Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 2002
Review[Can lung protective ventilation methods modify outcome?--A critical review].
A large body of experimental and clinical work leaves no room for doubt that mechanical ventilation can contribute to the progression of a lung disease or, in the worst case, produce acute pulmonary damage. The pathophysiological processes involved have been described as barotrauma, volutrauma, atelectrauma and biotrauma. In response, a socalled lung-protective ventilation strategy has been proposed, especially for patients with acute respiratory distress syndrome (ARDS). ⋯ Of these, only prone positioning has become part of routine clinical management, while ECMO is applied in selected cases only. Unfortunately, thus far, none of these measures has passed the litmus test of a randomized controlled trial. Recent large prospective observational studies, however, suggest that only an optimized concert of therapeutic interventions, but not a single measure alone, may improve the outcome of ARDS patients.
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Anaesthesiol Reanim · Jan 2002
Case Reports[Do position control methods for central venous catheters prevent complications? Hydromediastinum caused by an initially correctly placed tri-lumen subclavian catheter by using intra-atrial ECG recording--a case report].
Central venous catheters (CVCs) can be associated with various complications which arise during insertion, with the catheter in situ or upon its removal. Here we report a case of secondary CVC malposition that occurred despite checks of CVC position by different methods. A subclavian triple-lumen catheter was retracted until intra-atrial ECG indicated reversal to a normal P-wave. ⋯ Moreover, repeated chest radiographs are useful in verifying a correct CVC position and detecting late complications. In summary, CVC complications can occur with delay, are potentially life-threatening and may necessitate repeated checks of catheter position. This case report discusses different approaches to detecting malposition and reviews rare CVC complications.
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When caring for patients with an incurable progressive disease, the physician experiences a feeling of powerlessness because there is no curative treatment that he can offer. The reaction to this must not be resignation, but active palliative medicine to achieve the best possible quality of life for the remaining time. Palliative medicine is a holistic concept of treatment in an outpatient or inpatient setting, integrating physical, psychological, social and spiritual aspects. ⋯ The decision-makers in our health care system are called upon to support palliative medicine and ensure access to palliative care all over the country. Palliative medicine was started to ease suffering, preserve or restore autonomy and maintain dignity. As an active life aid it is, in our opinion, an alternative to any demand for euthanasia.
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Anaesthesiol Reanim · Jan 2002
[Postoperative epidural analgesia--current status, indications and management].
We are reporting on postoperative pain treatment using epidural analgesia in 1,822 patients, performed between 1995 to 2000, following continuous epidural anaesthesia combined with general anaesthesia for operations in various specialized areas (general or visceral surgery, vascular and thoraxic surgery, gynaecology, urology and orthopaedics). A total of 1,727 of these postoperative epidurals were included in a detailed evaluation. The postoperative epidural analgesia consisted of a continuous application of 0.25% bupivacain or 0.2% ropivacain. ⋯ This reveals the required puncture height. The following side-effects resulting from the epidural analgesia were found: blood pressure loss of more than 20% of the starting value (21%), temporary bladder voiding disorders (8%), temporary sensory disorders of the lower extremities (6.5%), seldom nausea (2.4%) and post-puncture headaches (1.2%). The most important prerequisites for successful postoperative epidural analgesia and thus for increased patient satisfaction are correct selection of the insertion height in relation to the planned operation, constantly available medical pain service, the inclusion of trained care personnel and unequivocal written instructions.