Der Anaesthesist
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Cardiovascular diseases are one of the leading causes of morbidity and mortality in Germany. In these patients, the high-risk profile necessitates an interdisciplinary and multimodal approach to treatment. ⋯ Epidural and spinal RA procedures should be carefully considered with respect to the risk-benefit ratio and consideration of the recent guidelines on anesthesia against the background of the current study situation and the regular use of therapy with anticoagulants. The following article elucidates the specific characteristics of anesthesia management as exemplified by some selected endovascular interventions.
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In medical education, simulation is gaining increasing importance for teaching a variety of subjects. A well-founded educational approach is necessary for effective use. In addition to material aspects, simulation environment, curriculum, learning environment, and methods of debriefing have to be considered. The role of a competent instructor should be emphasized and the importance of an elaborate change management process to implement a good concept should not be underestimated.
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Teamwork in the operating room and in the intensive care unit necessitates clear and precise communication; however, interruptions in communication frequently occur, especially in the perioperative phase. Patients are particularly susceptible to deficits in communication, e.g. due to higher stress peaks, simultaneous admission of several patients and concomitant treatment of emergency cases. The German Society of Anesthesiology and Intensive Care Medicine (DGAI) therefore recommends the implementation of the so-called SBAR concept (S situation, B background, A assessment, R recommendation) for standardization of patient handover. This concept was originally developed for high-risk areas and organizations with the aim of guaranteeing a rapid, effective and consistent transfer of information.
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Case Reports
[Extracorporeal CO2 removal as an alternative to tracheotomy in a patient with extubation failure].
We report a patient with chest trauma who was admitted to the ICU after surgery. As he fulfilled protocol-based criteria, he was extubated 7 days after admission. ⋯ Sufficient CO2 removal was established with a blood flow of 1.5 l/min and the patient was successfully extubated within a few hours. After 5 days of ECCO2‑R the patient could be weaned and transferred to a general ward in a stable condition.
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Observational Study
[Perioperative adverse respiratory events in overweight and obese children].
Overweight and obesity are increasing problems in pediatric anesthesia. This observational study was designed to examine how airway-related complications occur in overweight children and adolescents during general anesthesia and if this is a relevant problem in Germany. ⋯ This study demonstrated a very low incidence of respiratory problems, which may be caused by the low proportion of morbidly obese children and the older age of overweight children in comparison with other studies.