Der Anaesthesist
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Levosimendan is a recently developed drug which is not yet approved for clinical routine use in Germany. The clinical use is limited to a few selected cases and it has been used as a salvage therapy in patients with severe heart insufficiency. ⋯ However, in some European countries levosimendan is used in clinical routine situations and the European Society of Cardiologists has included the drug in their guidelines for treatment of acute heart failure. The following article describes the main pharmacological characteristics of levosimendan and summarises the indications for this new drug for physicians working in the field of anaesthesia or intensive care.
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Human factors (HF) play a major role in crisis development and management and simulator training can help to train HF aspects. We developed a modular training concept with psychological intensive briefing. The aim of the study was to see whether learning and transfer in the treatment group (TG) with the module "communication and team-cooperation" differed from that in the control group (CG) without psychological briefing ("anaesthesia crisis resource management type course"). ⋯ A training concept with psychological intensive briefing may enhance the transfer of HF aspects more than classical ACRM.
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The innate immune system succeeds against the majority of infections before the adaptive immune system is activated. New findings contribute to a better understanding of the pathophysiology of sepsis and lead to the development of new therapeutic strategies. The innate immune system, being responsible for the first response to infections, can trigger adaptive immune responses in case the initial response is ineffective. ⋯ The environment in sepsis can cause disseminated intravascular coagulation (DIC), but at the same time thrombin triggers the release of chemokines and adhesion molecules through endothelial cells, which represents a positive feedback mechanism for innate immune responses. New therapeutic strategies for sepsis try to establish a well-balanced immune response. Intervention is accomplished through inhibition of inflammatory cytokines, their receptors or through activation of immunostimulatory responses.
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From a pharmacological perspective, anesthesia is concerned with controlling the time course of drug effect. Mathematical models are commonly used to relate the administered drug dose to the measured drug concentration (a pharmacokinetic model) and to relate the measured drug concentrations to the measured drug effects (a pharmacodynamic model). With such models, the time course of the drug effect for different drug regimens can be predicted. ⋯ An understanding of the "effect compartment concept" and the "time of the peak effect site concentration," together with the concepts of" context sensitive"half-time and "relevant decrement time,' contribute substantially to the anesthetist's understanding of the principles governing the onset and offset of drug effect. As part of a computer-controlled infusion system, the pharmacokinetic model facilitates optimized and rational dosing. These systems, also called target-controlled infusion systems (TCI), calculate the infusion rates for rapidly achieving and then maintaining a target concentration.
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Clinical Trial
[Bispectral index and desflurane concentration below 1 MAC].
We investigated the relationship between bispectral index (BIS, A-2000, Aspect Medical Systems, USA) and end-tidal desflurane concentrations below 1 MAC which is especially the range of interest if desflurane is combined with remifentanil for fast-track anaesthesia. ⋯ We could demonstrate a relationship between bispectral index and end-tidal desflurane concentrations below 1 MAC with a BIS range of 49-40 being associated with approximately 0.5 MAC of desflurane during desflurane-remifentanil-anaesthesia.