Der Anaesthesist
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The microcirculation is unique in its anatomy and physiology and is a self-contained organ system within the human body. It is the site where gas exchange and nutrient supply takes place, but it is also the site which experiences pathological alterations during various shock states and therefore compromises the oxygen supply to tissues and organs. Systemic inflammation for example leads amongst others to increased heterogeneous blood flow, formation of interstitial edema, altered viscosity, leukocyte activation, disturbances in the coagulation system, and to a breakdown of the endothelial barrier function. ⋯ Without interruption of these pathomechanisms, the dysfunction of the microcirculation will consequently result in organ dysfunction. In this review article a short description of the microcirculatory physiology, the interaction between the macrocirculation and the microcirculation, as well as microcirculatory alterations generated by a systemic inflammatory response will be given. Finally, various therapy options will be described, which, experimentally, can lead to an improvement in microcirculatory dysfunction.
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In recent years peripheral and central regional anesthesia have become increasingly more important in pediatric anesthesia. Unlike adult patients, children typically receive regional anesthesia while under general anesthesia, an approach generally accepted among pediatric anesthesiologists. A well-founded knowledge of the specific anatomical, physiological and pharmacokinetic characteristics of pediatric patients is indispensable for safely practicing pediatric regional anesthesia. ⋯ The use of ultrasound when administering regional anesthesia can help reduce the risk of complications even further. Peripheral and central regional anesthesia are safe procedures which pediatric patients should not be deprived of. The present article discusses frequent as well as rare complications of pediatric regional anesthesia.
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The present article reviews improvements in the 2008 version of the German Refined - Diagnosis Related Groups (G-DRG) which are relevant for anaesthesia and intensive care medicine. The focal points of further developments and the data base of the updated DRG version are presented. The efforts of the InEK, the institution which is responsible for the design and development of the G-DRG system, to provide a transparent system driven by rules are also explained, followed by a description of changes in coding of diagnoses (e.g. new diagnosis codes, revised complication and comorbidity level matrix, new specifications of individual diagnosis-related groups such as acute paraplegia) and procedures (e.g. new procedure codes, modifications for complex procedures). ⋯ The present contribution is an update of previous articles on this topic published in this journal in 2007. Therefore, knowledge of these previous publications is a prerequisite for the understanding of the current article. Readers who are not familiar with the complex material should refer to the publications from 2007.
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Review Meta Analysis
[Glycemic control in sepsis and septic shock: friend or foe?].
Intensive care patients commonly suffer from hyperglycemia. Evidence is growing that strictly maintaining normoglycemia by intensive insulin therapy (IIT) ameliorates outcome in these patients. Whether or not this also holds true for patients with sepsis and septic shock is the issue of this post-hoc analysis of the database (2,748 patients) of 2 recent prospective clinical trials. ⋯ These data suggest that IIT improves outcome of patients with sepsis or septic shock. Hypoglycemia is a frequent complication, but its clinical relevance remains to be defined.
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One of the most important mandates of the anaesthesiologist is to control the depth of anaesthesia. An unsolved problem is that a straight definition of the depth of anaesthesia does not exist. Concerning this it is rational to separate hypnosis from analgesia, from muscle relaxation and from block of cardiovascular reactions. ⋯ For example, they cannot predict if a patient will react to a painful stimulus or not. In the future it would be desirable to develop parameters which allow an estimate of the other components of anaesthesia in addition to the presently available monitoring systems to estimate sedation and muscle relaxation. These could be sensoric-evoked potentials to estimate analgesia and AEPs for the detection of awareness.