Der Anaesthesist
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Scoring systems are used in all diagnostic areas of medicine. Several parameters are evaluated and rated with points according to their value in order to simplify a complex clinical situation with a score. The application ranges from the classification of disease severity through determining the number of staff for the intensive care unit (ICU) to the evaluation of new therapies under study conditions. ⋯ The scoring systems that are employed in intensive care and are discussed in this article can be categorized into prognostic scores, expenses scores and disease-specific scores. Since the introduction of compulsory recording of two scoring systems for accounting in the German diagnosis-related groups (DRG) system, these tools have gained more importance for all intensive care physicians. Problems remain in the valid calculation of scores and interpretation of the results.
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The rate of Caesarean sections in Germany continues to rise. The change in anesthetic technique of choice from general to spinal anesthesia began later than in other countries and at the last survey in 2002 was not widely established. The literature on the anesthetic management of Caesarean sections contains many controversies, for example fluid preload before performing spinal anesthesia and the vasopressor of choice. Other issues have received relatively little attention, such as the level of experience of anesthesiologists working autonomously on the labour ward or the timing of antibiotic prophylaxis. The aim of the current survey was to provide an updated overview of anesthetic management of Caesarean sections in Germany. ⋯ Currently the predominant anesthetic technique of choice in Germany is spinal anaesthesia and at a much higher rate than in 2002. In addition 12% of departments use traumatic Quincke needles which are associated with a higher incidence of postpuncture headache. Nitrous oxide is no longer frequently used in Germany. Finally, the administration of an antibiotic before cord clamping has been shown to lead to lower rates of endometritis and postoperative wound infection without detrimental effects on the newborn. This is practiced in only a small minority of departments across Germany.
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Case Reports
[Sheared catheter in regional anaesthesia : causes and follow-up of an axiallary plexus catheter].
In the past years intoxication with local anesthetics, damage to nerves, vessels and other accompanying structures as well as infectiological events have been discussed more and more as complications accompanying peripheral nerve blocks (PNB). The following case report highlights a complication which seems to rarely occur and deals with a sheared continuous PNB, where a fragment of the catheter remained in the patient. The possible causes for the damage are discussed and recommendations on the clinical management of such a case are made.
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Comparative Study
[ProSeal™laryngeal mask in normal weight and obese patients : oxygenation under pressure-controlled ventilation and different end-expiratory pressures].
Most of the data on combining pressure-controlled ventilation (PCV) with positive end-expiratory pressure (PEEP) come from studies with an endotracheal tube (ETT) whereas data on utilization of PEEP with a laryngeal mask airway (LMA) are limited. The LMA-ProSeal® (PLMA) forms a more effective seal of the airway than the LMA-Classic™ (CLMA). The application of PEEP when PCV is used with the PLMA could have an impact on oxygenation in adult patients. ⋯ The application of PEEP when PCV is used with the PLMA results in improved oxygenation in obese patients with a BMI ≥30 and <36 kg/m(2) but not in normal weight patients. Alveolar recruitment produced by seal pressure measurements below 30 cm H(2)O was sufficient to produce a clinically significant improvement in oxygenation in most obese patients and there was a significant improvement of oxygenation with PEEP=5 cmH(2)O. Both findings are in contrast to findings of studies using an ETT which suggests that higher pressures (40 cmH(2)O) are needed for recruitment of collapsed alveoli and higher PEEP (10 cmH(2)O) is needed to produce a clinically significant improvement in oxygenation in obese patients. The results of this study support data showing that the consequences of bronchopulmonary airway reactions known to occur with an ETT are less pronounced or absent when an LMA is used.
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Case Reports
[Live-threatening bronchospasm during anesthesia induction : when pure routine becomes a nightmare].
This article reports a case of live-threatening respiratory failure during induction of anesthesia. An 18-year-old female was admitted to hospital for an axillary abscess incision on a public holiday. The patient had a history of asthmatic episodes and an allergy to milk protein and 2 years previously an asthmatic attack had possibly been treated by mechanical ventilation. ⋯ The patient recovered completely and was discharged home on day 19. Initially propofol was suspected of having caused an anaphylactic shock but in retrospect, the diagnosis of near fatal asthma was more likely. The onset of the event was facilitated by the patient playing down the history of asthmatic episodes due to a strong wish for independency and negation of the severity of the disease.