Der Anaesthesist
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After intensive care unit (ICU) treatment, the recollection of experienced pain is one of the most burdensome aftermaths. In addition, pain has several negative physiological consequences. The majority of patients report moderate to severe pain while being treated on an ICU, often caused by diagnostic or therapeutic procedures. ⋯ When using regional anesthesia the positive therapeutic effect and the possible complications need to be carefully weighed. Non-pharmaceutical procedures, especially transcutaneous electrical nerve stimulation (TENS), have proven successful in postoperative pain management. Even if only limited data from intensive care are available, a therapeutic attempt seems justifiable because of the low risk of complications.
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The report describes the rare case of a periprocedural hemorrhage during percutaneous dilatation tracheotomy. In the final analysis, the innominate artery could be identified as the source of the hemorrhage. ⋯ In this case the potentially life-threatening hemorrhage could be stopped and the elective treatment was completed. Therefore, because palpation of the neck cannot exclude life-threatening vascular aberrations with certainty, a preprocedural ultrasound examination of the anatomical features should be performed before carrying out a dilatation tracheotomy.
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Surgically induced fire is a life-threatening hazard; this topic has received little attention, although only 3 factors, the so-called fire triad, are needed for surgical fires to occur: an oxidizer, fuel and an ignition source. This systematic review aims to determine the impact of each component and to delegate every staff member an area of responsibility, thus ensuring patient health through prevention or protection. The trial was registered in Prospero CRD42018082656. ⋯ It was concluded that the main problem is defining the real extent of this hazard. Exact numbers and exact condition protocols are needed; therefore, standardized registration of every fire and future studies with much evidence are needed. Immediate prevention consists of close attention to patient safety to prevent surgical fires from happening.