Der Anaesthesist
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Postoperative cognitive dysfunction (POCD) presents as a long-lasting decline in cognitive function after a surgical procedure, predominantly occurring in elderly patients. The causes are most likely multifactorial with the exact mechanisms still unknown. ⋯ The most important strategy to avoid POCD is to maintain the patient's physiological homeostasis perioperatively. According to the presently available clinical studies recommendations in favor or against certain anesthesiological procedures cannot be given.
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Many anesthesia textbooks advise anesthesiologists to demonstrate that ventilation with a facemask is possible before giving muscle relaxants. This recommendation is not evidence-based. If a functional airway obstruction is responsible for difficult mask ventilation and with high induction doses it will rarely be possible for the patient to recover spontaneous ventilation before hypoxia develops. ⋯ Therefore the authors recommend giving muscle relaxants after loss of consciousness and thereafter starting gentle bag mask ventilation. To prevent a cannot ventilate cannot intubate situation patient airways have to be carefully evaluated preoperatively. If difficult ventilation or intubation is expected an alternative procedure should be chosen.
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Gender differences can have a relevant influence on the perioperative outcome as male and female patients are affected differently by adverse events, e.g. side effects of drugs. Furthermore, differences relating to specific drug effects, comorbidities and outcome after anesthesia or intensive care have been demonstrated. ⋯ There is a need to study the influence of gender, age and race in order to optimize treatment towards a more individualized therapy. This article highlights already identified differences and discusses potential underlying mechanisms.
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Review Meta Analysis
[Corticosteroid administration for acute respiratory distress syndrome : therapeutic option?].
Despite a number of clinical trials there is still controversy about the role of corticosteroid therapy in acute respiratory distress syndrome (ARDS). In addition recent meta-analyses differed markedly in the conclusions. ⋯ A low-dose corticosteroid regime given for 4 weeks may potentially be helpful and can be considered in acute or unresolved ARDS in less than 14 days after onset of ARDS, if a close infection surveillance program is available, if neuromuscular blockade can be avoided and if a stepwise dose reduction of corticosteroids is performed. The total daily dose at the beginning of treatment should not exceed 2 mg/kg body weight (BW) methylprednisolone.
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Review Meta Analysis
[Age rationing : means of resource allocation in healthcare systems].
The necessity of limiting resource in healthcare systems is becoming increasingly more evident. The population has requirements especially in the field of healthcare which are principally unlimited. ⋯ One example of these models is called age rationing which means that defined services are only offered to patients up to a particular age. The aim of this article is to discuss the model of age rationing in the context of an optimized use of resources in the healthcare system.