Der Anaesthesist
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Editorial Comment
[Caring for patients-but carefully of course : Structured Handover].
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Case Reports
Laparoscopic partial nephrectomy in a patient on simvastatin : Delayed recovery from neuromuscular blockade.
Delayed recovery from anesthesia remains a very challenging subject for anesthesiologists. This case report describes the clinical course of delayed recovery from neuromuscular blockade after laparoscopic partial nephrectomy in a patient on simvastatin. The patient was hypertensive on regular treatment with oral captopril 25 mg twice daily and amlodipine 5 mg once daily and hypercholesterolemic on regular simvastatin 40 mg once daily with a normal electrocardiogram (ECG). ⋯ This potentiated the muscle relaxant effect of rocuronium bromide and was the reason for patient unresponsiveness and delayed postoperative recovery. We can conclude that anesthesiologists should preoperatively identify statin myotoxicity and to avoid neuromuscular blocking drugs for statin-treated patients. Also, preoperative adjustment of statin dosage may be recommended.
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Review
[Impact assessment of inadequate hospital disaster management : Reflection based on a risk model].
According to legal regulations alarm and emergency plans have to be developed and kept current in hospitals. However, often neither the hospital administration, nor the medical employees and nursing staff pay the necessary attention to these alarm and evacuation plans. In particular, risks and consequences - including financial ones - due to insufficient planning, are not adequately considered. ⋯ Risk management means recognizing risks, assessing risks and managing risks. In hospitals, this mostly means using a critical incident reporting system (CIRS), however risk management in the sense of disaster planning is largely unknown. With a three-dimensional risk matrix, we showed a clear correlation between the quality of disaster planning and relative risk or financial damage. To substantiate the presented theoretical considerations, however, further research must be designed and implemented.
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Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e. g. blood chemistry, ECG, spirometry, chest x‑ray) can contribute to a reduction of perioperative risk is often not very well known or is controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. ⋯ These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and updating when new validated evidence becomes available.
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Clear and consistent communication is pivotal for well-functioning teamwork, in operating theatres as well as intensive care units. However, patient handovers significantly vary between specialties and locations. If communication is not well structured, it might increase the risk for mishaps and malpractice. ⋯ These are pivotal for an effective teamwork and for ensuing patient safety. Furthermore, we will focus on possibilities to implement structured approaches but also on potential barriers of implementation. Communication failure among different health care providers can be identified more easily and hopefully can be eliminated.