Der Anaesthesist
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After surgical operations delirium can occur as a serious and possible lethal complication in about 5-15% of patients. Additionally, risk factors such as old age, polymedication, organic and psychiatric diseases raise the incidence. After open-heart and orthopedic surgery more than half of the patients are affected. ⋯ In acute treatment, the butyrophenon-neuroleptic haloperidol is the drug of choice. In delirium caused by intoxication with anticholinergic agents, physostigmin is indicated. Benzodiazepines, clonidine and clomethiazole are used in particular for the treatment of withdrawal delirium.
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In 1994 the Department of Anaesthesiology and Intensive Care Medicine of the Justus Liebig University of Giessen decided to implement an Anaesthesia Information Management System (AIMS) to replace the previous hand-written documentation on paper. From 1997 until the end of 1998 the data sets of 41,393 anaesthesia procedures were recorded with the help of computers and imported into a data bank. Individual aspects and results of this data pool are presented under the aspect of how the system in its present form is able to guarantee documentation of quality according to the requirements of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI). ⋯ The current documentation of AVBs in almost any hospital is incomplete. In contrast to the hand-written procedure, the AIMS provides recorded data for evaluation and guarantees more detailed and complete quality documentation. In addition, the effort needed for documentation is reduced. Whether these data sets really describe and measure quality or not has to be evaluated. In addition it has to be considered whether different requirements (such as automatic AVB recognition for an AIMS) are advantageous for quality documentation regarding the data raster and the AVB recognition, with respect to different documentation procedures.
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Randomized Controlled Trial Clinical Trial
[Postoperative analgesia in children after hernioplasty. Wound infiltration with different concentrations of bupivacaine: a pilot study].
Wound instillation seems to be an easy and preferable way to achieve postoperative analgesia in pediatric hernioplasty. This prospective, randomized and double-blinded pilot-study was initiated to gain preliminary information in order to define the appropriate concentration of local anaesthetic for efficient posthernioplastic analgesia. ⋯ Wound instillation with 0.2 ml of bupivacaine 0.5% seems to be easy to perform, safe and efficient in controlling posthernioplastic pain. Because of the small numbers of patients included however, no statistically significant differences were observed between the groups. Neither in the LAPS on arrival and observation at the PACU nor in the need for supplementary analgesics. Despite lacking significance the clinical impression suggests a difference to be validated by larger studies. Our data implies that wound instillation with 0.2 ml/kg bupivacaine 0.5% should be regarded for routine usage.
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Simulation has gained an important role in medical education and continuing education in the field of anaesthesia and emergency medicine. This article gives background information on how full-scale simulators are applied in medical education as well as in continuing education for advanced anesthesia and scientific applications. Acceptance of training seems enhanced by inclusion of the human factor aspect, since this has proven to be a major source for the development of critical situations in our specialty. Furthermore, drawbacks of the simulators available and the current training availability in Germany is described.