Der Anaesthesist
-
Alcohol withdrawal syndrome has a high clinical prevalence. Severe cases must be treated in an intensive care unit and are associated with a high mortality rate, depending on patient comorbidities. Clinical requirements include sedation, control of vegetative symptoms, treatment of hallucinations and, when necessary, anticonvulsive therapy. ⋯ In consideration of its pharmacological characteristics, dexmedetomidine is assumed to be more advantageous compared to clondine. Case studies with dexmedetomidine in alcohol withdrawal syndrome show the safety of its application and a benzodiazepine-sparing effect. Its incorporation in escalating intensive care therapy of severe cases could be appropriate.
-
The Ventrain® emergency ventilation device allows active inspiration and expiration through transtracheal catheters or the lumen of an airway exchange catheter. This single-use handheld device is manually operated and driven by an external pressurized oxygen source. The Ventrain® may be used to ventilate patients with a complete or pending upper airway obstruction reducing the risk of barotrauma due to the possibility of active expiration. However tidal volumes (V T) applied and withdrawn with the Ventrain® can only be controlled by visual inspection of chest movements; V T monitoring is not provided. Excessive inspiratory volumes or air trapping due to insufficient expiration may remain clinically undetected until pulmonary trauma and/or cardio-respiratory deterioration occur. Active expiration itself carries the risk of overwhelming lung deflation with the formation of atelectasis. Thus, an inspiratory and expiratory tidal volume monitor is urgently required. The aim of this study was to evaluate efficacy and precision of the Florian respiratory function monitor (RFM) to monitor in- and expiratory V T administered by the Ventrain® emergency ventilation device through a small cannula to the ASL 5000 test lung (ASL). ⋯ The tested respiratory function monitor using hot-wire anemometer technology has the potential to monitor tidal volumes applied by the Ventrain®. With the software thus adapted, the RFM measures precise inspiratory and expiratory tidal volumes within common technical tolerance. This could help perform adequate patient ventilation with Ventrain® and reduce the potential risk of patient trauma.
-
Sterile and clean working conditions are one of the keystones of medical practice and this is also true for ultrasound-guided regional anesthesia. The routine clinical practice in ultrasound-guided regional anesthesia does not always comply with the principles of sterile and clean working conditions in medicine: therefore, patients are exposed to potential hazards regarding the transmission of pathogens via the ultrasound equipment. ⋯ The use of sterile ultrasound probe covers and sterile ultrasound contact media is an important prerequisite to avoid cross-infection between patients. An appropriate scientific evaluation should serve as evidence in this field.
-
Multicenter Study
[Pre-operative documentation of individual in-patient therapy goals : A medical staff questionnaire].
Perioperative care demands consideration of individual treatment goals. We evaluated the attitudes of medical staff towards a short standardized advance directive (SSAD) as a means of improving patient-orientated care at the transition from operating theater to general or intensive care wards. ⋯ Our study shows the dilemma of insufficiently structured directives for changing treatment goals as well as a high number of legal procedures to obtain proxy decisions due to missing out-patient advance health planning. From a medical staff perspective there is strong support for the concept of SSAD based on medical, ethical, economic and organizational reasons.