Der Anaesthesist
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In neonates, infants and young children central venous catheters are of vital importance during surgery as well as postoperative care. The benefit of ultrasonography seems to be very important for vascular access of the internal jugular (IJV), subclavian (SCV), femoral and even peripheral veins. Ultrasound-guided cannulation of the IJV increases the success rate, reduces the time to the successful puncture and decreases the inadvertent puncture of the carotid artery in children in comparison to the landmark-guided technique. ⋯ After catheterization of the SCV the homolateral IJV is screened by the use of ultrasound to detect wrong guide wire migration. A clear and rapid visualization of visceral pleura movement against the parietal pleura during respiration via ultrasound indicates the absence of pneumothorax after cannulation. In the case of haemodynamic instability, ultrasound should be used to exclude pericardial effusion.
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Review
[Scalp blocks. A useful technique for neurosurgery, dermatology, plastic surgery and pain therapy].
Safe and effective cranial analgesia can be achieved by blocking the sensitive nerves of that region. These include the supraorbital nerve, the supratrochlear nerve, the zygomaticotemporal nerve, the auriculotemporal nerve and the greater and lesser occipital nerves which are accessible at typical and most proximal points. ⋯ Scalp blocks are useful for intraoperative neurologic testing of the patient during awake craniotomy or for supplementation of general anesthesia for other forms of craniotomy. Other applications are minimally invasive and stereotactic neurosurgery including deep brain stimulation, photodynamic therapy of actinic ceratosis, cranial plastic surgery and pain therapy.
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Despite numerous publications, new guidelines for the treatment of acute pain and efforts from a number of initiatives, there is still a tremendous need for improvement in postoperative pain therapy. One of the reasons for the shortcomings in the care of patients with postoperative pain is the lack of applicability of guidelines in daily clinical practice. Therefore, simple but effective and easy to implement concepts need to be developed. ⋯ The pros and cons will be discussed and ideas on how to deal with balanced analgesia in daily practice will be given. Another pain concept of "procedure-specific postoperative pain therapy", is an appealing idea of an international initiative from surgeons and anaesthesiologists and an essential part of the German S3 guidelines for acute pain released last year. Critical evaluation of the available recommendations for procedure-specific analgesia together with the presentation of relatively simple but evidence-based algorithms for specific procedures may help to implement this concept in clinical routine.
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Although the prognosis of many diseases relies on timely diagnosis and treatment, the admission process of patients taken into hospitals by emergency medical services (EMS) is often affected by delays or rejection of patients. A smooth interaction between these two phases is critical for the prognosis in time-critical situations. The implementation of an in-hospital coordinating emergency physician (ZINK) responsible for the admission of EMS patients, a concept which was developed and introduced in our hospital, is suggested. ⋯ Implementation of a ZINK can optimize the process of hospital admission in emergency patients. This can decrease the legal risk of hospitals and improve the external representation. Hospitals should consider designating a ZINK.
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This case report reviews the anesthesiological complications of intrathecal baclofen (ITB) therapy. An 11-year-old boy with spasticity and apallic syndrome needed general anesthesia for exchange of a baclofen pump but 2 h later he became increasingly hypothermic, hypotonic with bradycardy and dyspnea. ⋯ The ITB is an increasingly used therapeutic option for multiple sclerosis and cerebral palsy. Therefore, emergency personal and anesthesiologists must be aware of the possible side effects of this medication.