Der Anaesthesist
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Observational Study
[Optimization of blood gas analysis in intensive care units : Reduction of preanalytical errors and improvement of workflow].
Point of care testing with blood gas analysis (BGA) is an important factor for intensive care medicine. Continuous efforts to optimize workflow, improve safety for the staff and avoid preanalytical mistakes are important and should reflect quality management standards. ⋯ The implementation of a new BGA system with labeled syringes and automated processing of the specimens was possible without any difficulties under daily clinical routine conditions in this 10-bed intensive care unit (ICU). A gain of time could not be measured but a reduction in preanalytical errors using the labeled syringes with automated processing was found. Delayed analysis of blood samples can lead to significant changes in pO2 and pCO2 depending on the type of syringe used.
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The origin of emergence agitation in children remains unclear; however, an association between surgical procedure, patient age and anesthetic regimen and the incidence of postoperative agitation has been described in the literature. ⋯ Emergence agitation is still seen as a relevant clinical problem by experienced pediatric anesthesiologists. Propofol is first choice when it comes to pharmacological prevention and treatment of emergence agitation. Postoperative parental presence was considered beneficial by the majority of anesthesiologists.
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This article reports the case of a 62-year-old male patient who ingested the roots of Monkshood (Aconitum napellus) and white hellebore (Veratrum album) dissolved in alcohol with a suicidal intention and suffered cardiotoxic and neurotoxic symptoms. After contacting the Poison Information Centre ventricular arrhythmia was treated with high-dose magnesium sulphate as the only antiarrhythmic agent and subsequently a stable sinus rhythm could be established after approximately 3 h. ⋯ As no specific antidote is known so far, poisoning is associated with a high mortality. The therapy with high-dose magnesium sulphate is based on in vitro and animal experiments as well as limited clinical case reports.
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Historical Article
[Protoplasm, coagulation and colloids : Forgotten chapter in the research history of anesthesia between zeitgeist and paradigm].
The historically most important mechanistic theories attributed the fundamental cause of anesthesia to interactions betweeen anesthetics and proteins as early as the 1870s. According to the underlying thought, the resulting changes in the consistency of cellular protoplasm were the cause of the anesthetized state of the whole organism. These protoplasm coagulation theories, as they were collectively referred to, brought the contemporary enthusiasm for protoplasm, the rapid advances in colloid chemistry and the unified theory of narcosis proclamed by Claude Bernard under a unified mechanistic theory that reflected the Zeitgeist of the epoch. ⋯ They united research in anesthesia with research of fundamental cell biology. In contrast to the much less fruitful lipid theories, protoplasm coagulation theories are largely forgotten without leaving a trace in contemporary discussions of the history of anesthesia. For many tyears, however, they constituted an essential part of fundamental anesthetic research and must therefore be mentioned in any historical review.