Der Anaesthesist
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For patients with acute kidney injury (AKI) and continuous renal replacement therapy, it is essential that the dosing of antibiotics is adequately adjusted in order to achieve an effective drug level above the minimum inhibition concentration but avoiding toxic side effects. In the selection of substances, preference should be given to antibiotics with a broad therapeutic spectrum, low incidence of side effects and, as far as possible, extrarenal elimination. ⋯ An accurate as possible estimation of residual renal function and calculation of the mechanical clearance allows determination of the necessary maintenance dosage, which is acceptably accurate for clinical needs. Recent studies have shown that under modern continuous renal replacement therapy, the extent of elimination of antibiotics is regularly underestimated so that nowadays, the risk of antibiotic underdosing is higher than toxicity due to overdosing.
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Stress is an integral part of the daily routine among healthcare workers in anesthesiology and emergency medicine. ⋯ Research in aviation and psychology has provided various tools to improve performance during stressful events and should be taken into consideration for routine daily use.
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Emergency sonography encompasses a number of targeted sonographic investigation techniques, which allow a quick response to frequently occurring situations arising in anesthesiology, including intensive care and emergency medicine. Emergency sonography supports point of care diagnostics to clarify the possible causes of hemodynamic and respiratory instability, e.g. to determine the extent of intra-abdominal bleeding in a still compensated patient with multiple trauma and to support interventions, such as pleural fluid drainage. ⋯ In comparison to conventional sonographic examination techniques, these techniques are used with reduced examination times and a focussed assessment of specific clinical problems. By means of a few standardized cross-sectional planes, numerous questions can be quickly addressed and therapeutic consequences can be deduced.
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Because of an ageing population and a relative lack of professionals, the German health system is under great pressure. In rural regions in particular, anesthesiology is also affected - nursing staff, anesthetists, intensive care physicians, and emergency physicians often have to be supported by freelancers from other regions and from abroad - at least periodically. In addition to the increasing number of treatments, the potential quality of therapy is also increasing owing to progress in medical research. ⋯ In the various anesthesiological sub-sections the number of scientific papers published to date varies. For anesthesia and pain therapy only a few telemedical applications or concepts have been reported in the literature. However, in tele-intensive care medicine and tele-emergency medicine several national and international research projects have successfully been carried out, leading to established routine systems in some cases.
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Pediatric patients represent a special challenge both for the management of anesthesia and for communication, especially the anxious and screaming child. Children have specific features of fears, cognition, comprehension and skills depending on the stage of development. In addition, behavior and anxiety are strongly shaped by the parents who have to be incorporated. ⋯ Meeting at eye level, talking to the child instead of just about it, a language appropriate for children but not childish, comprehensible information and explanations, return of control and care more than pure technical distance, all play an important role. A serious look into such communication strategies can help the anesthetist to overcome uncertainties that a child can easily sense.