Der Anaesthesist
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Trauma care personnel are at risk of occupational exposure to blood-borne pathogens. Little is known regarding compliance with standard precautions or occupational exposure to blood and body fluids among multiple trauma care personnel in Germany. ⋯ The process of treatment in prehospital settings is less predictable than in other settings in which invasive procedures are performed. Periodic training and awareness programs for trauma care personnel are required to increase the knowledge of occupational infections and the compliance with standard precautions. The legal and ethical aspects of testing an index patient for blood-borne pathogens after a needlestick injury of a healthcare worker have to be clarified in Germany.
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In order to extrapolate novel therapies from the bench to the bedside (translational research), animal experiments are scientifically necessary. Swine are popular laboratory animals as their cardiorespiratory physiology is very similar to humans. Every study has to be approved by the local and/or national animal ethical committees. ⋯ For humane euthanasia of pigs, morphine, followed by propofol, rocuronium and potassium chloride are recommended. As radical animal right groups may threaten scientists, it is prudent that animal laboratories have unmarked entrance doors, are located in buildings that are not accessible to the public and strictly controlled access of laboratory staff is enforced. In conclusion, swine are an excellent laboratory animal for bench to bedside research and can be managed properly when basic knowledge and adequate skills on careful handling, anesthesia and surgical considerations are present.
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Sepsis is known to be a severe systemic immune reaction based on an infection of various origins. The initial immune response is accompanied by excess activation of immune cells and release of proinflammatory cytokines. Simultaneously initiated compensatory mechanisms lead to high levels of anti-inflammatory mediators to counterbalance the generalized inflammatory reaction; however, the compensatory immunoreaction itself equally overreacts and results in a prolonged sepsis-induced immunosuppression. ⋯ Recent findings indicate that epigenetic mechanisms change basic properties of important immune cells by mechanisms leading to changes in gene expression. Dynamic exchanges of histone modifications result in a variation of transcription and seem to play a key role in cell function of macrophages and other immune cells. This article provides a current overview of epigenetic sepsis research and the sepsis-induced effects on the immune system.
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Since the development of the classic laryngeal mask airway (LMA) in the late 1980s, there has been a continuous increase in the frequency of its use as well as areas of application. While contraindications to its use for elective procedures must be recognized, there are an increasing number of clinical studies on expanded indications for the use of supraglottic airway (SGA) devices, particularly those of the second generation. The present article describes the added features of the second generation LMAs, with special emphasis on the behavior of these devices in position and performance tests. An appraisal is conducted based on the currently available literature on the value of the utility for indications, such as prolonged use, laparoscopic surgery, obesity, prone position and Cesarean section.
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An acceptable, standardized and mandatory terminology is important for the planning and implementation of anesthetic procedures on term and preterm newborns and infants. Contradictory use of perinatal terminology poses a problem in current medical practice. This article provides an overview of conventional definitions and technical terms. It also puts forward terminological principles for a model of risk stratification of anesthesia in the newborn period and infancy.