Der Anaesthesist
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The anesthesia team acts every day in a highly complex and high risk environment for the transmission of pathogenic organisms and the induction of infectious complications. With strict adherence to standard precautions and infection control practices in particular regular hand disinfection before and after direct patient contact and before performance of aseptic tasks during anesthesia and an optimized perioperative process the members of the anesthesia team can become infection control pioneers within the hospital. In order to be successful, structural and organizational resources in the form of training, personnel, materials and time, need to be adequate for the situation. This review summarizes the infection control recommendations for anesthesia practice based on the most recent literature and guidelines and offers practical advice for commonly observed mistakes.
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Review Historical Article
[Video laryngoscopy olé! Time to say good bye to direct and flexible intubation?].
A number of video laryngoscopy systems have been introduced into anesthetic practice in recent years. Due to the technical concepts of these systems exposure of the laryngeal structures is usually better than with direct laryngoscopy, both in normal airways as well as in those that are difficult to manage. With the increasing use of video laryngoscopy it seems as if direct laryngoscopy and flexible fibrescopic intubation are at risk of becoming redundant. This article describes current developments and discusses why expertise in direct laryngoscopy and flexible fibrescopic intubation should be maintained, particularly by experts in airway management.
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Dexmedetomidine is a highly selective, potent α₂-adrenoceptor agonist which was approved in 2011 by the European Medicines Agency for sedation of patients in intensive care units (ICU). Dexmedetomidine exhibits sedative as well as analgesic and anxiolytic effects. ⋯ This review summarizes the pharmacokinetics and pharmacodynamics of dexmedetomidine particularly in ICU patients and with special regard to covariate effects. Although dexmedetomidine is currently approved only for use in adults the pharmacokinetics and pharmacodynamics in children will also be addressed as there are numerous studies on this off-label use.
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The second part of this overview focuses on how to assess more complex metabolic causes of acid-base imbalance. This is precisely the battlefield where most of the fiery debates between the Copenhagen, the Boston and the Stewart schools aroused. ⋯ With the Stewart diagnostic approach in mind the practitioner might wish considering therapeutic options that differ from what is suggested by the more traditional approaches. The specific diagnostic steps are integrated into a simplified algorithm and an acid-base calculator is provided.
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Life-threatening pediatric emergencies are rare events in which precise, correct and fast drug dosing is essential. Intravenous drugs are most commonly dosed based on the child's weight in mg/kg. Numerous tools exist for aiding the physician in the error prone calculation, none of which meet all criteria for the perfect tool. Besides frequent training of practical skills and awareness of the problem of calculating the exact drug dose, it seems indispensable to have a localized tool at hand for these critical events.