Der Anaesthesist
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Central venous line placement is a standard procedure in critical care and peri-operative medicine. This procedure can be associated with severe complications. In contrast to the landmark technique, ultrasound-guided punctures can significantly reduce the rate of complications. ⋯ In children and small infants central venous access can also be challenging due to the anatomical relationship in the head and neck region. Puncture techniques are explained briefly by means of ultrasound anatomy. Typical ultrasonographic images visualize pathological findings in order to identify dangers and complications in central venous catheterization.
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Editorial Biography Historical Article
[Proven and new situations for Der Anaesthesist].
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Mastocytosis is a general term for a heterogeneous group of rare disorders. Many agents used in anaesthesia can trigger mast cell degranulation with release of histamine, prostaglandin, tryptase and heparin. Therefore, patients with mastocytosis are high-risk patients when undergoing anaesthesia. ⋯ A premedication with antihistamines and a glucocorticoid is recommended. For induction of general anaesthesia propofol, etomidate, ketamine, a fentanyl-type opioid, cis-atracurium or pancuronium are recommended. Anaesthesia can be maintained either by a total intravenous technique or with a volatile anaesthetic such as sevoflurane.
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Multicenter Study
[Paediatric simulation today and tomorrow. Perspectives and concepts].
The confrontation with critically ill newborns, infants and small children is rare and poses a particular challenge for the medical team. Confident technical and non-technical skills are essential for successful emergency treatment. Paediatric simulators facilitate a didactic infrastructure, linking textbook theory with experience-based practice. ⋯ Nearly all centres (92%) place particular emphasis on non-technical skills which include the interpersonal aspects of crisis resource management. Video-supported debriefing is considered to be the basis for effective training. Within the scope of the recently established PaedSim project the curricula of paediatric simulation courses should be more structured and internationally standardized, thereby increasing both efficacy and sustainability of these training programs.
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Case Reports
[Intra-operative drop in sevoflurane and oxygen concentrations. Leakage of the ventilation system].
After problem-free induction of narcosis in an 84-year-old female patient an intra-operative drop in sevoflurane and oxygen concentrations occurred during low-flow anesthesia. Although the concentrations of sevoflurane and oxygen in the fresh gas flow were increased no adequate elevation of the inspiratory concentrations could be achieved. ⋯ This case demonstrates how important knowledge of the function, set-up and alarm conditions of respiratory machines is. This should be an important component of training in anesthesiology as well as securely established algorithms for difficult ventilation to ensure safe anesthesia despite technical failures.