Der Anaesthesist
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Case Reports
[Naloxone-induced pulmonary edema. Case report with review of the literature and critical evaluation].
A case of pulmonary edema after the administration of naloxone for laparoscopic splenectomy is reported. Previous reports of naloxone-induced pulmonary edema are listed and reviewed. The clinical course is compared to other forms of non-cardiogenic pulmonary edema. Uncertainty remains about the underlying pathophysiological process and the true impact of naloxone on the development of pulmonary edema.
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The dedicated target region should be systematically examined before performing an ultrasound-guided nerve block so that the anatomy can be assessed and anatomic variants or pathologic findings are not missed. In the case described an ultrasound-guided interscalene plexus block was performed in a 73-year-old man. During this examination a cystic structure was detected within the thyroid gland. The further diagnostic procedure showed a metastasis of a renal cell carcinoma which had been treated by resection 10 years before.
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Case Reports
[Legal liability problems in outpatient operations. View from an anesthesiological perspective].
The rapid technical and medical progress in endoscopic and laparoscopic interventions and the increasing acceptance by patients, lead to an expansion of outpatient operations. The endoscopic laparoscopic operation technique, the operative implementation and the inclusion of an accompanying and a surveillance person in the postoperative phase conceal, however, specific dangers which the physician must recognize and remove. It is absolutely necessary that anesthetists pay attention to some basic principles concerning protection and safety of patients, considerations on the comfort of patients, quality measures and the resulting practical consequences. Particularly prone to liability problems are the postoperative phase and discharge of patients which will be demonstrated in some exemplary cases.