Der Anaesthesist
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Randomized Controlled Trial Comparative Study
To what extent can local anesthetics be reduced for infraclavicular block with ultrasound guidance?
To assess the adequacy of different amounts of local anesthetics (LA) in infraclavicular blockade (ICB) under ultrasonographic (US) guidance and neurostimulation and compare them to the conventional doses under neurostimulation (NS). ⋯ The results show that US guidance is more effective in maintenance of successful ICB than neurostimulation guidance alone and a reduction of LA doses even to 70% of conventionally used doses seems possible with US guidance. This article is published in English.
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The preanesthesia informed consent document is regarded mainly as a legal prerequisite but patient autonomy in the authorization of a proposed intervention requires that the relevant information is provided in a suitable and useful way. ⋯ Demographic criteria can help to tailor pre-anesthetic information to individual patient needs. The explanatory power of these variables was, however, low. The relationship between self-assessed HRQoL and the demand for information underlines the necessity to adapt the amount and kind of information provided during the consultation to individual patients preferences.
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Besides reliable efficacy and patient satisfaction, economic efficiency is becoming increasingly more important in postoperative pain management. ⋯ Both pain pump systems provide equally effective pain management, while the electronic model caused less costs. Both pumps offer advantages and disadvantages that should be considered based on local circumstantial demands.
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Perioperative pain therapy using an epidural catheter is the standard operating procedure for numerous surgical interventions. The necessity of initiating anticoagulant therapy in a patient with an epidural catheter requires a careful weighing up between thromboembolic complications and epidural hematoma. ⋯ By using the short-acting antiplatelet drug tirofiban over a time period of 7 days the gap for dual antiplatelet therapy was reduced with the help of specific platelet aggregation assays to a time frame of a few hours to minimize the risk of stent thrombosis. The epidural catheter was removed without complications under consideration of the current recommendations for regional anesthesia and antithrombotic agents.