Der Anaesthesist
-
More than 50% of all patients on intensive care units acquire a systemic inflammation such as systemic inflammatory response syndrome (SIRS) or sepsis. The development of hepatic microcirculatory failure with consecutive organ damage might occur during the course of the systemic inflammation. The liver microcirculation is regulated by a complex network of cellular components and specific mediators. ⋯ Some investigations aim to determine the impact of sedatives and analgesics on the hepatic microcirculation in sepsis and SIRS. Therefore, a decisive recommendation about the choice and dosage of sedatives and analgesics for these patients is not possible. Nevertheless, ketamine, midazolam and fentanyl with their potential anti-inflammatory properties seem to be suitable for patients with systemic inflammation.
-
A decade after the onset of a discussion whether ventilation could be omitted from bystander basic life support (BLS) algorithms, the state of the evidence is reevaluated. Initial animal studies and a prospective randomized patient trial had suggested that omission of ventilation during the first minutes of lay cardiopulmonary resuscitation (CPR) did not impair patient outcomes. ⋯ Instead of calling basics of BLS training and practice into question, more and better training of lay persons and professionals appears mandatory, and targeted use of dispatcher-guided telephone CPR should be evaluated and, if it improves outcome, it should be encouraged. Future studies should focus much less on the omission but on the optimization of ventilation under the specific conditions of CPR.
-
In the majority of emergency situations definite airway control can be achieved by endotracheal intubation with or without preceding bag valve mask ventilation. However, both techniques can fail because of many different reasons. Therefore, alternative techniques for routine anaesthesia and emergency situations are required. In the present article difficulties that may arise using bag valve mask ventilation and endotracheal intubation are discussed and an overview of available alternatives is given.
-
Propofol infusion syndrome has not only been observed in patients undergoing long-term sedation with propofol, but also during propofol anesthesia lasting 5 h. It has been assumed that the pathophysiologic cause is propofol's impairment of oxidation of fatty acid chains and inhibition of oxidative phosphorylation in the mitochondria, leading to lactate acidosis and muscular necrosis. It has been postulated that propofol might act as a trigger substrate in the presence of priming factors. ⋯ To increase elimination of propofol and its potential toxic metabolites, hemodialysis or hemofiltration are recommended. Due to its possible fatal side effects, the use of propofol for long-term sedation in critically ill patients should be reconsidered. In cases of unexplained lactate acidosis occurring during continuous propofol infusion, propofol infusion syndrome must be taken into consideration.
-
Approximately 8000 patients with multiple trauma are admitted annually to an emergency room in Germany. The prognosis of these severely injured patients is influenced in particular by concomitant craniocerebral injury, an abdominal wound, or thoracic trauma. ⋯ Management of patients with multiple trauma poses a particular challenge to the responding team. This article in the continuing education series deals with current algorithms for preclinical management of patients with multiple injuries with particular focus on the significant factor of time.