Der Anaesthesist
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The management of general anaesthesia in patients with neuromuscular disorders remains challenging. The underlying causes and clinical presentations of these rare heterogeneous diseases are highly variable and the only common feature is usually skeletal muscle weakness. ⋯ Neuromuscular monitoring can be complicated because of disease-induced alterations in neurophysiology; however, continuous monitoring of the neuromuscular blockade should be realized to accurately determine the recovery from the blockade. These patients very often have an increased risk for postoperative pulmonary complications, which increases further if a residual neuromuscular blockade is present.
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Besides protection of vital functions, pain treatment is one of the fundamental tasks in emergency care. However, in emergency situations patients frequently do not receive any pain treatment at all or, despite high pain intensities, treatment remains insufficient. ⋯ Thereby one should not disregard that pain has several negative effects on the patient that should be avoided. In this article the basics of preclinical analgesia are shown and concepts presented that should help the emergency physician to accomplish adequate analgesia in an emergency situation.
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Chronic obstructive pulmonary disease (COPD) and bronchial asthma are the most common causes of obstructive pulmonary diseases and acute dyspnoea. In the preclinical emergency situation a distinction between bronchial asthma and exacerbated COPD is difficult because symptoms are similar. Although the preclinical measures differ only marginally, a differential diagnosis from other causes of respiratory obstruction and acute dyspnoea, such as cardiac decompensation, anaphylaxis, aspiration of foreign bodies, tension pneumothorax and inhalation trauma is necessary because alternative treatment options are required. ⋯ For severe asthma attacks the administration of magnesium is a possible additional option. Systemic intravenous administration of steroids has an anti-inflammatory effect and for this reason is the second column of treatment for both diseases. Invasive ventilation remains a last resort to ensure respiratory function and indications for this are given in patients with clinical signs of impending exhaustion of breathing.
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Review
[Economic benefits of overlapping induction: investigation using a computer simulation model].
The aim of this study was to investigate the potential economic benefit of overlapping anaesthesia induction given that all patient diagnosis-related groups (AP DRG) are used as the model for hospital reimbursement. A computer simulation model was used for this purpose. Due to the resource-intensive production process, the operating room (OR) environment is the most expensive part of the supply chain for surgical disciplines. ⋯ For longer surgical times, the additional costs for the workforce result in a reduced contribution margin depending on the models chosen to handle overtime of the technical OR personnel. Important advantages of this approach for simulation are the use of the historical production data and the reflection of the specificities of the local situation. Computer simulation is an ideal tool to support operation room management, particularly regarding the planning of resource allocation and the coordination of workflow.
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The demographic development in Germany is heading towards a significant shortage in specialists within the next 10-15 years with an increased demand for health services at the same time. The three-stage model of family life planning (work, family phase, return) will also be gradually replaced by a model of simultaneous compatibility of family and work. This change in values, although initiated by the parents themselves, may turn out to be a crucial countermeasure in national economy against the demography-related loss of qualified personnel. ⋯ In the hospital daily routine, in particular, creative solutions meeting the local demands are deemed necessary that do not involve the use of high financial resources. Family-friendly personnel policy not only arises from altruistic enthusiasm but also pays off economically. This article discusses the necessity, opportunities and threads of family-oriented hospital management and fields of action for anaesthesia departments.