Der Anaesthesist
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Atypical cholinesterase prolongs the duration of neuromuscular blocking drugs such as succinylcholine and mivacurium. Measuring the dibucaine number identifies patients who are at risk. This study shows the frequency distribution of dibucaine numbers routinely measured and discusses avoidable clinical problems and economic implications. ⋯ An incidence of 1:1,400 of dibucaine numbers below 30 is higher than documented in the literature. Therefore, routine measurement of dibucaine number is a cost-effective method of identifying patients at increased risk of prolonged neuromuscular blockade due to atypical cholinesterase.
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Case Reports
[Incorrect positioning of a catheter for continuous block of the nervus suprascapularis. A case report].
The case of a 55-year-old woman is described where shoulder pain was successfully treated with a suprascapular catheter. During arthroscopy of the shoulder the catheter was detected in the subacromial space. The reasons and consequences of an abnormal position of the suprascapular catheter are discussed.
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The present study evaluates the use of muscle relaxants for rapid-sequence induction (RSI) and different application techniques (pre-curarisation, priming, timing) as a part of a nationwide survey in Germany. In 86.8% of anaesthesia departments succinylcholine is used for RSI and an average of 56.5% of respondents used only succinylcholine for RSI. Of all non-depolarising muscle relaxants rocuronium is the most frequently used alternative. ⋯ Despite ist known side-effects and the on-going discussion over the past years, succinylcholine is still the most frequently used muscle relaxants for RSI. Priming is often declined by anaesthetists in Germany, most probably due to the absence of clear advantages and the possibility of severe complications. It is the opinion of the authors that timing but also drugs with a slow onset (e.g., alcuronium and Pancuronium) are obsolete in the context of RSI.
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Assessment in anaesthesia traditionally takes the form of written papers and oral examinations. These are important for assessing trainee's knowledge and judgement, but do not test for competency in practical skills, which is essential for successful clinical practice. The presence of learning curves for practical skills in anaesthesia is now well recognized and they are useful tools to monitor a learning process. ⋯ Not only technical skills need to be taught, but also decision-making and even more important behavioral skills. In clinical practice there are often problems in providing all the necessary training on patients and by this reorganization of residency programs may be necessary. However, the role of medical simulation in the assessment of anesthetists in training is still unclear, and the introduction of simulator-based tests may be premature.
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The axillary brachial plexus block is a very safe, but sometimes unreliable technique for anaesthesia of the upper extremities. Alternative methods like the infraclavicular block offer a higher success rate, but also the possibility of severe complications. We suggest a modified axillary technique with an injection site medial to the artery, evaluated by clinical experience and anatomical investigations, which could solve the problem of high failure rate, especially in the area of the radial nerve while still maintaining patient safety.