Der Anaesthesist
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Since ancient times poisoning has been treated medicinally. Clinical toxicology, in the narrow sense of the term, developed from the foundation of specialized medical treatment units for poisoning and the formation of the first poison information centers in the second half of the twentieth century. Historically, the first poison information centers were often localized at pediatric clinics or departments of internal medicine. It became increasingly more obvious that this pooling of competences made sense. ⋯ In all, even questionable cases of poisoning consultation at emergency poison centers is recommended. An extensive list of all German speaking poison information centers is available on the homepage of GIZ-Nord (http://www.giz-nord.de).
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Practice Guideline Guideline
[Practice Guidelines for Management of the Difficult Airway : Update by the American Society of Anesthesiologists Task Force.]
In February 2013 the Committee of the American Society of Anesthesiologists (ASA) Task Force published the amended version of the "Practice guidelines for management of the difficult airway" which replace the recommendations from 2003. The amended version re-evaluated the recommendations from 2003 in 2011, evaluated recently published studies and recommendations and included them in the new practice guidelines. ⋯ In short, the current guidelines basically correspond to the previous version published 10 years ago but are, however, more than twice as extensive. This article summarizes and comments on the cornerstones of the guidelines.
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Review Meta Analysis
[Update on preemptive analgesia : Options and limits of preoperative pain therapy.]
Wall created the term preemptive analgesia in 1988 and in doing so set in motion a movement to prevent acute and chronic postsurgical pain. The concept of preemptive analgesia implies the administration of analgesic drugs or an intervention before a surgical procedure. A preemptive analgesic approach can comprise non-steroidal anti-inflammatory drugs (NSAID) and cyclo-oxygenase-2 inhibitors (coxibs) used to decrease the production of prostaglandins, local anesthetics (e.g. epidural) to reduce nociceptive input to the spinal cord as well as opioids, N-methyl-D-aspartate (NMDA) antagonists, antidepressants and anticonvulsants, all of which have an inhibitory influence on the central nervous system. ⋯ Reduction of chronic postoperative pain is an important medical function which is also justified from socioeconomic perspectives. Future studies should combine several procedures for perioperative pain therapy in order to do justice to the multifactorial aspects of pain chronification and should also be planned over a sufficiently long observation time period.
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Resection of the esophagus is an invasive 2-cavitiy procedure which requires special anesthesiological expertise during perioperative care. Furthermore, in surgery new minimally invasive techniques are continually being established which place special challenges on the treatment team because the anesthesiologist is decisively involved in the course of surgery. ⋯ Minimally invasive esophagectomy with transoral anastomization appears to be an enrichment of the minimally invasive spectrum as interdisciplinary cooperation leads to reduced operation time and a more efficient process of anastomization. This also results in decreased one-lung ventilation time which is directly correlated to postoperative pulmonary complications. In particular, the interdisciplinary character of this technique and the necessity for targeted communication proved to be of assistance also in other situations.