Der Anaesthesist
-
Patients with type 1 diabetes require continuous substitution of exogenous insulin due to their disability to produce insulin themselves. The insulin dosage required is individual-specific and may change dramatically during the perioperative period. ⋯ When planning the operation, an individual treatment regime should be drawn up and be made available to the medical team. In order to facilitate the challenging perioperative management of these patients, this article presents the current recommendations for the perioperative management of children and adolescents with type 1 diabetes mellitus (i.e. of the International Society for Pediatric and Adolescent Diabetes, ISPAD).
-
In epidural anaesthesia, the anaesthetist injects one or more drugs into the epidural space bordering on the spinal dura mater to achieve a "central" and/or "neuraxial" block. It is one of the earliest techniques in anaesthesia, originally performed exclusively with local anaesthetic agents. ⋯ Continuous epidural analgesia is an important tool in postoperative pain management. More and more often, the increasing proportion of patients who have comorbidities or are permanently taking medication that modulates the clotting system demands that the anaesthesiologist balance the individual risks and benefits before inducing epidural anaesthesia.
-
Accidental intravascular administration of bupivacaine can cause severe neurotoxic and cardiotoxic effects. We report a case of suspected bupivacaine intoxication due to intravascular injection via an epidural catheter and treatment with lidocaine, propofol, and a 20% lipid emulsion resulting in fast resolution of cardiotoxic and neurotoxic effects. Possible mechanisms of action of the medications used are discussed.
-
Preclinical emergency medical treatment necessitates a comprehensive interdisciplinary knowledge by the emergency physician as well as a high level of manual dexterity. The quality of treatment therefore depends on the level of education and continuous training in emergency medical techniques. Based on an evaluation of the frequency of life-saving interventions by a physician-staffed rescue helicopter system, strategies for in-hospital training of relevant skills are suggested. ⋯ The frequency of on-site life-saving interventions in emergency medicine is insufficient to fulfill the quota necessary to maintain adequate training of emergency physicians. Only a link-up program at a hospital for primary care can ensure an adequate training level.
-
Hypovolemic shock is not a form of disease and can be subdivided into four special types with varying therapeutic demands. The decisive approach in the therapy of hypovolemic shock is to initially attain normovolemia by rapid administration of volume replacement agents in the sense of controlled hemodilution. This allows an adequate increase in the cardiac output resulting in delivery of sufficient oxygen to tissues. In the following article the limits of intervention will be described and the advantages and disadvantages of these measures for patients suffering from hypovolemic shock will be critically considered.