Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 2002
Review[Etiology and sequelae of perioperative accidental hypothermia].
Accidental hypothermia is a frequent event during the perioperative period. Recent studies revealed a drop in core temperature of over 2 degrees C in more than 50% of all patients undergoing an operation. This drop in core temperature seems to be primarily due to the following factors. ⋯ On the other hand, there is accumulating evidence that accidental perioperative hypothermia may also adversely affect organ function and outcome. For example, unfavourable effects of perioperative hypothermia on the immune defence, on the function of the coagulation system, on cardiovascular performance, as well as on postoperative recovery have been reported. Consequently, measures should be taken to actively control the perioperative heat balance of patients.
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Anaesthesiol Reanim · Jan 2002
Case Reports[Critical infusion incident caused by incorrect use of a patient-controlled analgesia pump].
We report on the case of a 17-year-old male patient who received a PCA pump after nephrectomy for postoperative analgesia. The syringe of the PCA pump was filled with 50 mg morphine and positioned about 25 cm above the heart. Since the piston of the syringe was not bolted while the pump was switched off, an unnoticed accidental evacuation of the whole content of the syringe into the intravenous line of the patient occurred because of gravity. ⋯ This critical incident was caused by various factors: incorrect application in combination with insufficient experience or training, stress, inadequate handing-over of the patient and a lack of arrangements and instructions for procedures in routine situations. Suggestions for preventing such dangerous critical incidents are made and discussed. In particular, an algorithm for the correct procedure when inserting or changing the syringe of a syringe pump is presented.
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Anaesthesiol Reanim · Jan 2002
[Evaluation of emergency medicine knowledge and procedures after finishing the course "resuscitation specialty"].
Emergency medical services are an indispensable part of out-patient medical care. For this purpose, special qualifications are necessary and these are taught within the framework of a course entitled "Certificate for Emergency Medical Services". These courses are organized either as a block course, that is a one-week course, or as weekend courses in progression. ⋯ Accuracy regarding the volume requirements in the case of large-scale burns, as well as choosing the quantity (16.7% compared with 7.4%) and the correct solution (47.9% compared with 40.7%) was unsatisfactory. For these reasons, we strongly recommend intensifying training in block courses for the future qualification of doctors in emergency services. It would also be useful to conduct an oral exam at the end of the entire course, which could also entitle candidates to use this professional designation as one of their qualifications.
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Anaesthesiol Reanim · Jan 2002
Case Reports[Accidental hypothermia--a challenge for rescue service and intensive care].
Accidental hypothermia is a rare clinical picture with different causes. Specific features are shown by patients who have accidents in water, due to rapid cooling. The SARRRAH project (Search and Rescue, Resuscitation and Rewarming in Accidental Hypothermia) was launched to secure fast and professional medical care right up to rewarming by extracorporal circulation. ⋯ Five of the non-survivors belonged to the group of eight patients who were rewarmed by extracorporal circulation. With one exception, they also had the lowest core temperatures. Only a homogeneous and up-to-date documentation will allow further conclusions to be made for improving the concept of therapy.
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Several elements of the "open lung concept", like ventilation with small tidal volumes, were incorporated into various ventilatory strategies. Our study demonstrates how the whole concept can be applied in an animal model using a standardized protocol with the following possible results. Eighteen pigs weighing between 30 and 45 kg were anaesthetized, tracheotomized and ventilated. ⋯ Despite a short arterial systolic blood pressure drop of 23 +/- 11 mmHg during recruitment, no significant difference was detectable afterwards compared to the baseline. Using low tidal volumes alone, complete reopening was not achieved in an experimentally induced acute lung injury. After recruitment manoeuvres, it was possible to reopen the lung and keep it open by application of a sufficient PEEP.