Der Anaesthesist
-
Acute renal failure is a common complication in intensive care medicine. While the incidence of acute renal failure increases, mortality still remains at a high level. In Europe continuous renal replacement therapy (CRRT) has become the standard treatment for acute renal failure. ⋯ A new approach in renal replacement therapy is the slow extended daily dialysis (SLEDD), which combines the advantages of CRRT and IHD. First results are promising, but further investigations are needed to show whether outcome can be improved. A final evidence-based recommendation on the dosing of CRRT or a definitive answer to the question whether daily IHD is better than CRRT, can probably only be possible after two running multicentre studies, the VA/NIH Acute Renal Failure Trial Network (ATN) study and the Augmented Versus Normal Renal Replacement Therapy in Severe Acute Renal Failure Study (ANZICS 2005) Australia and New Zealand Intensive Care Group.
-
Randomized Controlled Trial
[Intra-articular ketamine after arthroscopic knee surgery. Optimisation of postoperative analgesia].
Surgery of the knee can be very painful and sufficient postoperative pain treatment is often problematic. To optimize postoperative analgesia, application of local analgesics has been suggested. In the present study it was investigated whether intra-articular administration of ketamine reduces the level of pain after arthroscopic knee surgery. ⋯ The i.a. application of ketamine after arthroscopic knee surgery leads to a significant decrease of postoperative analgesic demand and decreases patients' subjective level of pain compared to i.a. application of bupivacaine or placebo. Likewise, the i.v. application of ketamine is similarly effective but the effect is of shorter duration.
-
We have used the Stewart approach to typical acute and compensated acid-base disorders here. Dedicated software developed by the author is available with this article and will be of help to anyone considering analyzing his or her own patients using the Stewart approach. The Stewart approach shares analytical steps with the more traditional Siggard-Andersen method, and in most cases the two methods arrive at the same therapeutic solutions. The Stewart approach is, however, more than merely a biophysical appendix to the traditional clinical model, since metabolic acid-base disorders in particular are understood within a completely different pathophysiological framework; this results in a fresh and sometimes unexpectedly helpful perspective that highlights the functional relevance of seemingly forgotten components such as the chloride ion or albumin.
-
Over the last 30 years the Advanced Trauma Life Support (ATLS) course has become the most successful training program in the world for the early care of severely injured patients. It has shaped trauma care systems in many countries and is now on the verge of being introduced into Germany by the German Society of Trauma Surgery (DGU). However, after publication of the latest edition in 2004 there are rising concerns regarding the lack of multi-disciplinarity, out-dated contents and lack of adaptability to regional needs. This article questions the beneficial effect of ATLS on the advanced German trauma care system and concludes that ATLS is not likely to improve trauma care in Germany.
-
Case Reports
[Application of the current resuscitation guidelines 2005. Case report of successful cardiopulmonary resuscitation].
The international guidelines for cardiopulmonary resuscitation are subject to continuous modification and were revised in November 2005. This report describes a case of an out-of-hospital cardiopulmonary resuscitation where the patient survived a cardiac arrest without neurological sequelae after chest compression (30:2), bag-mask ventilation and multiple biphasic defibrillation (single shocks). This article gives a practical review of the most important new recommendations in the current resuscitation guidelines. The accomplished measures are discussed on the background of the new recommendations.