Der Anaesthesist
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Review
[General principles of sonography, part 2 : System technology, basic techniques and artifacts].
Since the introduction of portable ultrasound systems, sonography has become well established as an integral part of the anesthesiological and critical care equipment and of monitoring. The selection of various ultrasound transducers, sonographic techniques and imaging modes enables a broad variety of clinical applications. In depth background knowledge of the technical aspects is crucial for obtaining what a highly sophisticated ultrasound system has to offer, i.e., sonographic transparency of the complete body and valid information on the structure and dynamics of organs and the circulation.
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The German Society of Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI) established an expert panel to develop preliminary recommendations for the application of peripheral nerve blocks on the upper extremity. The present recommendations state in different variations how ultrasound and/or electrical nerve stimulation guided nerve blocks should be performed. ⋯ The first section comprises recommendations regarding dosages of local anaesthetics, general indications and contraindications for peripheral nerve blocks and informations about complications. In the following sections most common blocks techniques on the upper extremity are described.
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Case Reports
[Completely subcutaneous implantable cardioverter defibrillator : Care of S-ICD® wearers during childbirth].
Inappropriate shock delivery is a problem that has been described for subcutaneous implantable cardioverter defibrillators (S-ICDs). Situations which predispose inappropriate shock delivery, such as childbirth, must be identified and the best treatment strategies selected. Inactivation of the S-ICD is the safest approach to avoiding inappropriate shock delivery. Inactivation of the S-ICD requires adequate patient monitoring and facilities for manual shock delivery.
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Noble gases are chemically inert elements, some of which exert biological activity. Experimental neuroprotection in particular has been widely shown for xenon, argon and helium. ⋯ Besides an interference with neuronal ion-gated channels and cellular signaling pathways as well as anti-apoptotic effects, the modulation of neuroinflammation seems to play a crucial role. This review presents the current knowledge on neuroprotection by noble gases with a focus on interactions with the neuronal-glial network and neuroinflammation and the perspectives on clinical applications.
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Although anesthesia-associated mortality has been significantly reduced down to 0.00068-0.00082% over the last decades, recent studies have revealed a high perioperative mortality of 0.8- 4%. Apart from anesthesia and surgery-induced major complications, perioperative mortality is primarily negatively influenced by individual patient comorbidities. These risk factors predispose for acute critical incidents (e.g., myocardial infarction); however, the majority of fatal complications are a result of slowly progressing conditions, particularly infections or the sequelae of systemic inflammation. ⋯ While the incidence of severe postoperative complications amazingly does not show much variation between hospitals, FTR shows significant differences implying a major potential for improvement. With 14 million surgical procedures per year in Germany, a postoperative mortality of approximately 1% and an avoidable FTR rate of 40% mean that there are an estimated 60,000 preventable deaths per year. Hence, in the future it will be imperative to (1) identify patients at risk, (2) to prevent the development of postoperative complications with the use of adequate adjunctive therapeutic strategies, (3) to establish surveillance and monitoring systems for the early detection of postoperative complications and (4) to treat postoperative complications efficiently and in time when they arise.