Der Anaesthesist
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Ketamine is the only intravenous anesthetic that causes an increase in mean arterial pressure without compromising cardiac output. These beneficial effects are basically linked to stimulation of the sympathetic nervous system, inhibition of adenosine triphosphate-sensitive potassium channels and interactions with the nitric oxide pathway. Experimental and clinical studies have shown that ketamine exerts antiinflammatory properties by inhibiting the release of proinflammatory cytokines, such as tumor necrosis factor-alpha and interleukin-6. ⋯ In view of the current literature ketamine appears to represent a beneficial therapeutic option for long-term sedation of patients with arterial hypotension resulting from sepsis and systemic inflammatory response syndrome (SIRS). However, it has to be taken into account that ketamine inhibits endothelial nitric oxide synthase, thereby potentially aggravating impaired (micro) regional blood flow in sepsis. Future studies are required to investigate the role of ketamine in the treatment of patients with sepsis and SIRS.
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Multicenter Study
[Current level of patients' knowledge of anaesthesiology].
The anaesthesiologist's competence in anaesthesia, intensive care medicine, pain therapy and emergency medicine is accepted throughout the medical society. Nevertheless, during the last decades patient surveys demonstrated a considerable lack of information of the responsibility of our work. By continuous education and information anaesthesiologists have aimed to improve the information and decision-making process for the patient. ⋯ In the case of emergency medicine (10%) the in-hospital and out-of-hospital responsibilities were not clear among patients. We conclude that the continuous distribution of information in recent years has contributed to improving patients' knowledge on interdisciplinary responsibilities. Future efforts should focus on the gaps in patient's knowledge to allow the patient to ask the right questions necessary for decision-making.
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Randomized Controlled Trial Comparative Study
[Propofol for paediatric patients in ear, nose and throat surgery. Practicability, quality and cost-effectiveness of different anaesthesia procedures for adenoidectomy in infants].
The aim of this study was an improvement in patient comfort, reduction of anaesthesia costs and room contamination by the use of propofol for adenoidectomy. ⋯ The use of propofol for preschool children undergoing ear, nose and throat (ENT) surgery seems to be advantageous because of less postoperative agitation, emesis and costs.
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Comparative Study
[Desflurane and isoflurane in minimal-flow anesthesia. Consumption and costs with forced fresh gas reduction].
In the present investigation we compared the consumption of desflurane (DES) and isoflurane (ISO) using a standardized minimal-flow protocol with a forced reduction of the fresh gas flow (FGF). ⋯ With a forced reduction of the FGF the DES consumption is still higher.
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In neonates and infants, arterial and central venous catheters are of vital importance to optimize perioperative surveillance during surgery as well as postoperative care in the intensive care unit. The insertion of umbilical venous (UVC) and umbilical arterial catheters (UAC) in neonates in the first days of life is relatively simple and associated with a low procedure-related risk. As with other centrally placed catheters, correct positioning must be verified and the catheters should not be used for more than 5-7 days. ⋯ In order to minimize the risk associated with catheter malposition, correct position must always be verified by appropriate imaging studies or ECG guidance. Surgically placed Broviac catheters are mainly used in patients with a long-term need for central venous access. Finally, it has been shown that adherence to strict guidelines for insertion and handling can significantly reduce catheter-associated infections.