Der Anaesthesist
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Accurate scheduling of operations is essential for an efficiently used OR. The aim of this investigation was to describe the quality of OR scheduling in the analyzed OR. Furthermore suggestions for avoiding underutilization or overutilization through optimized OR planning should be addressed if possible. ⋯ Prognosis of operations with longer planned duration (>150 min) should be improved in the OR area analyzed. Scheduling of these operations at the beginning of the OR list or with a sufficient time interval towards the end of the appointed OR block time within the OR list can avoid or at least minimize underutilization and overutilization of the OR.
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In cases of unclear depression of conciousness, arrhythmia and symptoms of cardiac insufficiency inadvertent carbon monoxide intoxication should always be taken into consideration. Rapid diagnosis of acute carbon monoxide intoxication with mostly unspecific symptoms requires an immediate supply of high dose oxygen which enables a distinct reduction of mortality and long-term morbidity. ⋯ There is no sufficient coherence between carboxyhemoglobin blood levels and clinical symptoms. Increased carboxyhemoglobin concentrations help to diagnose acute carbon monoxide intoxication but do not allow conclusions to be drawn about possible long-term neuropsychiatric or cardiac consequences.
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Intoxication due to local anaesthetic drugs poses a rare but potentially life-threatening complication. In particular long-acting local anaesthetics can cause refractory cardiac arrest due to their lipophilic properties. This is often preceded by neurological symptoms such as confusion, vertigo and tonic-clonic seizures. ⋯ In case of cardiac arrest standard protocols for cardiopulmonary resuscitation have to be implemented immediately. The use of lipid emulsion can then be initiated as a supplement to standard resuscitation. It is recommended that lipid emulsions are instantly accessible in all facilities where local anaesthetics are administered.
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In order to reduce the incidence of postoperative nausea and vomiting (PONV) a standard operating procedure (SOP) was developed in our department. This consists basically in the administration of one antiemetic intervention for moderate risk (2 risk factors), two interventions for high risk (3-4 risk factors) and no prophylaxis in patients who have no or only one risk factor. The aim of this study was to find out whether PONV prophylaxis according to our SOP was followed and led to a lower incidence of PONV. ⋯ Patients with medium and high risk have a lower incidence of PONV than expected per risk calculation by complying with the SOP. However, the recommended risk-adapted approach was inadequately implemented. Considering this there is room for improvement. Moreover taking into account these implementation issues a general PONV prophylaxis may be beneficial.
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Fibromyalgia ossificans progressiva (FOP) is a severely disabling disorder of connective tissue characterized by congenital malformation of the toes, fingers and vertebrae associated with progressive ossification of striated muscles. Anesthetic management of these patients involves preferably general anesthesia as local or regional anesthesia should be avoided due to possible heterotopic ossification. Airway management is determined by the age of the patient and the progression of the disease. ⋯ As demonstrated and discussed in this case report of a 2-year-old boy, fiberoptic intubation after induction of general anesthesia should be preferred in pediatric patients. Puncture of a vein should be non-traumatic, i.m. injections strictly avoided and careful positioning and padding are needed. Every effort should be made to avoid situations stimulating new heterotopic ossification due to its substantial effect on the quality of life of FOP patients.