Der Anaesthesist
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Case Reports
[Patient with heparin-induced thrombocytopenia type II and implanted left ventricular assist device].
The administration of heparin can lead to life-threatening heparin-induced thrombocytopenia (HIT) type II, which is caused by antibodies against heparin-platelet factor 4-complexes. The multimorbid patient presented here suffered from HIT II. ⋯ During therapy with argatroban, discrepancies in the partial thromboplastin time (PTT) and the international normalized ratio (INR) appeared sporadically. The clinical causes for these differences remain unclear.
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Review Meta Analysis
[Glycemic control in sepsis and septic shock: friend or foe?].
Intensive care patients commonly suffer from hyperglycemia. Evidence is growing that strictly maintaining normoglycemia by intensive insulin therapy (IIT) ameliorates outcome in these patients. Whether or not this also holds true for patients with sepsis and septic shock is the issue of this post-hoc analysis of the database (2,748 patients) of 2 recent prospective clinical trials. ⋯ These data suggest that IIT improves outcome of patients with sepsis or septic shock. Hypoglycemia is a frequent complication, but its clinical relevance remains to be defined.
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One of the most important mandates of the anaesthesiologist is to control the depth of anaesthesia. An unsolved problem is that a straight definition of the depth of anaesthesia does not exist. Concerning this it is rational to separate hypnosis from analgesia, from muscle relaxation and from block of cardiovascular reactions. ⋯ For example, they cannot predict if a patient will react to a painful stimulus or not. In the future it would be desirable to develop parameters which allow an estimate of the other components of anaesthesia in addition to the presently available monitoring systems to estimate sedation and muscle relaxation. These could be sensoric-evoked potentials to estimate analgesia and AEPs for the detection of awareness.