Der Anaesthesist
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Studies on stress factors for patients in intensive care units (ICU) have so far concentrated on whether certain stressors have occurred or how stressful they were. There are no studies on stress for patients in ICUs that measured both the perception of stress and the chances perceived to control it; however, loss of control can result in long-term psychopathological consequences, such as depression or posttraumatic stress disorder. Therefore, a questionnaire was developed to evaluate the influence of controllability on perception of stress. The aim of this study was to answer the following questions: which situations were experienced as stressful by patients in ICUs, whether patients perceived them as being controllable and whether the experience of stress depended on the controllability? Furthermore, it was examined which stressful situations are specific to ICUs. ⋯ The experience of loss of control seems to negatively modify the impact of stressors. Thus, an increase in aspects of controllability could reduce the burden on patients during intensive care.
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Case Reports
[TEG-guided treatment of a dabigatran overdose in a patient with acute kidney failure].
This article presents the case of a multimorbid male patient with an accidental dabigatran overdose caused by kidney failure in the context of an acute intestinal disorder. After effective initial antagonizing of the dabigatran effect using idarucizumab a dabigatran rebound was detected caused by a single hemodialysis leading to a severe intrapulmonary hemorrhage. As dabigatran plasma level testing was not available and conventional coagulation analysis was out of interpretable range due to the impact of dabigatran, continuous thrombelastography (TEG) was used to detect the effect of dabigatran and monitor the treatment results. The most significant parameter used in the kaolin activated clotting time was the R‑time parameter, which was massively prolonged by the interrupted coagulation cascade.
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The application of artificial intelligence (AI) is currently changing very different areas of life. Artificial intelligence involves the emulation of human behavior with the aid of methods from mathematics and informatics. ⋯ Although the majority of the applications in medicine are still limited to data analysis and research, it is certain that ML will become increasingly more important in scientific and clinical aspects in this supportive function. Therefore, it is necessary for clinicians to have at least a basic understanding of the functional principles, strengths and weaknesses of ML.
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Adaequate antibiotic therapy is crucial for successful anti-infective therapy. In addition to the choice of the right antibiotic and the duration of therapy, the dose also plays a decisive role. ⋯ Since pharmacokinetic differences between plasma and the interstitial fluid of different target tissues have been observed for different antibiotics, the measurement is also necessary in the target tissue. The technique of microdialysis is best suited for this purpose as it allows concentrations to be measured continuously in the target tissue.
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Review Case Reports
["Legal highs" (new psychoactive substances) : What does the anesthesiologist need to know?]
In recent years, the social media, the press and the internet have reported more about the topic of "legal highs" and new psychoactive substances (NPS). The use of these drugs is accompanied by a serious risk of undesired side effects, intoxication and even death. The often unknown chemical composition, unspecific clinical presentations and lack of quickly available routine diagnostic tests are aggravating factors in this situation. For anesthesiologists, knowledge of this dangerous substance class plays an important role in the field of preclinical treatment, perioperative management and intensive medical care.