Der Anaesthesist
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The supine position is still the most frequently used type of positioning during surgical procedures. Positions other than the supine position lead to physiological alterations that have a relevant influence on the course of anesthesia and surgery. As a matter of principle, hemodynamic stability is at risk because venous blood is pooled in the lower positioned body parts. ⋯ The pathophysiological intraoperative changes caused by Trendelenburg positioning are described and approaches suitable for risk reduction are discussed. The prone position and lateral decubitus position have little influence on the intraoperative homeostasis. Nevertheless, there is an ongoing discussion concerning the efficacy of a 15° left lateral position during caesarean section, which is also discussed in a separate section of this review.
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Extracorporeal membrane oxygenation (ECMO) is becoming more and more clinically important. The extracorporeal circuit for membrane oxygenation consists of a pump, a membrane oxygenator and large volume tubing. ⋯ As a consequence, the pharmacokinetic-pharmacodynamic (pk-pd) target parameters cannot be achieved. The selection of an appropriate substance and the mode of application, combined with therapeutic drug monitoring (TDM), can significantly improve the therapeutic outcome of critically ill patients.
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A 58-year-old female was admitted due to a suspected seizure. A blue colored pharyngeal fluid was visualized during intubation, which is indicative of poisoning. Clinical research revealed an ingestion of 2.4 g of alpha-chloralose, a rodenticide with a lethal dose of 1 g. ⋯ Substance detection was carried out by gas chromatography-mass spectometry of a urine sample. There are only a few cases reporting poisoning by this substance. Coma and bilateral myoclonus have been reported but blue gastric fluid as the "red flag" in this case has never been described.
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Case Reports
Perioperative analgesia during thymectomy via median sternotomy : Ultrasound-guided bilateral parasternal block.
Thymectomy is sometimes carried out via median sternotomy; however, patients undergoing thymectomy via median sternotomy may experience severe postoperative pain. In this study, an ultrasound-guided regional anesthetic technique called a parasternal block, which can be used to relieve postoperative surgical pain after thymectomy via median sternotomy by blocking the medial nerve branch of the anterior cutaneous branch is presented. ⋯ While these are preliminary findings, further confirmatory clinical trials will be conducted. In summary, ultrasound-guided bilateral parasternal block appears to be a safe, simple, effective and minimally invasive technique for surgery via median sternotomy.