Der Anaesthesist
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Malignant hyperthermia (MH) is a latent, autosomal dominant inherited syndrome of skeletal musculature which results in excessive hypermetabolism induced by halogenated anesthetic agents and depolarizing muscle relaxants and is caused by an uncontrolled intramuscular calcium release. This case report focuses on the description of symptoms of a fulminant MH crisis. A possible link between central core disease (CCD) and the clinical severity of MH crisis is postulated in this paper.
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Adverse events are not unusual in a more and more complex anesthesiological environment. The main reasons for this are an increasing workload, economic pressure, growing expectations of patients and deficits in planning and communication. However, these incidents mostly do not refer to medical deficits but to flaws in non-technical skills (team organisation, task orientation, decision making and communication). ⋯ The results (84 % of medical and 97 % of healthcare staff answered the questionnaires) showed improvements with high relevance to parameters associated with awareness concerning safety issues and team coordination. In conclusion, it appears that patient safety can be significantly improved with little time effort of 3-5 min per patient. A prospective trial will be conducted to confirm the impact of this measure on improvements in patient safety.
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Comparative Study
[Postoperative assessment of daily energy expenditure. Comparison of two methods].
The reference method for determining resting energy expenditure (REE) in clinical nutrition practice is measurement by indirect calorimetry; however, indirect calorimetry has some limitations, is expensive and not widely available. Therefore, the most used methods to estimate the caloric requirements in intensive care patients are predictive equations. The Harris-Benedict equations (HBE) are the most common formulae in the clinical setting. The SenseWear(®) armlet (SWA) is a noninvasive device that monitors skin temperature, heat flux, galvanic skin response and movement. These data as well as anthropometric characteristics are used to calculate REE. The aim of this study was to evaluate the levels of agreement and interchangeability of REE estimated by HBE (EEHBE) and measured by SWA (EESWA) in normometabolic patients after elective bowel resection with laparotomy. Furthermore, postsurgical pain therapy by continuous thoracic epidural anaesthesia (t-PDA) was compared with continuous intravenous pain therapy regarding EESWA in these patients. ⋯ The SWA showed reliable concordance with daily REE estimated by HBE in normometabolic postsurgery patients. This noninvasive, convenient and easy to handle device may be helpful in determining energy requirements as part of metabolic monitoring. Further research is needed to validate the method in patients with severe metabolic disturbances. The energetic requirements of patients with postoperative t-PDA were not different from those with intravenous pain therapy.