Der Anaesthesist
-
The recovery room as a central monitoring unit plays a crucial role in the perioperative care of patients. Here, the patient is monitored until the subsequent transfer to a further care ward; however, due to the previous anesthesia and surgery the recovery room also provides a high risk for (the development of) complications. The present article provides an overview of the most frequent complications to be expected in the recovery room (in adults), the diagnostics and the acute treatment.
-
Near-infrared spectroscopy (NIRS) has been available in research and clinical practice for more than four decades. Recently, there have been numerous publications and substantial developments in the field. This article describes the clinical application of NIRS in relation to current guidelines, with a focus on pediatric and cardiac anesthesia. ⋯ Limitations of the method and the lack of comparability of values from different devices as well as generally accepted standard values are explained. Technical differences and advantages compared to pulse oxymetry and transcranial Doppler sonography are illuminated. Finally, the prognostic significance and requirements for future clinical studies are discussed.
-
Due to SARS-CoV‑2 respiratory failure, prone positioning of patients with respiratory and hemodynamic instability has become a frequent intervention in intensive care units (ICUs), and even in patients undergoing transfer in an ambulance or helicopter. It has become increasingly important how to perform safe and effective CPR in prone position, achieving both an optimal outcome for the patient and optimal protection of staff from infection. ⋯ We found mCPR to be feasible in manikins in both prone and supine positions.
-
In 1971 the British rock band Jethro Tull published their milestone album Aqualung with a song of the same title. The song tells the story of a character also named "Aqualung", a homeless person, who spends a cold day on a bench in a park in London. Nothing much happens: he watches little girls playing, bends to pick up a cigarette butt, walks to a public restroom, is offered a cup of tea by the Salvation Army, is scared by and flees from a young prostitute called "cross-eyed Mary", and then finally dies with "rattling last breaths with deep-sea diver sounds". ⋯ The description of his final breaths may remind the anesthetist of the death rattle. One avenue for mediating medical knowledge to physicians is to link data and facts on diseases to elements of popular culture. This essay strives to use a still extremely popular rock song to sensitize and educate anesthetists and intensive care physicians regarding diseases of the homeless relevant to critical care.
-
Levosimendan is a cardiac inotrope that augments myocardial contractility without increasing myocyte oxygen consumption. Additionally, levosimendan has been shown to exhibit anti-inflammatory, antioxidative, and other cardioprotective properties and is approved for treatment of heart failure. Recent studies indicated that these beneficial effects can be achieved with doses lower than the standard dose of 12.5 mg. Patients with preoperatively diagnosed left ventricular ejection fraction (LVEF) ≤40% received 1.25 mg levosimendan after induction of anesthesia. After surgery, administration of low-dose levosimendan was repeated until cardiovascular stability was achieved. ⋯ The presented concept of pharmacological preconditioning with 1.25 mg levosimendan followed by individualized additional dosing in cardiac surgery patients with preoperative LVEF ≤40% suggests that this concept is safe, with possible advantages regarding the need of inotropic agents, renal replacement therapy, and 30-day mortality, compared to the current literature. Individualized treatment with levosimendan to support hemodynamics and a timely reduction of inotropic agents needs further confirmation in randomized trials.