Der Anaesthesist
-
In the last 10 years interventional neuroradiology has become established especially in the endovascular treatment of aneurysms as the preferred treatment according to level 1 evidence and more recently in the treatment of acute ischemic stroke. These interventions are performed as routine procedures in an increasing number of centers. ⋯ As a further challenge there are different aspects to be considered in elective procedures and emergency procedures where time is brain. This article highlights these aspects for the two most common procedures: aneurysm treatment and multimodal recanalization treatment for acute ischemic stroke.
-
Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. ⋯ The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.
-
In primary and secondary brain diseases, increasing volumes of the three compartments of brain tissue, cerebrospinal fluid, or blood lead to a critical increase in intracranial pressure (ICP). A rising ICP is associated with typical clinical symptoms; however, during analgosedation it can only be detected by invasive ICP monitoring. ⋯ The most relevant parameter for brain perfusion is cerebral perfusion pressure (CPP), which is calculated as the difference between the middle arterial pressure (MAP) and the ICP. A mixed body of evidence exists for the different ICP-reducing treatment measures, such as hyperventilation, hyperosmolar substances, hypothermia, glucocorticosteroids, CSF drainage, and decompressive surgery.
-
Gitelman syndrome is a rare autosomal recessive inherited disease that affects the thiazide-sensitive sodium chloride cotransport channels and the magnesium channels of the distal renal tubuli. Characteristic features are hypokalemia, hypomagnesemia, metabolic alkalosis and hypocalciuria. This case report presents the anesthesiological management of the Gitelman syndrome. The article demonstrates the pathophysiology, symptoms, diagnosis and therapy of this disease from the anesthesiologists point of view.
-
For the evaluation of postoperative pain therapy, nausea and vomiting (PONV), the Children's Hospital in Lucerne acts as a member of the postoperative quality improvement project QUIPSi for children. Initial results and the potential for evaluation of the postoperative pain therapy and PONV are presented here. The central questions are whether the postoperative therapy concept is sufficient and if QUIPSi serves as an ideal tool for postoperative quality improvement? ⋯ The quality analysis showed that especially children with the requirement for more pain medicine and a high PONV incidence (inpatient group) need further improvement in postoperative care. Because of small numbers in some operation groups this qualitative evaluation of the postoperative pain and PONV management only gives an approximate overview. The results of QUIPSi uncovered gaps in the postoperative pain management which will help improve the quality in the postoperative setting. The QUIPSi approach should be integrated as a daily tool into all pediatric surgical departments.