Der Anaesthesist
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Review
[The child with minor trauma. Does observation of fasting times reduce the risk of aspiration?].
According to a literature search, it seems most unlikely based on patho-physiological requirements and physiological aspects that traumatized children benefit from preoperative waiting times aimed at achieving a 6-h fast. Irrespective of fasting, traumatized children are at risk of requiring aspiration. Many generally recommended measures for the avoidance of aspiration are neither reasonable nor effective in traumatized children. The physical and psychological benefits that can be derived from shorter preoperative waiting times can more than over-ride the organizational difficulties caused by waiting longer.
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Comparative Study Clinical Trial
[Venovenous extracorporeal membrane oxygenation (ECMO) with a heparin-lock bypass system. An effective addition in the treatment of acute respiratory failure (ARDS)].
Mortality of severe acute respiratory distress syndrome (ARDS) in Germany is about 60%. Respiratory therapy can make the lung injury worse by high positive airway pressures, high tidal volumes and high inspiratory oxygen concentrations. Extracorporeal membrane oxygenation (ECMO) was employed to reduce aggressive mechanical ventilation, but it has not been proved to be superior to conventional ventilation. ⋯ CONCLUSION. In comparison with the historical results at our own institution, the present study demonstrates an improvement in the survival rate from 56% to 78% since ECMO has become available. We conclude that venovenous ECMO with a heparin-bonded bypass circuit is an effective additional option for the treatment of patients with severe ARDS.
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Postoperatively, after an uncomplicated vaginal hysterectomy, a 58-year-old female patient developed the signs of disseminated intravascular coagulation and fever, which progressed to a septic shock. She received two units of autologous blood, one during and one after the operation. ⋯ The source of bacterial contamination could not be identified. Autologous blood products thus also include a risk of infection that shouldn't be underestimated, and a strict medical indication to retransfusion is indispensable.
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Prerequisites for experimental study designs are extremely difficult to realise under prehospital emergency conditions. Results obtained in animal experiments always need validation with prehospital or in hospital patient studies. Investigations related to emergency medicine are, however, an ethical obligation on behalf of the patient. ⋯ Biases in emergency medicine studies focus on the variability of EMS, personnel qualifications, etc. This is in part why it is extremely difficult to prove efficacy and efficiency in emergency medicine. The results of emergency medicine investigations should be published in suitable journals, i.e., journals with a reasonable rating.
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GOAL OF THIS REVIEW: We review the recent literature and our experience in order to determine how one can recognize and handle patients with difficult endotracheal intubation.