Der Anaesthesist
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The first part of this overview on diagnostic tools for acid-base disorders focuses on basic knowledge for distinguishing between respiratory and metabolic causes of a particular disturbance. Rather than taking sides in the great transatlantic or traditional-modern debate on the best theoretical model for understanding acid-base physiology, this article tries to extract what is most relevant for everyday clinical practice from the three schools involved in these keen debates: the Copenhagen, the Boston and the Stewart schools. Each school is particularly strong in a specific diagnostic or therapeutic field. Appreciating these various strengths a unifying, simplified algorithm together with an acid-base calculator will be discussed.
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The determination of cerebral oxygen saturation (S(c)O(2)) by means of near-infrared spectroscopy allows non-invasive assessment of the cerebral oxygen delivery and demand ratio in the frontal cortex region. Studies in cardiac as well as non-cardiac patients have shown that maintaining S(c)O(2) in the preoperative range reduces the incidence of postoperative cognitive dysfunction and general morbidity; however, S(c)O(2) is not only reflective of cerebral but also of systemic oxygen balance, is inversely related to cardiopulmonary function and has prognostic relevance in cardiac surgery patients. This suggests that cerebral oximetry is not only useful for neurological but also for hemodynamic monitoring and preoperative risk stratification of cardiac surgery patients.
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Suicide rates of male and female physicians are about 3-5 times higher compared with the general public. Detailed studies about medical student suicides in the United States exist but similar current data from German speaking countries are lacking. ⋯ The suicide risk of medical students at the Medical University of Innsbruck appears to be increased. Because of a lack of comparable data it is not possible to show whether these observations can be extrapolated to other universities. It appears that there was no single special event which triggered suicide by the medical students but a combination of individual risk factors and the environment was involved. However, this problem receives insufficient attention.
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Bloodstream infections due to intravascular catheterization, peritoneal catheters for dialysis, suprapubic or transurethral catheters, are one of the major sources of nosocomial infections. Therefore, the prevention of catheter-associated infections is an important issue for physicians and nursing staff working in hospitals or in outpatient settings. The risk can be minimized by diligent checking of the indications, hygienic measures, using the right materials, thorough follow-up and education of the medical and nursing staff. Thus it is possible to avoid individual suffering of patients and to reduce costs in the healthcare system.
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Cardiopulmonary bypass (CPB) is a standard procedure in cardiac surgery; however, apart from its therapeutic options a CPB might also initiate systemic and organ-specific complications, such as heart failure, renal and pulmonary dysfunction, impaired coagulation as well as neurological and cognitive dysfunction. The immunological response to the extracorporeal circulation generates systemic inflammation which often meets the definition of systemic inflammatory response syndrome (SIRS). The main inducers of SIRS are contact of blood with the artificial surfaces of the CPB, mechanical stress which affects the blood components and the extensive surgical trauma. ⋯ By reason of surgical demands, the majority of cardiothoracic procedures still depend on the use of CPB; however, there is an on-going development of new techniques trying to reduce the surgical trauma and the negative consequences of CPB. Here, minimized systems with biocompatible surfaces have been shown to be effective in attenuating the inflammatory response to CPB. Alternative procedures such as off-pump surgery may help to avoid CPB-associated complications but due to specific limitations will not replace conventional bypass surgery.