Der Anaesthesist
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Acute hyperkalemia is a life-threatening event and often occurs abruptly and without warning in the perioperative field. Risk factors are found on multiple levels as they can derive from a patients pre-existing condition or result from the surgical intervention or management of anesthesia. The therapy of hyperkalemia depends on the dimensions of electrolyte disturbance and a distinction can be made between therapeutic measures with a rapid and those with a long-term effect.
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Acute subarachnoid hemorrhage (SAH) is a severe and acute life-threatening cerebrovascular disease. Approximately 80% of all acute non-traumatic SAHs are the result of a ruptured cerebrovascular aneurysm. Despite advances in diagnosis and treatment a high morbidity and mortality still exists. ⋯ For an appropriate therapy an understanding of the extensive pathophysiology, the options in diagnostics and therapy and the complications of the disease are essential. Anesthesiologists are decisively involved in the therapy of the primary and secondary damages and subsequently in the outcome as well. This article provides an overview of the perioperative and intensive care management of patients with SAH.
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Anisocoria during general anaesthesia is rare. The combination of anisocoria and absence of any reaction to light is highly suspicious of an intracerebral lesion. This article reports the case of a patient with known Adie's syndrome where anisocoria led to an unnecessary immediate interruption of anesthesia. A preoperative examination, including inspection of the pupils, frequent perioperative check ups and documentation of diagnostic findings, even if negative, has to be standard for every anesthesia.
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Spinal anesthesia causes sympathetic blockade which leads to changes in the local temperature of the skin surface due to hyperemia. ⋯ Therefore, it can be concluded that systematic processing of skin temperature data, collected at defined dermatomes can be used as a promising parameter for predicting surgical tolerance. The objective is to improve this experimental method with an extended patient population study.
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In 2009 and 2011 all German physicians authorized to provide postgraduate training (WBB) and physicians in postgraduate training (WBA) were invited to participate in a survey focusing on various aspects of postgraduate training. The survey was initiated by the German Medical Council and the contents and underlying methodology were based on a survey carried out annually in Switzerland. ⋯ The current survey gives an insight into the assessment of over 9,000 physicians authorized to provide postgraduate training in Germany and over 20,000 physicians in training programs. While the comparison between the different medical disciplines within each survey appears to be valid the comparison between the results of the 2009 and 2011 surveys needs to be critically evaluated due to some inhomogeneities in the collectives. A higher than average participation of anesthesiologists indicates a notable willingness to contribute to measures aiming at the improvement of postgraduate training. It is difficult to assess the extent to which the data obtained in this evaluation reliably reflect the quality of postgraduate training in German medical institutions. Nevertheless, the survey provides valuable information about targeted attempts for improvement. Obvious potential for improvement can be seen not only within the scope of structural quality (training plan and target) but also in feedback. Personal contact to persons authorized to provide postgraduate training seems to have a very positive effect on the result of the evaluation. The results concerned with job situation, which were above average for anesthesiology, was not included in the evaluation performed by the German Medical Council and hence had no chance to positively influence the overall result. These results should be included in the evaluation of future surveys dealing with postgraduate training quality.