Der Anaesthesist
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The microcirculation is unique in its anatomy and physiology and is a self-contained organ system within the human body. It is the site where gas exchange and nutrient supply takes place, but it is also the site which experiences pathological alterations during various shock states and therefore compromises the oxygen supply to tissues and organs. Systemic inflammation for example leads amongst others to increased heterogeneous blood flow, formation of interstitial edema, altered viscosity, leukocyte activation, disturbances in the coagulation system, and to a breakdown of the endothelial barrier function. ⋯ Without interruption of these pathomechanisms, the dysfunction of the microcirculation will consequently result in organ dysfunction. In this review article a short description of the microcirculatory physiology, the interaction between the macrocirculation and the microcirculation, as well as microcirculatory alterations generated by a systemic inflammatory response will be given. Finally, various therapy options will be described, which, experimentally, can lead to an improvement in microcirculatory dysfunction.
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In recent years peripheral and central regional anesthesia have become increasingly more important in pediatric anesthesia. Unlike adult patients, children typically receive regional anesthesia while under general anesthesia, an approach generally accepted among pediatric anesthesiologists. A well-founded knowledge of the specific anatomical, physiological and pharmacokinetic characteristics of pediatric patients is indispensable for safely practicing pediatric regional anesthesia. ⋯ The use of ultrasound when administering regional anesthesia can help reduce the risk of complications even further. Peripheral and central regional anesthesia are safe procedures which pediatric patients should not be deprived of. The present article discusses frequent as well as rare complications of pediatric regional anesthesia.
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The present article reviews improvements in the 2008 version of the German Refined - Diagnosis Related Groups (G-DRG) which are relevant for anaesthesia and intensive care medicine. The focal points of further developments and the data base of the updated DRG version are presented. The efforts of the InEK, the institution which is responsible for the design and development of the G-DRG system, to provide a transparent system driven by rules are also explained, followed by a description of changes in coding of diagnoses (e.g. new diagnosis codes, revised complication and comorbidity level matrix, new specifications of individual diagnosis-related groups such as acute paraplegia) and procedures (e.g. new procedure codes, modifications for complex procedures). ⋯ The present contribution is an update of previous articles on this topic published in this journal in 2007. Therefore, knowledge of these previous publications is a prerequisite for the understanding of the current article. Readers who are not familiar with the complex material should refer to the publications from 2007.
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Acid-base disturbances are commonly found in critically ill patients and are often associated with fatal complications. The basis of a successful treatment is a thorough understanding of the causes of these disorders. ⋯ An acidosis masked by hypochloremic and hypoalbuminemic alkalosis was identified with the help of Stewart's concept and finally permitted a successful therapy. The modern Stewart concept provides enhanced information, enabling an exact diagnosis and causal therapy even in complex cases.
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Case Reports
[Basal tako-tsubo cardiomyopathy. Induction of a pheochromocytoma after general anesthesia].
A 71-year-old female patient developed acute myocardial failure immediately after cataract surgery under general anesthesia. Subsequently performed laevocardiography demonstrated a basal ballooning of the left ventricle characteristic of basal tako-tsubo cardiomyopathy. The basal tako-tsubo cardiomyopathy was induced by a previously asymptomatic pheochromocytoma. The left ventricular function recovered completely within 4 days without specific treatment.