Der Anaesthesist
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Standardized treatment approaches can improve the quality of the management of acute postoperative pain. ⋯ Content, structure and type of the evaluated treatment standards showed a considerable heterogeneity with respect to the availability of rescue and baseline medication. Safety aspects were not addressed in many cases. These findings show that despite the requirements of the German guidelines for treatment of perioperative and posttraumatic pain for treatment standards, there are still no practical recommendations with respect to contents and structure of such standards.
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Hypotensive states that require fast stabilisation of blood pressure can occur during anaesthesia. In 1963, the 20:1 mixture of cafedrine/theodrenaline (Akrinor) was introduced in Germany for use in anaesthesia and emergency medicine in the first-line management of hypotensive states. Though on the market for many years, few pharmacodynamic data are available on this combination net beta-mimetic agent. ⋯ Cafedrine/theodrenaline quickly restores MAP during anaesthesia. Female gender is associated with higher effectiveness, while heart failure and beta-blocker administration lower the anti-hypotonic effect. Prospective studies in defined patient populations are warranted to further characterise the effect of cafedrine/theodrenaline.
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Statistically, the chance of a patient to win a court case because of a legally insufficient informed consent is approximately 70%. In Austria the judgment whether the anesthesia-related risk of a patient was correctly addressed depends generally on the opinion of a certified expert court witness (CW). ⋯ In future new methods of knowledge transfer to the patients should be developed. In addition, a standardization of the evaluation criteria for CWs in terms of improvement of legal certainty would be desirable.