Der Anaesthesist
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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.
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Patients with hypothermia are frequently encountered in emergency medicine. Particularly trauma patients, but also other predisposed persons, can be expected to suffer from hypothermia at any time of the year. ⋯ This paper first gives a brief overview of the typical clinical symptoms of hypothermia, before giving a detailed description of the preclinical and in-hospital management of the hypothermia patient. The various rewarming strategies are the subject of special attention and critical evaluation.
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Managing the difficult airway poses an enormous challenge for anaesthesiologists, intensivists and A&E physicians, particularly because of the high probability of a potentially fatal outcome. Development and (pre-) clinical distribution of supraglottic airway devices (e.g. LMA, LT) and their enhancements, as well as the broad acceptance of awake fibre-optic intubation, led to a profound change in the strategy for managing the difficult airway. ⋯ In view of the utmost importance of this topic the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) framed an independent German guideline, considering German national terms and conditions. In analogy algorithms and guidelines of the ILCOR, ERC and ATLS were revised as well as those of many other national anaesthesiological boards. Nevertheless, massive national and international deficits exist in implementing these guidelines into practice and the implicated structural requirements with respect to education, reflection, team building and equipment concerning the individual institution.
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Review
[Determinants of insensible fluid loss. Perspiration, protein shift and endothelial glycocalyx].
Accurate perioperative fluid balance is the basis of a targeted infusion regimen. However, neither the initial status nor perioperative changes of the fluid compartments can be reliably measured in daily routine. In particular, insensible losses are not consistently assessed, so that substitution therapy is generally empirical. ⋯ An inconstant fluid and protein shift towards the interstitial space perioperatively seems to be associated with hypervolemia, which suggests it should be preventable. The decisive factor in this context seems to be deterioration of the endothelial glycocalyx, whose further patho-physiological impact is currently only partially known. Clinical studies have revealed a link between fluid restriction and improved outcome after major abdominal surgery.
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Comparative Study
[Intended and actual paths of epidural needles. Investigations with a test tissue model].
Peridural anaesthesia needles (PDA) do not only differ in calibre or gauge but also vary in the design of the needle tip, which shows a special configuration to place a catheter in the epidural space. A laboratory model was performed to determine the influence of different types of virgin epidural needles concerning their path through tissue. In an additional test run we analysed the influence of a previous use on the path through tissue. ⋯ As expected, the average deviation of PDA needles depended on the diameter. No differences in the degree of deviation for virgin needles compared to previously used needles could be found. Thus, more than one application of the same needle in one patient is considered to be safe as long as the needle is not deformed in any way.