Der Anaesthesist
-
The aim of this investigation was to describe the effects of standardization and central control of the processes involved in postoperative pain management from patient and employee perspectives. ⋯ The quality of care was improved by standardization of the postoperative pain management. The legal and practical ability of the nursing stuff to administer pain medication within well-defined margins reduced the dependence on the ward doctor and at the same time patient pain levels. Patients received analgesics more quickly and experienced increased effectiveness. These results should be an incentive to reconsider the importance of the organization of postoperative pain management, because the quality of care with all potential medical and economic advantages, can be easily optimized by such simple mechanisms. They also show that the quality assessment of acute pain and the selection of appropriate indicators need further development.
-
Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) may have a significant impact on physiological functions and is therefore a special challenge for anesthetists. In the presented case after opening the parietal pleura during subphrenical peritonectomy the HIPEC solution accidentally leaked into the right hemithorax with subsequent pleural effusion of more than 2,000 ml. ⋯ Following pleural sonography and chest X-ray in the operating theatre and recovery area, a thorax drainage was inserted into the pleural space and ventilation support was provided by non-invasive continuous positive air pressure (CPAP) ventilation. With reference to recent publications the anesthesiological management of patients undergoing HIPEC is presented.
-
Life-threatening pediatric emergencies are rare events in which precise, correct and fast drug dosing is essential. Intravenous drugs are most commonly dosed based on the child's weight in mg/kg. Numerous tools exist for aiding the physician in the error prone calculation, none of which meet all criteria for the perfect tool. Besides frequent training of practical skills and awareness of the problem of calculating the exact drug dose, it seems indispensable to have a localized tool at hand for these critical events.
-
The first part of this overview on diagnostic tools for acid-base disorders focuses on basic knowledge for distinguishing between respiratory and metabolic causes of a particular disturbance. Rather than taking sides in the great transatlantic or traditional-modern debate on the best theoretical model for understanding acid-base physiology, this article tries to extract what is most relevant for everyday clinical practice from the three schools involved in these keen debates: the Copenhagen, the Boston and the Stewart schools. Each school is particularly strong in a specific diagnostic or therapeutic field. Appreciating these various strengths a unifying, simplified algorithm together with an acid-base calculator will be discussed.