Der Anaesthesist
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In the fall of 1957 there was a momentous ship disaster, during which the four-masted barque PAMIR sank in the Hurricane Carrie northwest of the Azores and 80 crew members were killed. Among the crew members killed was the ship's doctor Dr. med. Heinz Ruppert, a specialist in anesthesiology, gynecology and obstetrics from the University Women's Hospital of the Charité in East Berlin. ⋯ As an avid supporter of neuraxial conduction anaesthesia techniques, he primarily worked on this topic scientifically and tried to establish peridural anaesthesia in obstetrics. In 1954 he was able to habilitate at the Charité with a thesis on this subject and was appointed as lecturer. His scientific oeuvre has so far not been appreciated, a reason to remember this forgotten German protagonist of gynecological obstetric anaesthesia.
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The implementation of patient blood management (PBM) is increasingly becoming standard in operative medicine. Recently, interest has also been shown for the vulnerable collective of pregnant women and neonates. ⋯ Furthermore, loss of blood in anticipation of bleeding complications should be reduced by interdisciplinary preventive measures and an individually coordinated postpartum care should be organized. This results in an early diagnosis of anemia or iron deficiency with subsequent treatment also postpartum, analogous to the prepartum period.
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The revised and redefined "International Guidelines for Management of Sepsis and Septic Shock 2021" of the Surviving Sepsis Campaign were published on 4 October 2021. As in the previous version from 2016, the focus of these international guidelines is on the diagnosis and acute treatment measures in sepsis. ⋯ These recommendations and the underlying studies reflect the increasing awareness about the long-term consequences of severe diseases requiring intensive medical care. This article summarizes the updates in a clearly comprehensible form.
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Postpartum hemorrhage (PPH) nowadays still represents a severe complication of both a vaginal delivery and a cesarean section. In German-speaking areas a new definition of the term has recently become established and the nomenclature with respect to the severe form of PPH was dropped. ⋯ In addition to an adequate hemostasis, a developing coagulopathy must be recognized at an early stage and treated with targeted coagulation management. Through implementation concepts, particularly the second pillar (minimization of blood loss) and the third pillar (rational use of blood transfusions) of patient blood management, various aspects for improvement of treatment of a PPH can be identified.
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Treatment of acute pain is a central task in emergency medicine. Yet, prehospital pain relief is often insufficient or delayed since the administration of potent intravenous analgesic drugs (such as opioids) is mostly limited to physicians due to legal restrictions or training deficiencies in Germany and Austria. Frequently, prehospitally operating emergency physicians have to be demanded later for anguished patients limiting disposability of physicians for patients who are in a potentially life-threatening condition. ⋯ The use of methoxyflurane is limited in patients with severe hepatic or renal insufficiency and the characteristic odor has been described as unpleasant by some patients. In Europe, three large in-hospital trials showed strong pain relief in trauma patients, even comparable to opioids. Overall, based on the current evidence, the use of nitrous oxide and even more of methoxyflurane may be recommended also for prehospital use by skilled paramedics.