Der Anaesthesist
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Even after many years of intensive research acute respiratory distress syndrome (ARDS) is still associated with a high mortality. Epidemiologically, ARDS represents a central challenge for modern intensive care treatment. ⋯ Lung protective mechanical ventilation and adjuvant therapies, such as the prone position and targeted extracorporeal lung support are of particular importance in the treatment of ARDS, depending on the severity of the disease. In order to guarantee an individualized and needs-adapted treatment, ARDS patients benefit from treatment in specialized centers.
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Observational Study
[Preoperative fasting period of fluids in bariatric surgery].
Aspiration of stomach content is a severe complication during general anaesthesia. The DGAI (German Society for Anesthesiology and Intensive Care Medicine) guidelines recommend a fasting period for liquids of 2 h, with a maximum of 400 ml. Preoperative fasting can affect the patients' recovery after surgery due to insulin resistance and higher protein catabolism as a response to surgical stress. ⋯ There is evidence suggesting that a liberal fluid fasting regimen (1000 ml of fluid) in the preoperative period is safe in patients undergoing bariatric surgery.
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We report an unusual complication following placement of a thoracic epidural catheter in a patient that had undergone surgery for pulmonary metastases of a malignant melanoma. The intra- and postoperative course was initially without complications. At 2 days, there was a small, conspicuous swelling above the site of epidural puncture, which was neither reddened nor painful. ⋯ Facklamia hominis was detected in the pure culture. To avoid bacterial infection, we treated the patient for 7 days with antibiotics. The clinical course was without further pathological findings.
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Biography Historical Article
[Beginning of continuous wound infusion with local anesthetics : With special emphasis on the contributions from Walter Capelle and Ewald Fulde].
Wound infusion with local anesthetics is a proven and safe analgesic procedure for modern perioperative patient care. Even the pioneers of local anesthesia practiced wound analgesia and emphasized the shortcomings of "single-shot" wound infusions. At the same time, they drew attention to the importance of long-lasting pain relief to prevent sequelae, especially after upper abdominal surgery with pneumonia, embolic events or postoperative ileus. ⋯ This measure was carried out to enable reduction in pain and allow early postoperative mobilization. The conceptual development of this pioneering analgesia method is closely connected with the names of the Berlin surgeons Walter Capelle and Ewald Fulde; however, their inaugurated and propagated therapy concept did not find the attention and dissemination that it deserved. This is a reason for us to remember their pioneering ideas on pain management in the context of current developments.
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Editorial Comment
[Sharpen the classical view of septic cardiomyopathy].