Der Anaesthesist
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Extraglottic airway devices (EGA) are not only used in routine anaesthesia practice, they also have a distinct value for in-hospital and out-of-hospital difficult airway management. In the environment of the intensive care unit (ICU) EGA are not used on a regular basis. ⋯ This review presents the potential indications for EGA on the ICU for the management of difficult airway situations as well as during percutaneous tracheotomy. Furthermore, the possible advantages of EGA during postoperative recovery from anaesthesia as well as termination of controlled ventilation for intensive care patients are discussed.
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Accurate scheduling of operations is essential for an efficiently used OR. The aim of this investigation was to describe the quality of OR scheduling in the analyzed OR. Furthermore suggestions for avoiding underutilization or overutilization through optimized OR planning should be addressed if possible. ⋯ Prognosis of operations with longer planned duration (>150 min) should be improved in the OR area analyzed. Scheduling of these operations at the beginning of the OR list or with a sufficient time interval towards the end of the appointed OR block time within the OR list can avoid or at least minimize underutilization and overutilization of the OR.
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In cases of unclear depression of conciousness, arrhythmia and symptoms of cardiac insufficiency inadvertent carbon monoxide intoxication should always be taken into consideration. Rapid diagnosis of acute carbon monoxide intoxication with mostly unspecific symptoms requires an immediate supply of high dose oxygen which enables a distinct reduction of mortality and long-term morbidity. ⋯ There is no sufficient coherence between carboxyhemoglobin blood levels and clinical symptoms. Increased carboxyhemoglobin concentrations help to diagnose acute carbon monoxide intoxication but do not allow conclusions to be drawn about possible long-term neuropsychiatric or cardiac consequences.
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Intoxication due to local anaesthetic drugs poses a rare but potentially life-threatening complication. In particular long-acting local anaesthetics can cause refractory cardiac arrest due to their lipophilic properties. This is often preceded by neurological symptoms such as confusion, vertigo and tonic-clonic seizures. ⋯ In case of cardiac arrest standard protocols for cardiopulmonary resuscitation have to be implemented immediately. The use of lipid emulsion can then be initiated as a supplement to standard resuscitation. It is recommended that lipid emulsions are instantly accessible in all facilities where local anaesthetics are administered.
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Critical care medicine plays an important role for the medical and economic success of hospitals. Knowledge and implementation of recent relevant studies are prerequisites for high quality intensive care medicine. The aim of the present manuscript is to present an overview of the most important publications in intensive care medicine in 2009 and comment on their clinical relevance. ⋯ New trends are bedside echocardiography and telemedicine. Unfortunately, a magic bullet has not been identified last year. The focus is still on team education and guideline-assisted therapy.