Der Anaesthesist
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The new version of the guidelines, which have now been renamed Cross-sectional guidelines on therapy with blood components and plasma derivatives, is distinguished by focusing on key recommendations. In each section clear recommendations for the selection and indications for the use of each blood product are presented and these recommendations are classified with respect to their strength and evidence level. The most important recommendations in section 1 "Erythrocyte concentrates", which is especially important for the faculty of anesthesiology, will be presented in this article with special reference to the data on which the recommendations are based.
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One-lung ventilation causes adverse effects in pulmonary gas exchange and cardiocirculatory function. These adverse effects become particularly important for patients with underlying cardiopulmonary comorbidities. Alterations in pulmonary gas exchange have been investigated in several experimental and clinical trials. ⋯ Furthermore, no conclusive recommendations exist as to which kind of hemodynamic monitoring should be preferred in the situation of one-lung ventilation. Many issues regarding hemodynamic monitoring in one-lung ventilation remain unacknowledged. This article will review the current literature on hemodynamic monitoring in one-lung ventilation in order to derive recommendations for the application of hemodynamic monitoring in this specific peri-operative situation.
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The treatment of out-of-hospital palliative emergency care situations during cardiac arrest is a special situation. The prehospital emergency physician (EP) and the paramedic must be informed about the medical, legal, and ethical specifics of these situations, but this knowledge is not integrated within emergency medical curricula at all. We present a case study to discuss such legal and ethical specifics. ⋯ Every EP and paramedic may be involved in the care of palliative care patients who are at the end of their lives. EPs and paramedics do not always adapt their treatment to the will or supposed will of the patient (especially in accordance with the new German law concerning advance directives). The reasons for this usually concern legal uncertainties. Therefore, EPs and paramedics should know that different legal meanings could be important in emergency medical care therapy of palliative care patients. A written "do not resuscitate" order as an advance directive must be evaluated as a desired therapeutic limitation.
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A case of extreme metabolic acidosis (pH 6.6) and severe hypothermia (27.3 degrees C) is reported. The patient's anamnesis and medical examination led to the assumption of ketoacidosis. Pronounced ketoacidosis is not unusual in juvenile diabetics type 1 and the incidence in Europe is reported to be between 15 and 70% for all type 1 diabetics. The case describes the targeted therapy of controlled re-warming to avoid neurological damage.
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The use of nerve stimulation is a common standard procedure for peripheral nerve blocks. However, ultrasound guidance is increasingly being used as an alternative. This study explored the relationship between needle positioning defined by ultrasound guidance and the electrical nerve stimulation before and after injection of 5% glucose solution (G5%). ⋯ With the protocol used the success of a blockade depends only on the quality of visualization. With correct ultrasound-guided needle tip positioning the electrical information seems to be skewed and doubtful.