Der Anaesthesist
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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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Terrorist attacks have become reality in Germany. The aim of this work was, after the Würzburg terrorist attack, to define quality indicators and application characteristics for rescue missions in life-threatening situations. The results can be used to record data from future missions using this template in order to make them comparable with each other. ⋯ There is an important need to systematically evaluate rescue missions after mass killing incidents. In this study we report a template of parameters and quality indicators in order to systematically evaluate mass violence events. The presented template is the result of an expert consensus process and may serve as a basis for further development and research.
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The increasing endeavors to make inpatient treatment processes more effective leads to a reduction of the length of stay in hospital and minimization of postoperative monitoring. Therefore, the aim of our study was to determine potential postoperative complications for neurosurgical patients undergoing elective surgery with respect to assessment of the relevance for intensive medical care. Furthermore, our approach was compared with the standard of postoperative care of such patients in Germany. ⋯ The undisputed gold standard of postoperative monitoring of neurosurgical patients undergoing elective surgery is still the intensive care unit. Although more flexible surveillance modalities are available, a cost-driven restructuring of postoperative monitoring and in particular reduction of the length of stay in hospital must be subjected to detailed scrutinization.
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One of the aims of the Scientific Working Group Neuroanesthesia (WAKNA) of the German Society of Anesthesiology and Intensive Care Medicine is to disseminate new findings in the field of neuroscience and neuroanesthesia and to propagate novel therapeutic and diagnostic options into clinical practice. Once a year, the WAKNA displays and discusses recent noteworthy publications from the past 12 months at the German Anesthesia Meeting. In 2016, a new pharmacologic strategy with dexmedetomidine to prevent postoperative pain after craniotomy, the impact of the widely used anesthetic drug propofol on GABA receptor surface expression, a study highlighting the ultrasound-guided detection of increased intracranial pressure, and an article showing the interactions of neuromuscular blocking drugs on the BIS neuromonitoring were presented.
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Editorial Comment
[Caring for patients-but carefully of course : Structured Handover].