Der Anaesthesist
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Reduction of costs or increase in efficiency may lead to optimization of cost-effectiveness in operating rooms. Overlapping induction by additional anesthesia teams reduces the changeover time between surgical interventions and, therefore, increases utilization effectiveness of surgical theatres. ⋯ Using the example of a university hospital it could be demonstrated that the simulated addition of one anesthesia team to different clusters of operations rooms resulted in an increase of 15-40 % of operations and an increase up to 81 % of utilization effectiveness. Therefore, the presented simulation tool may help to estimate the maximum effect of staff allocation in surgical theatres.
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Comment Letter
[Precurarization with a non-depolarizing muscle relaxant].
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Inhaled anesthetics are inhaled via the lungs. They subsequently pass through the alveolocapillary membrane and diffuse into the blood to finally target the central nervous system and induce anesthesia. This principle of anesthesia induction was first described for diethylether in 1847. ⋯ Depression of CO2 and hypoxia-induced respiration are other serious side effects. Further side effects are liver and kidney related but they are rare and not induced by anesthetics per se but preferentially by toxic metobolites. Another promising inhalative anesthetic is xenon which fulfils many aspects of an ideal inhalative anesthetic.
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Nerve injury after peripheral regional anesthesia is rare and is not usually permanent. Some authors believe that inducing peripheral nerve blocks in patients during general anesthesia or analgosedation adds an additional risk factor for neuronal damage. This is based on published case reports showing that there is a positive correlation between paresthesia experienced during regional anesthesia and subsequent nerve injury. ⋯ Currently anesthesiologists are free to follow personal preferences in this matter as there is no good evidence favoring one approach over the other. The risk of systemic toxicity of local anesthetic agents is not higher in patients who receive regional anesthesia under general anesthesia or deep sedation. Finally, in children and uncooperative adults the administration of peripheral nerve blocks under general anesthesia or deep sedation is widely accepted.