Der Anaesthesist
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As in adult anesthesia, morbidity and mortality could be significantly reduced in pediatric anesthesia in recent decades. This fact cannot conceal the fact that the incidence of anesthetic complications in children is still much more common than in adults and sometimes with a severe outcome. Newborns and infants in particular but also children with emergency interventions and severe comorbidities are at increased risk of potential complications. ⋯ In the postoperative setting, nausea and vomiting, pain, and emergence delirium can be mentioned as typical complications. In addition to the systematic prevention of complications in pediatric anesthesia, it is important to quickly recognize disturbances of homeostasis and treat them promptly and appropriately. In addition to the expertise of the performing anesthesia team, the institutional structure in particular can improve quality and safety in pediatric anesthesia.
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Acute normovolemic hemodilution (ANH) is performed with the intention to reduce the requirement for allogeneic blood transfusions. After preoperative withdrawal of whole blood, corresponding amounts of crystalloids and/or colloids are infused to maintain normovolemia. The main benefit of ANH is the availability of whole blood containing red blood cells, clotting factors and platelets for reinfusion after removal during the dilution process. Until retransfusion whole blood components are stored at the patient's bedside in the operating theatre. ⋯ The results of the present study indicate that disturbances of platelet aggregation may occur during storage of whole blood components prepared for the purpose of ANH. Further investigations are needed to analyze whether the observed phenomena are of hemostatic relevance.
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Transoral laser surgery has become a standard procedure in the treatment of benign and malignant neoplasms of the upper aerodigestive tract. As the laser cuts and coagulates simultaneously, intraoperative bleeding is reduced, thus improving visualization of the operative field. ⋯ Although potentially fatal complications are rare, surgeon and anesthesiologist need to be aware of the dangers at all times and have exact knowledge of emergency measures. The use of suitable laser-resistant endotracheal tubes, total intravenous anesthesia and an optimized breathing gas mixture can contribute to minimize the occurrence of complications in otorhinolaryngology laser surgery.
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Prewarming is a useful and effective measure to reduce perioperative hypothermia. Due to §23(3) of the German Infektionsschutzgesetz (Gesetz zur Verhütung und Bekämpfung von Infektionskrankheiten beim Menschen, Infection Act, act on protection and prevention of infectious diseases in man) and the recommendations of the Hospital Hygiene and Infection Prevention Committee of the Robert Koch Institute, implementation of prewarming is clearly recommended. ⋯ Using a locally adapted concept for the implementation of prewarming does not lead to inefficiency in the perioperative process. In contrast, the implementation can help to achieve stable arrival times for patients in the OR.
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Peripheral electrical nerve stimulation is one of the standard applications in peripheral regional anesthesia in addition to the ultrasound technique. Among other findings, the visualization of needle and nerve during ultrasound-guided blockade caused a change in clinical practice of peripheral nerve stimulation in the last decade. In the present article old and new aspects of principles and clinical practice of the nerve stimulation technique are presented and summarized in a total clinical concept in order to achieve safe and successful peripheral regional anesthesia using electrical peripheral nerve stimulation.