Der Anaesthesist
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Experimental studies have demonstrated the neuroprotective effects of induced hypothermia in prevention of secondary insults following acute brain injury. Therefore, therapeutic hypothermia could be effective in the clinical setting of intensive care therapy. In this paper pathophysiological aspects of induced hypothermia are discussed and clinically relevant study results of hypothermia therapy are given in respect to evidence-based medicine.
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The constancy of body temperature (CBT) is a cornerstone of homeostatic, homothermic organisms and is essential for a regulated course of biochemical and biophysical reactions. Severe deviations from normothermia (36.8+/-0.4 degrees C) are life threatening and even a moderate perioperative reduction of the CBT is coupled with an increased morbidity and mortality especially in high-risk patients. The relevant factors are coagulation disturbances, increased infection rate and increased cardiac risk. ⋯ On the other hand, a deliberate reduction in temperature or induced hypothermia is a neuroprotective procedure, which offers a therapeutic option to minimize neuronal secondary damage after primary hypoxic-ischemic events as well as extending the neuronal tolerance to ischemia. Management includes the practice of cooling down to a defined temperature, rewarming as well as a differentiated control of various parameters. Furthermore, side-effects which increase in severity with decreasing temperature must be taken into consideration.
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Recording of adequate mission data is of utmost importance in prehospital emergency medicine. For this, a nationwide uniform core dataset for prehospital data reporting, the so-called MIND 2, was introduced. With this procedure adequate information about structure and outcome quality, but only little information about process quality, can be obtained. Regarding the quality of data recording, primarily computer-based techniques are superior to other techniques. Against this background, the aim of this study was to develop a documentation system, which sets new standards regarding documentation dataset and documentation quality. ⋯ The new data recording concept, which is based on the "digital paper" technology, has proven to be completely satisfactory with respect to functionality and documentation quality during the test period.
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Case Reports
[Microvascular bone transplantation in a child. Pain therapy with combined nerve blocks].
Apart from the perioperative care in children undergoing microvascular bone transplantation, postoperative pain therapy plays an important role in avoiding the development of chronic pain. Additionally perfusion of the transplant can possibly be improved by sympathicolysis provided by a continuous peripheral nerve block. ⋯ Via both catheters a continuous postoperative infusion of 0.1% ropivacaine (3 ml/h) was performed. Within the first 5 postoperative days complete pain relief at rest could be achieved.
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Randomized Controlled Trial
[Levobupivacaine for parturients undergoing elective caesarean delivery. A dose-finding investigation].
The optimum intrathecal dose of hyperbaric levobupivacaine for spinal anaesthesia during elective caesarean section has not yet been investigated. ⋯ Levobupivacaine 7.5 mg did not provide satisfactory intraoperative analgesia in all parturients. There were no statistically significant differences between 10 and 12.5 mg levobupivacaine with respect to analgesic, sensory and motor block characteristics. Therefore, based on these data, 10 mg levobupivacaine is recommended for parturients undergoing elective caesarean section with spinal anaesthesia.