Anaesthesiologie und Reanimation
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Over the last years, ambulatory anaesthesia has gained more significance within the realm of anaesthesiology in Germany. The German health care system aspires to improve the link between ambulatory and clinical health care. Also, the increasing percentage of older people has changed the demographics of society considerably. ⋯ It also reviews important structural and procedural requirements and recommendations for the implementation of ambulatory anaesthesia. Topics included are technical requirements, equipment, selection of patients, informed consent, fasting regulations, choice of anaesthetics and postoperative care. In order to accomplish a favourable outcome quality in ambulatory anaesthesia, professional judgement and implementation of the respective guidelines appear to be important rules of conduct.
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Anaesthesiol Reanim · Jan 2000
Review Comparative Study[Perioperative management with short-acting intravenous anesthetics].
Total intravenous anaesthesia (TIVA) with short-acting drugs is a standard procedure for day case surgery and is increasingly used for neurosurgical, cardiac surgical and paediatric surgical operations. The combination of propofol with alfentanil or remifentanil is frequently applied due to its favourable pharmacological properties. Propofol is characterized by a large volume of distribution at steady state and a relatively long elimination half time (t1/2 beta). ⋯ Adequate pain therapy is mandatory after total intravenous anaesthesia with short-acting drugs. Continuous infusion of remifentanil for postoperative analgesia or supplementation of regional anaesthesia requires careful monitoring of vital functions. The economic aspects of TIVA remain to be determined.
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Anaesthesiol Reanim · Jan 2000
Biography Historical Article[Paul Sudeck--his contribution to anesthesia].
Paul Sudeck is not generally recognised as a pioneer in anaesthesia, although he is well known for the atrophy of bone named after him. However, he not only championed the use of ether as a safe anaesthetic agent, described a method of ether analgesia for outpatient surgery and devised an inhaler for its administration, but also reintroduced nitrous oxide into Germany and invented possibly the first circle carbon dioxide absorption system with an optional attachment for continuous positive pressure respiration useful for the performance of thoracotomies.
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Anaesthesiol Reanim · Jan 2000
Randomized Controlled Trial Clinical Trial[Clonidine within the scope of balanced inhalation anesthesia with sevoflurane--effects on pEEG parameters].
The anaesthetic-saving property of clonidine has often been reported. In our own prospective, randomized study, in which the depth of anaesthesia was controlled by using spectral edge frequency (target-SEF90 = 10 Hz) and clinical parameters, we confirmed the anaesthetic-saving property only for fentanyl (-20%). On the other hand, there was no difference in MAC-sevoflurane values between the groups in keeping a steady target-SEF. ⋯ The described EEG effects on the power-spectrum inevitably influence SEF50 and SEF90. In our opinion, SEF50 is not a powerful predictor of depth of anaesthesia, when anaesthesia is performed in the way described. By performing this variation of balanced anaesthesia and co-medication with clonidine, higher values of SEF90 (11-14 Hz) seem to be adequate for surgical manipulation.
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Carbon monoxide (CO) is a product of incomplete burning of coals and carbon compounds and is a gas without any typical taste, colour or smell. Defective radiators or gas pipes, open fireplaces, fires and explosions are sources of unintended CO production and inhalation. CO bonds with haemoglobin much more readily than oxygen does. ⋯ Patients with neurological symptoms including loss of consciousness and expectant mothers should undergo HBO treatment, no matter how high their CO levels are. Neonates and in-utero fetuses are more vulnerable due to the natural leftward shift of the dissociation curve of fetal haemoglobin, a lower baseline pO2 and carboxyhaemoglobin levels at equilibration that are 10-15% higher than maternal levels. Physicians need to be aware of the potential occurrence of this life threatening hazard so that appropriate emergency treatment can be administered and fatalities prevented.