves, vessels and other accompanying structures as well as infectiological events have been discussed more and more as complications accompanying peripheral nerve blocks (PNB). The following case report highlights a complication which seems to rarely occur and deals with a sheared continuous PNB, where a fragment of the catheter remained in the patient. The possible causes for the damage are discussed and recommendations on the clinical management of such a case are made.
-
Comparative Study
[ProSeal™laryngeal mask in normal weight and obese patients : oxygenation under pressure-controlled ventilation and different end-expiratory pressures].
Most of the data on combining pressure-controlled ventilation (PCV) with positive end-expiratory pressure (PEEP) come from studies with an endotracheal tube (ETT) whereas data on utilization of PEEP with a laryngeal mask airway (LMA) are limited. The LMA-ProSeal® (PLMA) forms a more effective seal of the airway than the LMA-Classic™ (CLMA). The application of PEEP when PCV is used with the PLMA could have an impact on oxygenation in adult patients. ⋯ The application of PEEP when PCV is used with the PLMA results in improved oxygenation in obese patients with a BMI ≥30 and <36 kg/m(2) but not in normal weight patients. Alveolar recruitment produced by seal pressure measurements below 30 cm H(2)O was sufficient to produce a clinically significant improvement in oxygenation in most obese patients and there was a significant improvement of oxygenation with PEEP=5 cmH(2)O. Both findings are in contrast to findings of studies using an ETT which suggests that higher pressures (40 cmH(2)O) are needed for recruitment of collapsed alveoli and higher PEEP (10 cmH(2)O) is needed to produce a clinically significant improvement in oxygenation in obese patients. The results of this study support data showing that the consequences of bronchopulmonary airway reactions known to occur with an ETT are less pronounced or absent when an LMA is used.
-
Case Reports
[Live-threatening bronchospasm during anesthesia induction : when pure routine becomes a nightmare].
This article reports a case of live-threatening respiratory failure during induction of anesthesia. An 18-year-old female was admitted to hospital for an axillary abscess incision on a public holiday. The patient had a history of asthmatic episodes and an allergy to milk protein and 2 years previously an asthmatic attack had possibly been treated by mechanical ventilation. ⋯ The patient recovered completely and was discharged home on day 19. Initially propofol was suspected of having caused an anaphylactic shock but in retrospect, the diagnosis of near fatal asthma was more likely. The onset of the event was facilitated by the patient playing down the history of asthmatic episodes due to a strong wish for independency and negation of the severity of the disease.
-
The data of the German hospital nosocomial infection surveillance system (KISS) were used to investigate the association between the frequency of blood cultures (BC) and central venous catheter associated bloodstream infection (CVC-BSI) rates in intensive care units (ICU). ⋯ If an external benchmarking of ICU CVC-BSI rates is intended an adjustment according to the BC frequency is necessary. The BC frequency itself should be established as a quality indicator in intensive care.
-
Demographic development and changes in healthcare utilization have led to a rising number of calls for emergency services. In Germany life-threatening situations are responded by physician-staffed ambulances in a 2-tier system whereas paramedic-staffed ambulances are dispatched in non-life-threatening emergencies. A nationwide protocol guides dispatchers in triage decisions. In the years 1999 to 2009 a continuous rise in the number of calls for a physician-staffed ambulance in Münster was recorded. The degree of healthcare utilization according to socioeconomic status and age structure was retrospectively examined. ⋯ A low socioeconomic status of an urban district will result in more ambulance responses. However, the proportion of life-threatening emergencies is equal to districts with a high socioeconomic status. Thus, the greater need for physician-staffed ambulance responses matches clinical needs and legitimates current resource use in a 2-tier ambulance system. Indications for the abuse of physician-staffed ambulances were not found. Considering an aging population the number of emergency calls will rise in the future.