Der Anaesthesist
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Infusion sets with precision flow regulators are frequently used in children undergoing surgery in order to control the perioperative administration of fluids. There are no data about the safety and accuracy of these infusion sets. A study was therefore conducted to compare adjusted and actual flow rates of three different infusion sets with precision flow regulators under standardized conditions. ⋯ The actual flow rates differed considerably from the adjusted flow rates in the evaluated infusion sets. The flow rates substantially depended on the static level of the infusion. First and foremost, regulation of the administered infusion volume does not seem to be reliable when using an infusion set with a precision flow regulator.
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Liver transplantation (LTPL) is the only curative option for patients with end stage liver disease (ESLD) or with hepatocellular carcinoma (HCC). Eurotransplant in Leiden, the Netherlands, is responsible for organ allocation. The model of end stage liver disease (MELD) score, which describes the severity of the liver disease, is decisive for organ allocation. ⋯ The anesthesiologist is responsible for evaluating the overall prognosis, whereby cardiac, pulmonary, renal and neurological comorbidities must be taken into consideration. During LTPL surgery is divided into several stages. Besides volume management, heat preservation and coagulation management, major challenges for the anesthesiologist are hemodynamic stabilization and regulation of the acid-base balance.
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Health services research (HSR) is a multidisciplinary field of research that describes disease treatment and health care and their framework conditions. In the last 20 years, the HSR aspect became more and more the clinical focus of intensive care medicine. Under this aspect HSR investigates the use of clinical measures and their impact on patient outcome under routine intensive care medical conditions. ⋯ As part of the establishment of the innovation fund for HSR, promising intensive medical care projects have been promoted to improve the quality of care and the quality of long-term outcome for intensive care patients. An important focus lies on the identification of factors that improve long-term quality of life after intensive care. The expansion of registries and telemedicine in intensive care offers the opportunity to bundle and share experiences more effectively and thereby establish (guideline-based) treatment recommendations faster in the clinical practice.
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In 2018 the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) published an update of the guidelines on myocardial revascularization from 2014. In these updated guidelines both associations agreed on joint recommendations concerning myocardial revascularization. Especially anesthesiologists being part of the cardiac anesthesia or heart team and intensive care physicians should have knowledge about the new or changed recommendations of these guidelines. This article summarizes the most important changes of the ESC/EACTS guidelines on myocardial revascularization.
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Due to an increasing number of severe complications reported during the prehospital application of laryngeal tubes, the Austrian Society for Anesthesiology, Resuscitation and Intensive Care Medicine (ÖGARI) is prompted to formulate a respective statement. With regard to the current training situation and the applicable laws, ÖGARI recommends to convert the "Emergency Competence for Endotracheal Intubation (NKI)" for emergency paramedics into an "Emergency Competence for Extraglottic Airway Management, (NK-EGA)". Training should include at least 40 h of theoretical instruction, hands-on training on the manikin to secure mastery of the methodology and at least 20 successful applications under clinically elective conditions in adult patients under direct medical supervision. ⋯ Only 2nd generation EGA should be used. After successful EGA placement timely cuff pressure monitoring and gastric suction should be performed. The use of an EGA by ambulance-men cannot be recommended; these have to be limited to bag-mask ventilation.