Der Anaesthesist
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Major incidents are high-profile events where many lives are at stake. The response of the health-care-related agencies has to be well-planned and co-ordinated, thus retaining the public's confidence in the emergency services whilst efficiently responding to those in need. The communication between supervising officers such as medical incident officer (MIO) and ambulance incident officer (AIO) with the ambulance personnel is vital for the proper employment of doctors and ambulance teams at the incident scene. In Germany the experience gained at such events has not yet been collected into a single coherent and comprehensive analysis. This study investigates the delivery of ambulance vehicles and personnel at major incidents. Was appropriate emergency treatment and transport for each seriously injured patient possible? Were the communication structures between the supervising officers and the ambulance teams sufficient to provide effective co-ordination and utilisation of the teams at the scene? ⋯ Quality assurance in emergency medicine can only be achieved by research and documentation. Analysis of the data for this study revealed a severe documentation gap. Only in Bavaria did a one-page documentation form for major incidents exist. For a comprehensive analysis of the health-care-related response to major incidents, a standardised and detailed documentation form should be introduced. According to the data from this study, ambulance staff and vehicles can be quickly and sufficiently provided for the vast majority of major incidents in Germany. For the optimal use of these resources, however, communication skills and knowledge and understanding of on-side supervision structures such as the MIO and AIO need to be promoted.
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In February 1995 a questionnaire was sent out on perioperative management during neurosurgical operations performed in the sitting position to 136 centres and hospitals within the Federal Republic of Germany that perform neuroanaesthesia. The response rate was 61.02%. Besides the question of perioperative monitoring during neurosurgical operations in the sitting position, we asked about currently used positions for patients during the following neurosurgical operations:posterior fossa, craniospinal and posterior cervical surgery. ⋯ To determine the effect of the recommendations by the DGAI on clinical practice, the survey will be repeated in 1997.
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The reliability of continuous fibreoptic oximetry in cerebral venous blood and its correlation with intracranial and cerebral perfusion pressures (pressure-volume curve) were examined in an experimental porcine study. ⋯ We conclude that in physiological CPP ranges down to 50 mmHg, SjO2 measurement is a reliable method of detecting oxygen desaturation in cerebrovenous blood. Below that CPP value, the fibreoptic catheter showed repeated false-high oxygen saturation values. The accuracy of SjO2 measurement seems to depend on sufficient cerebral blood flow (CBF): with decreasing CBF the amount of cerebral venous outflow is diminished. We believe this is why we could not find a correlation in low CPP ranges with the oximetry catheter. This flow-dependency is a new aspect of fibreoptic cerebrovenous oximetry. The authors recommend that rising SjO2 values after desaturation events be confirmed by blood-gas analyses.
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
[Circulatory reactions under spinal anesthesia. The catheter technique versus the single dose procedure].
Life-threatening cardiovascular complications are a serious risk even for healthy patients during spinal/epidural anaesthesia. The incidence of fatal cardiovascular complications for epidural anaesthesia is 1:10000, for spinal anaesthesia 1:7000. In contrast, general anaesthesia has an overall mortality of only 1:28000. Administration of IV fluids to minimise the haemodynaemic reactions of beginning sympatholysis is not always sufficient. In this study, we examined whether fractionated application of local anaesthetics via a spinal catheter would provide better haemodynamic stability. ⋯ With the use of CSA, the haemodynamic effects of sympatholysis can be minimised. This method thus has advantages, especially for high-risk cardiovascular patients.