Der Anaesthesist
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While guidelines represent systematically developed aids for decision-making on appropriate courses of action, recommendations should focus the attention of the medical profession on noteworthy circumstances which are in need of amendment. The new recommendations on the "Execution of analgesia and anesthesia procedures in obstetrics" of the German Society for Anesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI) and the Professional Association of German Anesthetists (Berufsverband Deutscher Anästhesisten, BDA) in cooperation with the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) comprehensively fulfill these requirements. The new recommendations include not only revisions in the form of updating but also supplementations in the form of the new chapters "Initial care of newborns", "Postpartum hemorrhaging" and "Morbid obesity". In the following article relevant alterations to newly formulated or completely amended sections with consequences for the clinical practice will be discussed.
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In recent years delirium in the intensive care unit (ICU) has internationally become a matter of rising concern for intensive care physicians. Due to the design of highly sophisticated ventilators the practice of deep sedation is nowadays mostly obsolete. To assess a ventilated ICU patient for delirium easy to handle bedside tests have been developed which permit a psychiatric scoring. ⋯ A certain constellation of pre-existing patient-related conditions, the current diagnosis and surgical procedure and administered medication entail a higher risk for the occurrence of ICU delirium. A favored hypothesis is that an imbalance of the neurotransmitters acetylcholine and dopamine serotonin results in an unpredictable neurotransmission. Currently, the administration of neuroleptics, enforced physiotherapy, re-orientation measures and appropriate pain treatment are the basis of the therapeutic approach.
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Case Reports
[Pneumothorax following nasogastric feeding tube insertion : Case report and review of the literature].
A 54-year-old alcohol-dependant male patient suffering from severe alcohol withdrawal syndrome had to be intubated and artificially ventilated because of autonomic instability, convulsions and pulmonary dysfunction. A nasogastric tube (NGT) was inserted for enteral feeding and although placement was difficult the NGT was finally inserted after repeated attempts. Correct positioning of the NGT was evaluated by clinical means using insufflation of air and epigastric auscultation. ⋯ The pneumothorax was treated successfully using pleural drainage. The patient was transferred to a peripheral ward 3 weeks after admission to the intensive care unit. The presented case report shows the importance of a correct position control of NGTs to avoid severe complications.