Der Anaesthesist
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In the last 10 years interventional neuroradiology has become established especially in the endovascular treatment of aneurysms as the preferred treatment according to level 1 evidence and more recently in the treatment of acute ischemic stroke. These interventions are performed as routine procedures in an increasing number of centers. ⋯ As a further challenge there are different aspects to be considered in elective procedures and emergency procedures where time is brain. This article highlights these aspects for the two most common procedures: aneurysm treatment and multimodal recanalization treatment for acute ischemic stroke.
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Gitelman syndrome is a rare autosomal recessive inherited disease that affects the thiazide-sensitive sodium chloride cotransport channels and the magnesium channels of the distal renal tubuli. Characteristic features are hypokalemia, hypomagnesemia, metabolic alkalosis and hypocalciuria. This case report presents the anesthesiological management of the Gitelman syndrome. The article demonstrates the pathophysiology, symptoms, diagnosis and therapy of this disease from the anesthesiologists point of view.
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For the evaluation of postoperative pain therapy, nausea and vomiting (PONV), the Children's Hospital in Lucerne acts as a member of the postoperative quality improvement project QUIPSi for children. Initial results and the potential for evaluation of the postoperative pain therapy and PONV are presented here. The central questions are whether the postoperative therapy concept is sufficient and if QUIPSi serves as an ideal tool for postoperative quality improvement? ⋯ The quality analysis showed that especially children with the requirement for more pain medicine and a high PONV incidence (inpatient group) need further improvement in postoperative care. Because of small numbers in some operation groups this qualitative evaluation of the postoperative pain and PONV management only gives an approximate overview. The results of QUIPSi uncovered gaps in the postoperative pain management which will help improve the quality in the postoperative setting. The QUIPSi approach should be integrated as a daily tool into all pediatric surgical departments.
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Many patients are victims of disastrous incidents during medical interventions. One of the obligations of physicians is to identify these incidents and to subsequently develop preventive strategies in order to prevent future events. Airway management and prehospital emergency medicine are of particular interest as both categories frequently show very dynamic developments. Incidents in this particular area can lead to serious injury but at the same time it has never been analyzed what kind of incidents might harm patients during prehospital airway management. ⋯ The incidents that were reported via the website http://www.cirs-notfallmedizin.de and that occurred during airway management in prehospital emergency medicine are described. To improve practical airway management skills of emergency physicians are one of the most important tasks in order to prevent critical incidents and are discussed in the article.
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Editorial Comment
[Second victim : Deliberations on dealing with treatment complications.]