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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Recently palliative care has become an integral and compulsory part of undergraduate medical training in Germany. From 2014 onwards every German medical faculty must have developed and implemented undergraduate teaching in this cross-disciplinary medical field and to conduct examinations. At Witten/Herdecke University (Germany) this new cross-sectional course in palliative care was taught for the first time in 2011. The film "Keep on the open road" was incorporated and the use of this film as part of compulsory palliative care education was evaluated from the student perspective. ⋯ According to the evaluation of the students and the judgement of the participating teachers the use of the film is a suitable method to clarify complex medical, social and psychological aspects in palliative care. Especially at faculties with much larger numbers of students the film unit is thought to be a helpful method to teach psychosocial aspects and to promote development of attitude in palliative care. In future semesters further experience with the unit and the use of films in palliative care teaching will be collected.