Der Anaesthesist
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In diabetics severe hyopotension can occur during anaesthesia as a consequence of cardiovascular autonomic neuropathy (CAN). A simple approach to recognize CAN is heart rate variability (HRV) measured at rest. The aim of this study was to determine the relationship between pre-operatively measured HRV and blood pressure stability during induction phase of anaesthesia. ⋯ The results confirm a significant relationship between HRV pre-operatively measured at rest and blood pressure stability during anaesthesia induction in diabetics. Particularly examination of CV, a simple test feasible within few minutes, may be useful in pre-operative risk stratification of these patients. Application of the time consuming traditional test combination to identify CAN seems to be unnecessary.
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Delayed awakening after general anaesthesia is in the majority of cases due to prolonged effects of anaesthetic drugs. However, intracerebral processes are also associated with disturbances of consciousness. Here, we report a case of a female patient who developed an intracerebral haemorrhage because of an arteriovenous malformation during routine surgery. This shows that in the case of delayed awakening after general anaesthesia the possibility of an intracerebral process should be considered early even after routine surgery.
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More efficacious anticoagulant and antiplatelet agents have been introduced in vascular medicine and in the prevention of perioperative venous thromboembolisms. Patient management should be guided by familiarity with the pharmacology of coagulation-altering drugs and by consensus statements. The present paper reviews recommendations from the Austrian Task Force for Perioperative Coagulation which are based on thorough evaluation of the available pharmacological information and case reports. The consensus statement focuses on neuraxial and peripheral techniques and is designed to encourage safe and quality patient care.
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A 27-year-old female patient was continuously treated with a psoas compartment catheter for pain therapy. The catheter was placed under strictly aseptic conditions. After 5 days a painful swelling and erythema were observed at the catheter introduction site and the catheter was removed. ⋯ An abscess of the psoas muscle is a rare complication of psoas compartment catheters. Erythema, pain or swelling at the site of introduction can be a sign of infection and the catheter must be removed immediately. In addition to the case report a review of the literature is given with data on risk management and own infection rates by 2304 peripheral pain catheters.