Der Anaesthesist
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Surgical interventions and invasive procedures can trigger an inflammatory reaction in patients. This inflammatory reaction is an inherent response by the body and can be triggered by different stimuli, including the surgical tissue trauma itself and also by the administration of drugs commonly used for the induction and maintenance of general anesthesia. ⋯ This article discusses the causes and effects of inflammatory processes in the perioperative phase. Additionally, it highlights the immunomodulatory effects of perioperatively administered therapeutics and anesthetics. Knowledge of this topic enables the reader to make qualified decisions in the perioperative setting to improve the individual patient outcome.
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Fortunately, mass casualty incidents involving a large number of children and adolescents are rare and the experience in this field, both in terms of medical as well as psychosocial emergency care is comparatively low. Children represent a vulnerable group and have a particularly high risk of developing posttraumatic stress disorder in the aftermath of experiencing disasters. A selective literature search was carried out in Medline. ⋯ Accordingly, it makes sense to integrate such structures into the respective deployment concepts. A specific screening algorithm for children could so far not prevail but due to the physiological and anatomical characteristics appropriate emergency medical care concepts should be provided. Furthermore, hospitals must adapt to this patient group in a suitable manner.
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Health services research (HSR) is a multidisciplinary field of research that describes disease treatment and health care and their framework conditions. In the last 20 years, the HSR aspect became more and more the clinical focus of intensive care medicine. Under this aspect HSR investigates the use of clinical measures and their impact on patient outcome under routine intensive care medical conditions. ⋯ As part of the establishment of the innovation fund for HSR, promising intensive medical care projects have been promoted to improve the quality of care and the quality of long-term outcome for intensive care patients. An important focus lies on the identification of factors that improve long-term quality of life after intensive care. The expansion of registries and telemedicine in intensive care offers the opportunity to bundle and share experiences more effectively and thereby establish (guideline-based) treatment recommendations faster in the clinical practice.
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In 2018 the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) published an update of the guidelines on myocardial revascularization from 2014. In these updated guidelines both associations agreed on joint recommendations concerning myocardial revascularization. Especially anesthesiologists being part of the cardiac anesthesia or heart team and intensive care physicians should have knowledge about the new or changed recommendations of these guidelines. This article summarizes the most important changes of the ESC/EACTS guidelines on myocardial revascularization.
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Due to an increasing number of severe complications reported during the prehospital application of laryngeal tubes, the Austrian Society for Anesthesiology, Resuscitation and Intensive Care Medicine (ÖGARI) is prompted to formulate a respective statement. With regard to the current training situation and the applicable laws, ÖGARI recommends to convert the "Emergency Competence for Endotracheal Intubation (NKI)" for emergency paramedics into an "Emergency Competence for Extraglottic Airway Management, (NK-EGA)". Training should include at least 40 h of theoretical instruction, hands-on training on the manikin to secure mastery of the methodology and at least 20 successful applications under clinically elective conditions in adult patients under direct medical supervision. ⋯ Only 2nd generation EGA should be used. After successful EGA placement timely cuff pressure monitoring and gastric suction should be performed. The use of an EGA by ambulance-men cannot be recommended; these have to be limited to bag-mask ventilation.