Der Anaesthesist
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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.
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Anaesthesiologists must be familiar with the particularities of the respiratory physiology of newborns and infants when providing perioperative care to these patients. Even brief periods of inadequate respiratory support can cause atelectatrauma and volutrauma which in turn can have deleterious cardiorespiratory consequences and accentuate pre-existing lung disease. ⋯ Optimal PEEP and normal tidal volumes during conventional ventilation, high volume strategy during high frequency ventilation, and permissive hypercapnia are the corner stones of a lung protective strategy. Using an interdisciplinary approach, surgery in the intensive care unit using total intravenous anaesthesia with the uninterrupted use of the ICU equipment is an attractive option for the most vulnerable patients in this age group.
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Levobupivacaine, the S-enantiomer of racemic bupivacaine, will be available in Germany in mid-2004. Pharmacological studies demonstrated that, compared to bupivacaine, levobupivacaine has equal local anaesthetic potency with reduced potential for cardiac and CNS toxicity. This review introduces the new long-acting amide local anaesthetic levobupivacaine to the reader and evaluates its place in obstetric analgesia and anaesthesia compared to bupivacaine and ropivacaine.
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With an incidence of 130,000 per year, sudden cardiac death is one of the most frequent causes of death in Germany. Each day 350 patients die from cardiac arrest. Survival depends essentially on the time delay before professional help arrives and sufficient resuscitation measures have been started. ⋯ Even in large hospitals with maximum care facilities, delays before beginning resuscitation measures can occur which results in a dramatic reduction of the survival rate. Therefore, it seems reasonable to use AED in large hospitals. For implementation, training programmes and a nationally standardized documentation of resuscitation events should be promoted.
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Disturbances of some partial liver functions, such as synthesis, excretion, or biotransformation of xenobiotics, are important for prognosis and ultimate survival in patients presenting with multiple organ dysfunction on the intesive care unit (ICU). The incidence of liver dysfunction is underestimated when traditional "static" measures such as serum-transaminases or bilirubin as opposed to "dynamic" tests, such as clearance tests, are used to diagnose liver dysfunction. Similar to the central role of the failing liver in MODS, extrahepatic complications, such as hepatorenal syndrome and brain edema develop in acute or fulminant hepatic failure and determine the prognosis of the patient. ⋯ In addition to specific and causal therapeutic interventions, e.g. N-acetylcysteine for paracetamol poisoning or termination of pregnancy for the HELLP-syndrome, new therapeutic measures, e.g. terlipressin/albumin or albumin dialysis are likely to improve the poor prognosis of acute-on-chronic liver failure. Nevertheless, liver transplantation remains the treatment of choice for fulminant hepatic failure when the expected survival is <20%.