Der Anaesthesist
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Mechanical ventilation is the mainstay of therapy for acute lung injury, a disease with remainingly high morbidity and mortality. As a result of an improved understanding that mechanical ventilation itself can contribute to and aggravate the disease process, the term ventilator-associated lung injury (VALI) has been introduced. Main risk factor for VALI are (1) alveolar overdistention caused by excessivly high tidal volumes and/or inspiratory pressures (volu-/barotrauma), as well as (2) cyclic alveolar collapse promoted by insufficient endexpiratory pressure. ⋯ An initial lung volume recruitment manoeuvre is mandatory for the optimal use of HFOV. Whereas for many years HFOV is a well established therapy for the infant respiratory distress syndrome, experience in adults is still rare. First results, however, look promising, and HFOV might as well turn out as a valuable treatment modalitiy for ARDS.
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This case report describes an epidural abscess with pseudomonas aeruginosa after the placement of two epidural catheters within one hour in a healthy 29-year old primipara. Spontaneous delivery occurred after an episiotomy about 4 hours later. Afterwards the epidural catheter was removed completely and again 5 hours later the woman was discharged from the hospital. ⋯ In this case report a hematogenic infection was considered. The traumatized tissue from the two catheter placements within one hour could easily be colonized with pseudomonas aeruginosa originating from a transient bacteriemia due to an episiotomy inspite of adequate local disinfection measures. The case report also underlines the need for proper information of the patient about the possibilities of complications after epidural anesthesia in outside patients.
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Ischemia-induced changes of diastolic leftventricular (LV) properties commonly precede corresponding ECG-changes. In the present experimental study the consequences of acute normovolemic hemodilution (ANH) induced dilutional anemia (hematocrit, hct 20%) for LV diastolic function were investigated. A total of 22 anaesthetized, splenectomized beagle dogs breathing room air were hemodiluted with isooncotic hydroxyethylstarch solution (6% HAES 200,000/0.5) until a hct value of 20% was reached. ⋯ Signs of subendocardial perfusion mismatch were not encountered. Presumed that the coronary vascular system is intact ANH to hct 20% does not provoque changes of LV diastolic function. Moreover neither myocardial perfusion and oxygenation nor myocardial function are endangered by this degree of dilutional anemia.
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Emergency medicine is characterized by rapid decision making to help patients in life-threatening situations. Teaching these skills requires a high level of interaction between medical students and the lecturer. We designed, implemented, and evaluated a generic computer-based training (CBT) system to provide a more active way of learning emergency medicine. ⋯ We designed an evaluation form consisting of 21 items focused on subjective rating of learning success, acceptance of CBT, and technical feasibility. We analyzed forms from 138 students and found high scores for acceptance and learning success (median 5 on a 6-point scale). user problems with the program were denied (median 1 on a 6-point scale). Computer-based training with Internet technology can provide a successful method for interactive teaching of emergency medicine and is well accepted by students.
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Case Reports
[Pneumothorax in vertical infraclavicular block of the brachial plexus. Review of a rare complication].
A 50 year old female patient received anaesthesia of the arm by the vertical infraclavicular blockade of the plexus brachialis (VIP). Postoperatively an ipsilateral pneumothorax occurred complicated by pleural effusion and a contralateral bronchopneumonia, which resolved completely after treatment. ⋯ Nevertheless, the VIP is an important method due to its high success rate concerning blockade of the musculocutaneous nerve and tolerance of tourniquet. The risk of a pneumothorax is about 0.2 to 0.7%.