Der Anaesthesist
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Comparative Study
[Out-patient and in-hospital palliative care in Germany : Comparison with emergency medical care infrastructure].
In Germany, specialized out-patient palliative care systems (SPCS) are still structurally and organizationally under construction. Palliative care patients need an easy access to a qualified SPCS. The purpose of the present investigation was to show the nationwide distribution of all SPCS teams in comparison to the distribution of emergency medical systems. Possibilities for an effective structure of palliative medical care systems will be discussed in order to optimize patient care.. ⋯ The coverage of SPCS and in-hospital palliative care is still a theoretical construct in many regions of Germany. The number of existing SPCS teams and in-patient palliative institutions is insufficient to guarantee an exhaustive coverage of patient care as in emergency medical services. In order to achieve a higher quality of results the quality of the structure and processes must first be ensured. The distribution of palliative care should be centrally coordinated along the same lines as the emergency institutions in order to achieve a need-oriented exhaustive coverage. A surplus of care in some regions at the expense of an undersupply in other regions must be avoided. In the next step a further development and adaption of existing structures to the requirements would be a logical approach.
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Idiopathic orthostatic hypotension (formerly known as Shy-Drager syndrome) is a multiple system atrophy, which is characterized by autonomic dysregulation. Providing perioperative hemodynamic stability during narcosis is therefore a particular challenge. The effects of general anesthesia on systemic vascular resistance and cardiac output in a patient with idiopathic orthostatic hypotension undergoing retropubic prostatectomy will be reported. In the case presented perioperative hemodynamic stability was achieved by aggressive volume therapy guided by global end-diastolic volume measurement and low-dose catecholamine therapy.
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The novel pandemic influenza A/H1N1v has also led to a rapid increase in the number of new cases in Germany. In the majority of patients the disease has taken a mild clinical course. However, in isolated cases severe complications requiring hospitalization or intensive care treatment have occurred. ⋯ Treatment decisions should not be delayed to await laboratory confirmation in these patients as early initiation of antiviral therapy is recommended. Elements of supportive care depend on the presentation of complications and secondary organ failure. If rapidly progressive lung dysfunction occurs, refractory to routine mechanical ventilation, early reporting to centers experienced in the use of extracorporeal membrane oxygenation (ECMO) should be established.
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Anticoagulation medications are frequently used for primary and secondary treatment of several thrombo-embolic disorders. An important side effect of all anticoagulants is hemorrhagic diathesis which necessitates acute treatment, ideally using medicinal therapy with an antidote. ⋯ With this new generation of anticoagulants no valid laboratory parameters or effective antagonists are presently available. Due to a lack of adequate studies regarding acute treatment this can at present only be carried out on a symptomatic basis.