Der Anaesthesist
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Peripheral regional anesthesia is a commonly used and safe procedure and eneral complications or side effects are generally rare. Nerve damage has an incidence <0.1% depending on the definition and the prognosis is good. To avoid bleeding complications the national standards of block performance under antithrombotic therapy should be respected. ⋯ Potential infectious complications can occur mainly as a result of catheter techniques and require a strict aseptic approach. Further rare complications are allergies, dislocation of catheters and knotting or loops in catheters. Besides the general complications, there are some specific complications depending on the puncture site, such as pneumothorax or renal puncture.
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Ambulatory surgery continues to grow and is slowly becoming routine in the majority of cases. Although the development of ambulatory surgery in Germany appears to be somewhat delayed, this is actually a chance to learn from worldwide experiences and avoid the mistakes others made earlier. This article investigates current trends and developments in day case surgery and discusses the extended role and influence of the anesthetist in the perioperative setting.
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High risk pulmonary embolism commonly presents with a variety of symptoms and is an acute life-threatening event. In patients showing unclear acute circulatory distress, pulmonary embolism should be quickly ruled out by computed tomography or echocardiography. The diagnostic steps and surgical treatment of pulmonary embolism in a 25-year-old female patient suffering from acute circulatory insufficiency resulting in cardiac arrest within 11 min after emergency hospital admission are reported. ⋯ The patient was successfully extubated the following day and despite the long resuscitation time the outcome was excellent without any neurological deficit. Recent publications addressing the advantages of primary embolectomy versus intravenous thrombolysis in acute circulatory distress caused by pulmonary embolism are discussed. Primary surgical treatment including cardiopulmonary bypass for right ventricular relief and re-establishing of systemic perfusion is recommended for patients with pulmonary embolism undergoing cardiopulmonary resuscitation.
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Epidural regional analgesia is still recommended as the gold standard for obstetric analgesia due to its high efficacy and less depressing effects to the central nervous system. However, if absolute or relative contraindications for a regional anesthetic technique are present, there is a need for an effective and safe alternative. This survey investigates the current use of intravenous opioids, with a focus on remifentanil as patient-controlled intravenous analgesia (PCIA), in obstetrics in German hospitals. ⋯ This survey revealed that pethidine, meptazinol and piritramide are the most common opioids for opioid-based systemic labor pain relief in Germany. If PCIA is offered, remifentanil is the most popular opioid. However, only a few clinics are routinely using PCIA for obstetric analgesia. Furthermore the study showed that the current monitoring standards seem to have room for improvement with respect to safe administration of an opioid PCIA. The safety standards require continuous observation of the oxygen saturation, the possibility for oxygen supply, one-to-one nursing for a close clinical observation of the mother and the presence of an anesthetist during the initial titration phase to safely apply this technique. Applying these safety standards PCIA may prove a useful alternative for central neuraxial labor analgesia in those women who either do not want, cannot have or do not need epidural analgesia.