Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 2004
Review[Regional anaesthesia versus general anaesthesia--pathophysiology and clinical implications].
Regional anaesthesia is well established in modern clinical practice. It provides a safe and reliable alternative to general anaesthesia, but is also of high clinical value in combination procedures. Our knowledge of perioperative pathophysiological characteristics increasingly indicates that regional blocks lead to excellent analgesia und profoundly modulate the postoperative stress response and thus, they can have therapeutic influence on postoperative convalescence, on the functional operation result and on the avoidance of frequent postoperative complications. ⋯ Optimised physiotherapy after total knee arthroplasty or improvements in pulmonary and gastrointestinal function demonstrate the capabilities of regional anaesthesia to facilitate postoperative rehabilitation. With regard to an improved organ function and a possibly shorter hospital stay, regional techniques appear cost-effective. It is important that regional anaesthesia is carried out on the basis of a clear individual indication, which considers the entire perioperative treatment process.
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As a basis for quality assurance measures, we analysed over a period of three years all iatrogenic tracheobronchial injuries that had to be repaired operatively at a university hospital. Twelve patients were affected. In most of these cases, the injuries were the result of an intubation during resuscitation attempts prior to or after admission to hospital (6 patients; 4 of them died later). ⋯ No such serious tracheal injuries were observed. The cause of death in the patients with tracheal injuries was mainly the underlying disease (resuscitation after myocardial infarction; tracheostomy because of pulmonary failure in septic disorders); however, it is likely that the injuries or the surgical intervention played an additional role in the negative outcome of the patients. The conclusion is that this complication rate must be reduced by in-service training and alteration of the procedures.
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Anaesthesiol Reanim · Jan 2004
Review[What is anaesthesiology worth in the German DRGs?--First experience with German DRGs].
This overview reports on first experience with German DRGs version 1.0 from 2003, with special regard to relevant procedures and diagnoses of anaesthesiology. Basically, the G-DRGs are a translation of the AR-DRGs 4.1. Only the 2004 version represents a first "real" German DRG system. ⋯ The correct documentation and transfer of ASA classifications is necessary for additional charges in external quality management and to avoid financial sanctions. In our experience, regarding operated patients, anaesthetists can contribute a lot to enquiries by health insurance companies, e.g. whether the payment code for an in- or an out-patient should be used. Departments of anaesthesia should appoint an anaesthetist as DRG representative to supervise anaesthesiological coding and DRG-relevant procedures.
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Cricoid pressure is a simple and effective measure to prevent regurgitation of gastric juice and content. This procedure, which prevents a possible reflux by compression of the oesophagus between the cricoid cartilage and the cervical vertebral bodies, is generally acknowledged in clinical practice, although there is lack of scientific evidence regarding its effect on the outcome of patients at risk of aspiration. ⋯ However, there is a lot of evidence in the literature that the knowledge of anaesthetists about the method and technique of cricoid pressure is rather unsatisfactory. Thus, the starting point for improving the efficiency and safety of cricoid pressure seems to be better teaching and training.
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Anaesthesiol Reanim · Jan 2004
Review[Implantable drug pumps for spinal opioid analgesia: technical solutions and problems].
Among the many technical appliances for pain therapy which are currently available, the use of implantable drug pumps for prolonged pain treatment is of increasing importance. Since this kind of pain therapy can be used without any problems outside the hospital, it improves the quality of life of the patient. Furthermore, it is combined with a reduction of side-effects which frequently occur when analgesics are given orally or parenterally in big single doses. ⋯ As with cardiac pacemakers, battery exchange is necessary. Using implantable drug pumps, relevant changes of body temperature and atmospheric pressure lead to more or less considerable deviations of the infusion rates. These deviations differ from product to product and can be studied in the informative material published by the manufacturer.