Der Anaesthesist
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The discovery of the local anaesthetic effect by blocking sodium ion channels was a milestone in anaesthesia but was soon limited by sometimes life-threatening toxic effects of the local anaesthetics. By developing novel local anaesthetics and also by adding so-called adjuvants, attempts have been made to limit these life-threatening events. This article focuses on the historic background and the current state of the use of these adjuvants for regional anaesthesia. ⋯ This is consistent with numerous clinical reports of a marked prolongation of the local anaesthetic effect. In addition to the known genomic effects of steroids that occur via a change in gene expression of pain-sustaining protein structures, faster non-genomic effects are also discussed, which occur via a change in intracellular signaling pathways. In summary, new insights into mechanisms and novel results from clinical trials will help the anaesthesiologist in the decision to use adjuvants for regional anaesthesia which, however, requires to weigh the individual patient's benefits against the risks.
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Safety strategies in civil aviation are well-established. The authors present a possible structure for induction of anesthesia, which includes elements of the so-called cockpit strategy. The objective is to reduce anesthesia-related mortality caused by the unexpected difficult airway through early detection and solution of cannot intubate cannot oxygenate (CICO) situations. ⋯ The transfer and implementation of a cockpit strategy in anesthesiology for improvement of patient safety is possible. The acceptance of the aviation safety strategy in medicine is a necessary prerequisite. A profound training in technical and non-technical skills and regular team training to solve CICO situations must be an integral part of advanced training in anesthesiology.
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Abstract
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Case Reports
[Sonographic diagnostics in operative intensive care medicine : Pericardial hematoma after cardiac surgery].
These two case reports describe the use of transthoracic echocardiography in cardiac surgery patients during postoperative intensive care, when a pericardial hematoma developed. A focused echocardiographic examination was performed, which in both cases led to the correct diagnosis and revealed the cause for hemodynamic instability. ⋯ The case reports demonstrate that intrathoracic bleeding after cardiac surgery may develop with a latency of days to weeks, which can become hemodynamically relevant and require an intervention. Bedside point of care echocardiography opens the way for securing the diagnosis by means of CT or magnetic resonance imaging (MRI) if the circulatory state of the patient allows this prior to hematoma drainage or evacuation.
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No systematic study has previously been undertaken in Germany to ascertain why irreversible brain death determination (BDD) has not been carried out. ⋯ The number of potential organ donors in Region East of the DSO could be significantly increased by identifying patients where BDD is indicated. By consistent evaluation of patients' wills in terms of organ donation before treatment is withdrawn in patients with poor neurological prognosis, additional potential organ donors could be identified. Furthermore, involving neurointensive care physicians in the care of all patients with brain damage could improve the prognostic assessment.