Der Anaesthesist
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Observational Study
Out-of-hospital airway management during manual compression or automated chest compression devices : A registry-based analysis.
Airway management during resuscitation is pivotal for treating hypoxia and inducing reoxygenation. This German Resuscitation Registry (GRR) analysis investigated the influence of the type of airway used in patients treated with manual chest compression (mCC) and automated chest compression devices (ACCD) after out-of-hospital cardiac arrest (OHCA). ⋯ Better outcomes were found for mCC in comparison to ACCD and ETI showed better outcomes in comparison to SAD only. This observational registry study raised the hypothesis that SAD only should be avoided or SAD should be changed into ETI, independent of whether mCC or ACCD is used.
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In a series of articles dealing with hypnotics for induction of anesthesia, this article describes the development and current value of propofol. Its significance far exceeds that of a pure induction hypnotic (sedation in diagnostic and therapeutic procedures and on the intensive care unit). Propofol is also used for sedation in diagnostic and therapeutic procedures and on the intensive care unit. ⋯ With appropriate caution nearly the whole spectrum of anesthesiology patients can be treated using propofol. The hemodynamic side effects and the rare but potentially fatal PRIS are limitations. Further developments address the water solubility and the solubilizing agents of propofol.
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The German post-mortem organ donation rate has dropped by one third since 2010. Furthermore, 958 patients died in 2015 in Germany while waiting for an organ. To decrease organ shortage, an amendment of the transplantation law was established in 2012. An information package including an organ donor card is sent to all German citizens via the postal service. A voluntary national transplantation register was introduced in 2016 to improve transparency in the organ donation process. The influence of several transplantation scandals starting in 2012 on organ donation rates is in question. Therefore, the objective of this article is to discuss approval and objections to post-mortem organ donation among the next of kin of potential donors and the general public in Germany. ⋯ Education on organ donation can be a means to increase organ donation rates. The effects of the change in legislation and the establishment of the transplant register need to be evaluated. Further research regarding the influence of religion, especially among religious minorities, on organ donation rates in Germany needs to be conducted to identify possible obstacles. Moreover, the use of social networks to address potential organ donors has proven to increase registration numbers and could easily be implemented in Germany.
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Case Reports
[Intramedullary injection with tethered cord : Case report of a rare complication during spinal anesthesia].
Although very rare, severe neurological complications can occur when undergoing spinal anesthesia. This report describes and analyses a case of spinal injury due to an undiagnosed tethered cord (TC) during spinal anesthesia for a cesarean section of a 31-year-old woman expecting twins. ⋯ Injuries can be caused by mechanical trauma from direct needle injury, hematoma or neurotoxicity from local anesthetics. Special attention should therefore be paid to frequent symptoms, such as a hairy nevus on the back, deformities of the feet or bladder and bowels, voiding and micturition dysfunction in order to reduce the risk of complications.
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Risk assessment prior to elective surgery is an important tool in the context of perioperative patient care; however, only a few studies have been carried out to address the processes and problems during preoperative assessment for anesthesia. ⋯ The analysis of processes and problems in the context of preoperative assessment for anesthesia revealed several options for optimization. Major efforts should be the implementation of an appointment system for the preoperative assessment clinic in order to generate a homogeneous distribution of patients during the course of a day. Furthermore, surgeons and case managers should be requested to refer patients to the preoperative assessment clinic only with complete records and test results according to the in-house standard.