Der Anaesthesist
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Pneumonia occurring more than 48 h after induction of mechanical ventilation is called ventilator-associated pneumonia (VAP). VAP is the most common nosocomial infection in intensive care medicine and is associated with prolonged intensive care and hospital stay and a higher mortality. The main pathomechanism for development of ventilator-associated pneumonia is not so much the mechanical ventilation per se but more the pathogens passing along the tube towards the lungs. ⋯ Therapeutic success in treatment of VAP is coupled to an early diagnosis and therapy. Suspicion of pneumonia is based on clinical and radiologic criteria. Biomarkers and microbiological findings are important for follow-up and reevaluation of the suspected diagnosis.
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Operation room (OR) management is not an end in itself. The challenge is more to organize the complex, inhomogeneous and interference-prone machinery of intraoperative service provision according to business objectives. Although business objectives may differ in some details the ultimate consequence is always to assure the quality of medical care along with adhering to the general economic conditions. ⋯ In the following selection process the important thing is to identify the candidate who fits best to the developed profile. This paper sees itself as an assistance in the development of such a company-specific qualification profile for an OR manager. On the basis of knowledge, skills and characteristics, different manager typologies are developed, facilitating the successful evaluation in a selection process for both the company and the candidate.
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The decrease in airway muscular tone seen during natural sleep and sedation, as well as in the supine position, can lead to anatomic changes in the structures that surround the airway. Some patients need sedation for diagnostic or interventional procedures. ⋯ In addition to different techniques of body positioning, simple airway maneuvers, such as chin lifting can maintain airway patency or open an obstructed upper airway. These maneuvers need an age-related evaluation and application.
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Lidocaine is commonly used for regional anesthesia and nerve blocks. However, recent clinical studies demonstrated that intravenous perioperative administration of lidocaine can lead to better postoperative analgesia, reduced opioid consumption and improved intestinal motility. It can therefore be used as an alternative when epidural analgesia is contraindicated, not possible or not feasible. ⋯ The lidocaine infusion is stopped in the recovery room 30 min before discharge or in the ICU at the latest after 24 h. Lidocaine is not used on normal wards. This overview summarizes the current evidence for the intravenous administration of lidocaine for patients undergoing different types of surgery and gives practical advice for its use.
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Acute type A dissection is among the most dangerous of vascular diseases and is associated with a high lethality. Surgery for type A dissection is a complex procedure which is accompanied by relevant blood losses and severe deterioration of the coagulation system. ⋯ Furthermore, reestablishment of sufficient hemostasis can be challenging and requires thorough understanding of the relevant aspects affecting normal hemostasis during surgical repair of aortic dissection. In this article relevant pathophysiological aspects and basic principles of anesthesiological management of type A dissection are described.