Der Anaesthesist
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Case Reports
[In situ broken 27-gauge spinal needle in a repeated caesarean delivery : Case report and literature review].
We report the rare case of an in situ fracture of a spinal needle within the setting of repeated caesarean delivery in a 28-year-old pregnant woman and discuss the responsible underlying factors. In particular, a wrong technique, limited experience, difficulties to identify the anatomical landmarks, as well as the use of spinal needles smaller than 25 G might promote such a complication. In order to ensure the stability of the spinal needle and to avoid an in situ fracture, the spinal needle should be never moved without the stylet. ⋯ Next, the use of an atraumatic spinal needle greater than 27 G should be considered to facilitate intrathecal puncture and to avoid the in situ fracture of a spinal needle. Within this context, the risk of post-spinal puncture headache should be balanced. If an in situ fracture of a spinal needle happens, its subsequent removal should be planned without delay by an interdisciplinary team and the anaesthetic method should be chosen with consideration of patient-specific risk factors.
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Review Meta Analysis
[Ventilator-associated pneumonia (VAP) : A risk already at the time of anesthetic induction].
Ventilator-associated pneumonia (VAP) is one of the most common and preventable infections in mechanically ventilated patients. It is associated with a high mortality rate. To prevent VAP, various strategies address this issue using "VAP-bundles", which are implemented in many intensive care units. The risk of acquiring VAP starts with the induction of anesthesia, strictly speaking at the time of intubation. This article considers measures to prevent VAP during general anesthesia in adult patients (>18 years). Procedures beyond standard hygienic precautions for VAP prevention are reviewed. ⋯ Beyond standard hygienic precautions, microaspiration should be avoided to prevent VAP. During mechanical ventilation at least 5 cm H2O PEEP is advised. Continuous monitoring and adjustment of cuff pressure is necessary. All patients mechanically ventilated after general anesthesia for more than 24 h should be intubated with an ETT with a port for subglottic suctioning.
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The world of medicine is becoming from year to year more complex. This necessitates efficient learning processes, which incorporate the principles of adult education but with unchanged periods of further education. The subject matter must be processed, organized, visualized, networked and comprehended. ⋯ An important factor is a healthy mixture of blended learning methods, which also use new technical possibilities. These include a multitude of e‑learning options and simulations, which partly enable situative learning in a "shielded" environment. An exemplary role model of the teacher and feedback for the person in training also remain core and sustainable aspects in medical further education.
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The continuous monitoring of vital parameters and subsequent therapy belong to the core duties of anaesthetists during acute trauma resuscitation in the trauma room. Important procedures may include placement of arterial lines and central venous catheters (CVCs). Knowledge of indication, performance and localization of invasive catheterisation of trauma care in Germany is scarce. ⋯ In Germany, medical indication and schedule of invasive vascular catheterisation of severely injured patients in the trauma room is rarely regulated by SOPs and often performed at the discretion of the attending trauma team. Sonographic assistance during vascular puncture and electrocardiography for CVC tip detection is not as common as in non-emergency anaesthesia. Further studies are required to explore the real necessity and safety of invasive vascular catheterisation in multiple trauma patients in order to improve trauma care.