Der Anaesthesist
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
[A factorial trial of six interventions for the prevention of postoperative nausea and vomiting].
Untreated, one third of patients who undergo surgery will have postoperative nausea and vomiting. Although many trials have been conducted, the relative benefits of prophylactic antiemetic interventions given alone or in combination remain unknown. ⋯ Because antiemetic interventions are similarly effective and act independently, the safest or least expensive should be used first. Prophylaxis is rarely warranted in low-risk patients, moderate-risk patients may benefit from a single intervention, and multiple interventions should be reserved for high-risk patients.
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Controlled hypothermia is used as a therapeutic intervention to provide neuroprotection and (more recently) cardioprotection. The growing insight into the underlying pathophysiology of apoptosis and destructive processes at the cellular level, and the mechanisms underlying the protective effects of hypothermia, have led to improved application and to a widening of the range of potential indications. ⋯ This review deals with some of the concepts underlying hypothermia-associated neuroprotection and cardioprotection, and discusses some potential clinical indications as well as reasons why some clinical trials may have produced conflicting results. Practical aspects such as methods to induce hypothermia, as well as the side effects of cooling are also discussed.
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Resuscitation of patients in hemorrhagic shock remains one of the most challenging aspects of trauma care. We showed in experimental studies that vasopressin, but not fluid resuscitation, enabled short-term and long-term survival in a porcine model of uncontrolled hemorrhagic shock after penetrating liver trauma. ⋯ In a third patient, an infusion of vasopressin was started before cardiac arrest occurred; in this case, we were able to stabilize blood pressure thus allowing further therapy. The patient underwent multiple surgical procedures, developed multi-organ failure, but was finally discharged from the critical care unit without neurological damage.
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For perioperative anesthesia in a case of shoulder arthroscopy, a continuous interscalene plexus block according to Meier was performed in a 51-year-old female patient. The catheter was placed after stimulator-assisted punction and application of a local anesthetic. ⋯ Blind advancement and deep placement increase the risk of an abnormal catheter position. Intraspinal misplacement should be reliably excluded.
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The use of therapeutic hypothermia following different hypoxic-ischaemic insults has played an important role in various concepts of non-specific protection of cells for a long time. Although the use of deep therapeutic hypothermia after cardiac arrest in the last century did not lead to an improved outcome, recent data have demonstrated very positive effects of mild therapeutic hypothermia. ⋯ In 2003, this led to the implementation of mild therapeutic hypothermia (32-34 degrees C) into the International Liaison Committee on Resuscitation (ILCOR) recommendations and guidelines for the treatment of unconscious patients after prehospital cardiac arrest. This article gives an overview on existing concepts and future perspectives of therapeutic mild hypothermia.