Paracetamol für die perioperative Analgesie

Since paracetamol was first synthesized in 1878 it has become one of the most popular and widely used drugs for the first-line treatment of fever and pain. The reasons for this popularity are a wide variety of formulations, an assumed positive safety record and the wide availability as an over-the-counter drug. However, recently several studies questioned the positive risk-benefit ratio of paracetamol for postoperative pain by observing several possible adverse effects and limitations. The aim of the present review is to give an update of the recent literature on the efficacy of paracetamol for postoperative pain and on the value of the clinical relevance of different adverse effects of paracetamol. Finally, based on the current findings the authors try to assess the role of paracetamol for the treatment of postoperative pain.     

Propofoleinsatz für Hals-Nasen-Ohren-Eingriffe im Kindesalter

BACKGROUND: The aim of this study was an improvement in patient comfort, reduction of anaesthesia costs and room contamination by the use of propofol for adenoidectomy. METHODS: A total of 103 infants (aged 1-5 years) undergoing elective adenoidectomy were randomized for anaesthesia with sevoflurane-nitrous oxide/oxygen (group 1), sevoflurane-air/alfentanil (group 2), alfentanil-propofol under induction with sevoflurane (group 3) or alfentanil-propofol (group 4). RESULTS: Using propofol, postoperative agitation and emesis were significantly less and the anaesthesia costs as well as the need for analgesics was reduced compared to inhalative anaesthesia. CONCLUSIONS: The use of propofol for preschool children undergoing ear, nose and throat (ENT) surgery seems to be advantageous because of less postoperative agitation, emesis and costs.     

Zeitfaktoren für den Ileus im Kindesalter

Ohne ZusammenfassungMit 2 Abbildungen     

Hilfsmittel für die Dosierung von Notfallmedikamenten im Kindesalter

Life-threatening pediatric emergencies are rare events in which precise, correct and fast drug dosing is essential. Intravenous drugs are most commonly dosed based on the child??s weight in mg/kg. Numerous tools exist for aiding the physician in the error prone calculation, none of which meet all criteria for the perfect tool. Besides frequent training of practical skills and awareness of the problem of calculating the exact drug dose, it seems indispensable to have a localized tool at hand for these critical events.     

Tracheotomie und Trachealkanülen im Kindesalter

Introduction

Emergencies in tracheotomized children is rare, so is the individual experience of emergency staff. The article gives information about routine care of such patients with hints how to avoid problems.

Problems and management

Tracheotomy can be a life-saving or life-sustaining intervention but in contrast there is a risk of life-threatening complications and a burden of secondary complications. The treatment of children by tracheotomy should be standardized and follow current guidelines as well as personal experience but training is absolutely necessary. Emergencies result in particular from blocked airways and deterioration of respiratory insufficiency.

Conclusion

Practicing on dummies and regular education in intensive care units provide safety in treating tracheotomized children.     

Aktueller Stellenwert der Laparoskopie für die Nierentransplantation

Laparoscopic techniques have not only become increasingly more important for patients on dialysis or after kidney transplantation, they also represent the operative standard procedures as almost all patients additionally suffer from concomitant diseases and do carry a higher operative risk. Therefore, these patients will derive special benefits from minimally invasive procedures offering lower morbidity and quick recovery. In centers with expertise in minimally invasive procedures, laparoscopic donor nephrectomy has already replaced open live donor nephrectomy as the standard procedure.     

Beitrag zur Kenntnis der Geschwürsbildungen des Magen und Duodenum im Kindesalter

Ohne Zusammenfassung (Mit 2 Abbildungen.)     

Hintergrund und aktueller Einsatz von Adjuvanzien für die Regionalanästhesie

Die Anaesthesiologie - Die Entdeckung der lokalanästhetischen Wirkung durch Blockade der Natriumionenkanäle war ein Meilenstein in der Anästhesie, die jedoch schon bald ihre...     

Institut für Qualitätssicherung und Transparenz im Gesundheitswesen

The Institute for Quality Assurance and Transparency in the Healthcare System (IQTIG) was founded in 2015 and since 1 January 2016 has undertaken its responsibilities as the central institute for external quality assurance (QA) under the auspices of the Federal Joint Committee (G-BA). As commissioned by the G?BA new concepts and instruments for external QA were developed also cross-sectorally and continues to carry out the existing QA procedures. Due to the Hospital Structure Act (KHSG), which came into force in the beginning of 2016, a quality orientation of the German healthcare system was promoted by the legislation. Now and in the future the IQTIG will take on a particularly important role in the development of a quality-oriented hospital planning and remuneration as well as for quality contracts for the G?BA. The performance fields of cardiac, thoracic and vascular surgery will probably be affected by the innovations earlier than other disciplines     

Einsatz von mesenchymalen Knochenmarkstammzellen für die Ex-vivo-Knorpelregeneration

Articular cartilage disorders and injuries often result in lifelong chronic pain and compromised quality of life. When it comes to local articular cartilage defects, modern medicine is limited to short-term pain relief and inflammation control. In extreme cases the affected tissue is surgically removed and replaced by a synthetic prosthesis of limited durability. Cell-based therapies to regenerate articular cartilage have been in use since 1994. Such therapies provide a healthy population of cells to the injured site and require differentiated chondrocytes from the uninjured site as base material. Their usage often leads to donor site morbidity and they generate rigid fibrous cartilage where more flexible hyaline cartilage is required. The major restrictive factors for such methods are inadequate number and limited proliferation capacity of chondrocytes in vitro. Tissue engineering of adult marrow stromal cells/mesenchymal stem cells (MSCs) with their almost unlimited proliferation potential and proven capability to differentiate into chondrocytes for ex vivo generation of cartilage tissue still remains a vision. For optimal harnessing of MSCs as chondroprogenitor cells, basic background information regarding commitment to the lineage, cartilage differentiation and the regulatory factors and molecules involved is essential.     

Klinische und experimentelle Untersuchungen zur Frage der Blut-Gelenk-Schranke für Antibiotica

Ohne Zusammenfassung Mit 5 Abbildungen     

Anleitung zur erfolgreichen Medienarbeit für Krankenhäuser und Rettungsdienste

Tragic accidents, e.g. involving celebrity patients or severe incidents in hospital occur suddenly without any advance warning, often produce substantial interest by the media and quickly overburden management personnel involved in both hospitals and emergency medical services. While doctors, hospitals and emergency medical services desire objective media reports, the media promote emotionalized and dramatized reports to ensure maximum attention and circulation. When briefing the media, the scales may quickly tilt from professional, well-deliberated information to unfortunate, often unintended disinformation. Such phenomena may result in continuing exaggerated reports in the tabloid press, which in the presence of aggressive lawyers and a competitive hospital environment can turn into image and legal problems. In this article, several aspects are discussed in order to achieve successful public relations. Interviews should be given only after consultation with the responsible press officer and the director of the respective department or hospital director. Requests for information by the media should always be answered as otherwise one-sided, unintentional publications can result that are extremely difficult to correct later. One should be available to be contacted easily by journalists, regular press conferences should be held and critics should be taken seriously and not be brushed off. Questions by journalists should be answered in a timely manner as journalists are continuously under time pressure and do not understand unnecessary delays. Information for the media should always be provided at the same time, no publication should be given preference and an absolutely current list of E-mail contacts is required. When facing big events a press conference is preferred as many questions can be answered at once. Always be well prepared for an interview or even for just a statement. Each interview should be regarded as an opportunity to put a story forward which you wanted to do for a long time and your message should not contain more than three main points. Each hospital or emergency medical service should have a professional department for public relations, an exact knowledge of the regional and national media and strategies how to handle an incident that is of interest for the media. The media should be provided with information not only when a negative incident has happened but should be provided with regular positive messages as well. An interview must be carefully prepared to achieve a good image.     

Aktueller Stand zur Diagnostik und nichtoperativen Therapie des Dünndarmileus

Zusammenfassung. Durch die Stase im Dünndarm kommt es zu einer Zunahme der faeculenten Flora im Dünndarm, die über eine Mediatorfreisetzung zum Vollbild der Ileuskrankheit führt. Die Therapie mu? dementsprechend zum Ziel haben, die Stase zu beseitigen. Bei mechanischen Ileussituationen ist die Heilung nur durch Operation m?glich, w?hrend funktionelle Darmverschlüsse oft konservativ zu beherrschen sind: Nach der Entlastung des Dünndarms durch Magensonde oder Dennissonde kann medikament?s eine Peristaltikinduktion versucht werden, obwohl der wissenschaftliche Nachweis der Wirksamkeit noch aussteht. Diagnostisch stellt nach sorgf?ltiger klinischer Untersuchung und Anamneseerhebung die Abdomenleeraufnahme die Basisuntersuchung dar. Zur Abkl?rung der zugrunde liegenden Ursache des funktionellen Ileus k?nnen die orale Kontrastmittelgabe, die Sonographie, die CT sowie eine Endoskopie zus?tzliche Informationen liefern.      

Simulationstraining für das Team im Rettungsdienst

Background

Simulator based training is extensively used in many non-medical high-risk industries. Critical scenarios and standard situations can be trained in complete safety.

Results and objectives

Situations which are regularly met in the field by the emergency team can be simulated. Careful planning and preparation of realistic scenarios is vital to ensure acceptance by the participants and a high rate of transfer of skills to the daily working environment. Only training which is carried out by all emergency medical personnel in the region can achieve a high level of effectiveness. The instructors of the simulation team at the Saint Josef Hospital in Freiburg developed a 1?day seminar with practical as well as theoretical contents. This was implemented over 1 year for more than 100 paramedics in the region. The concept focused on short lectures and intensive debriefings following scenarios in which the participants developed strategies for crew resource management, non technical skills and learned to put it into practice. The organizers wanted to demonstrate the practicability of a regionwide education concept in simulation and team training for the emergency medical service.

Conclusions

With the help of the carefully developed course concept an impressive training course was offered. The participants, when questioned directly after the course, were satisfied with the training and the results. In a further evaluation after some months the success and aftereffects of the project were confirmed.