Der Anaesthesist
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There are considerable similarities and intersections between forensic medicine and emergency medicine. This applies especially to frustraneously resuscitated patients or other lethal clinical courses of traumatized patients who are subject to latter forensic autopsy. ⋯ The pre-hospital situation represents a hotspot, but also a blind spot in the overall trauma mortality. In recent clinical registers, preclinical deaths go mostly unrecorded, despite the undisputed benefits of clinical registers.
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Acetylcholine is a neuromodulator which is released throughout the central nervous system and plays an essential role in consciousness and cognitive processes including attention and learning. Due to its 'activating' effect on the neuronal and behavioral level its interaction with anesthetics has long been of interest to anesthesiologists. ⋯ This notion is backed by numerous human and animal studies, but is also in seeming contradiction to findings that acetylcholine activates specific classes of inhibitory neurons: if acetylcholine excites elements within the neuronal network responsible for the release of the inhibitory neurotransmitter γ-aminobutyric acid (GABA), its withdrawal should diminish, not enhance, the effect of anesthetics. Focusing on cortical circuits, we present an overview of recent advances in cellular neurophysiology, particularly the interactions between inhibitory neuron classes, which provide insights on the interaction between acetylcholine and GABA.
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Review
[Does intraoperative lung-protective ventilation reduce postoperative pulmonary complications?]
Recent studies show that intraoperative protective ventilation is able to reduce postoperative pulmonary complications (PPC). ⋯ The use of intraoperative VT ranging from 6 to 8 ml/kg based on ideal body weight is strongly recommended. Currently, a recommendation regarding the level of PEEP during surgery is not possible. However, a PEEP increase that leads to a rise in driving pressure should be avoided.
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Sterile and clean working conditions are one of the keystones of medical practice and this is also true for ultrasound-guided regional anesthesia. The routine clinical practice in ultrasound-guided regional anesthesia does not always comply with the principles of sterile and clean working conditions in medicine: therefore, patients are exposed to potential hazards regarding the transmission of pathogens via the ultrasound equipment. ⋯ The use of sterile ultrasound probe covers and sterile ultrasound contact media is an important prerequisite to avoid cross-infection between patients. An appropriate scientific evaluation should serve as evidence in this field.
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Throughout its history, anesthesia and critical care medicine has experienced vast improvements to increase patient safety. Consequently, anesthesia has never been performed on such a high level as it is being performed today. ⋯ It turned out that there is a complex variety of possible errors that can only be tackled through consistent implementation of a safety culture. The key elements to reduce complications are continuing staff education, algorithms and standard operating procedures (SOP), working according to the principles of crisis resource management (CRM) and last but not least the continuous work-up of mistakes identified by critical incident reporting systems.