Der Anaesthesist
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In the present study the efficacy of subcutaneous tunneling and a 10 min disinfection time with a 70% alcoholic solution to reduce the infection rate in continuous interscalene plexus anesthesia were examined. In a prospective study 1,134 continuous interscalene plexus anesthesias were included. In group 1 (473 catheters) a cotton swab was soaked with the alcoholic solution and swabbed 3 times at the puncture site in the classical manner. ⋯ The difference between the groups in the infection rate is statistically significant (p<0.002). The practicability of the 10 min disinfection time in the clinical routine was excellent. A 10 min disinfection time with a 70% alcoholic solution combined with subcutaneous tunneling led to a significantly lower infection rate in continuous peripheral regional anesthesia in the neck of the patient.
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Patients with solid tumors and hematological neoplasia can be a special challenge for anesthetists with their multilayered core competences (induction of anesthesia, intensive care, emergency medicine, pain therapy and palliative medicine) due to the systemic manifestation of the disease especially in metastatic stages, to complex sequelae of toxic oncologic therapy especially in curatively intended treatment concepts, to difficult ethical decision-making especially in acute situations and to the special emotional state of the patient which can extend throughout the complete course of the disease. In addition there are many new developments in modern oncology, which complicate the special characteristics of oncology patients, can have a direct influence on the anesthesiologic approach and will, therefore, be presented in this article.
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Comparative Study
[Intensive care patients. Determining daily energy expenditure - a comparison of two methods].
Using indirect calorimetry (IC), required energy demand may be determined. The SenseWear (SW) armband uses skin temperature, galvanic skin response, heat flux, and a 2-axis accelerometer to estimate daily energy expenditure (EE). The aim of the present study was to evaluate accuracy of the SenseWear measurements in critically ill and ventilated patients. ⋯ The SenseWear armband is non-invasive, convenient and easy to handle, but has a significant measurement bias in the hypercaloric range. Although IC is still best suited to determining metabolic need in intubated patients, measurements with the SenseWear armband provide significant advantages, e.g. in non-intubated patients, and give a fair estimation of daily energy expenditure when used alone.
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Perioperative myocardial damage occurs with a high incidence depending on the operative procedure and the patients examined and is considered to be among the most relevant risk factors for increased perioperative morbidity and mortality in patients undergoing non-cardiac surgery. The pathophysiology of myocardial damage in the perioperative period is still not well understood. Both ischemia with and without acute coronary occlusion and non-ischemic stimuli can put a substantial strain on the heart in the perioperative period. ⋯ This is probably due to a considerable difference in phenotype and pathophysiology between perioperative and non-perioperative myocardial infarctions. As a result of this unexplained etiology of perioperative myocardial infarction it remains an open question whether the contemporary diagnostic and therapeutic recommendations for the acute coronary syndrome can be extrapolated to the perioperative situation. The present review reflects the current state of knowledge and presents an optional approach to the diagnosis and therapy of perioperative myocardial injury.