Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 1-1
DOI: 10.1055/s-0042-101152
© Georg Thieme Verlag Stuttgart · New York
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Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 40-48
DOI: 10.1055/s-0041-101757
Organisatorische Voraussetzungen und die Aus- und Weiterbildung von Klinikmitarbeitern schaffen die Basis für eine adäquate Versorgungsqualität der Akutschmerztherapie und sollten im Fokus der Bemühungen stehen. Obwohl organisatorische Empfehlungen der S3- Leitlinie zur „Behandlung akuter perioperativer und posttraumatischer Schmerzen" in der vergangenen Jahren zunehmend etabliert wurden, besteht dennoch in vielen deutschen Krankenhäusern noch erheblicher Nachholbedarf in der Umsetzung allgemeiner Versorgungsvoraussetzungen, wie der regelmäßigen Schmerzmessung oder der Einführung von geeigneten Behandlungsstandards für alle Arbeitsbereiche des Krankenhauses. Als spezialisierte Versorgungsstrukturen sind zwar in 80% der Krankenhäuser Akutschmerzdienste implementiert, jedoch erfüllen nur 45% davon Qualitätskriterien. Aufgrund der sehr heterogenen Umsetzung der Akutschmerztherapie wird deutlich, dass es trotz allgemeiner Leitlinienempfehlungen verbindlicher Definitionen für die Struktur- und Qualitätskriterien bedarf.
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© Georg Thieme Verlag Stuttgart · New York
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After successful FDA approval, Hamilton Medical is launching the IntelliCuff® pressure controller in the US. Previously available as an option for the ventilator HAMILTON-G5, the innovative IntelliCuff technology has now been given its own housing. The ergonomic, hand held device is now available for use with all mechanical ventilators. The IntelliCuff® pressure controller continuously measures ...
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We examined the association between postnatal depression (PND), acculturation and mother–infant bond among 38 Eritrean asylum seekers in Israel, who were within 6 months of delivery. Participants completed a survey in their native language. A high rate of women (81.6 %) met the clinical threshold for PND on the Edinburgh Postnatal Depression Scale. Higher severity of PND (partial r = −.64, p < .001), higher identification with Israeli culture (partial r = −.45, p = .02), and lower quality of romantic relationship were associated with impaired mother–infant bond (partial r = .58, p = .002). Findings highlight the need to establish services to screen and treat PND among this vulnerable population in the receiving countries.
Few population-based studies have assessed awareness of hepatitis C virus (HCV) seropositivity and chronic infection. We report awareness of HCV seropositivity and chronic infection and correlates of awareness in a multi-city (Bronx, Miami, Chicago, and San Diego) community-dwelling population sample of United States (US) Hispanics/Latinos recruited during 2008–2011. Included were 260 HCV-seropositive participants, among whom 190 had chronic HCV. Among those with chronic HCV, 46 % had been told by a doctor that they had liver disease and 32 % had been told that they had HCV-related liver disease. Among those with chronic HCV who also lacked health insurance (37 % of those with chronic HCV), only 8 % had been told that they had HCV-related liver disease. As compared with the uninsured, those with insurance were over five times more likely to be aware of having HCV-related liver disease (44 %). Sex, age, education, city of residence, and birthplace were not associated with HCV awareness. Less than half of Hispanics/Latinos were aware of their HCV chronic infection. Lack of health insurance may be an important barrier to HCV awareness in this population.
Background
Ultrasound-guided internal jugular venous access increases the rate of successful cannulation and reduces the incidence of complications, compared with the landmark technique. Three transducer orientation approaches have been proposed for this procedure: short-axis (SAX), long-axis (LAX) and oblique-axis (OAX). Our goal was to assess and compare the performance of these approaches.
MethodsA prospective randomized clinical trial was conducted in one teaching hospital. Patients aged 18 yr or above, who were undergoing ultrasound-guided internal jugular cannulation, were randomly assigned to one of three intervention groups: SAX, LAX and OAX group. The main outcome measure was successful cannulation on first needle pass. Incidence of mechanical complications was also registered. Restricted randomization was computer-generated.
ResultsIn total, 220 patients were analysed (SAX n=73, LAX n=75, OAX n=72). Cannulation was successful on first needle pass in 51 (69.9%) SAX patients, 39 (52%) LAX patients and 53 (73.6%) OAX patients. First needle pass failure was higher in the LAX group than in the OAX group (adjusted OR 3.7, 95% CI 1.71–8.0, P=0.002). A higher mechanical complication rate was observed in the SAX group (15.1%) than in the OAX (6.9%) and LAX (4%) groups (P=0.047).
ConclusionsAs OAX showed a higher first needle pass success rate than LAX and a lower mechanical complications rate than SAX, we recommend it as the standard approach when performing ultrasound-guided internal jugular venous access. Further clinical studies are needed to confirm this conclusion.
Clinical trial registrationNCT 01966354
Background
Early postoperative negative behaviour in preschool children after general anaesthesia is a common problem. The distinction between emergence delirium (ED) and pain is difficult, but management differs between the two. The aim of the current analysis was to identify individual observational variables that can be used to diagnose ED and allow distinction from postoperative pain.
MethodsThis retrospective analysis of data from three previous prospective observational studies included children undergoing general anaesthesia for elective adeno-tonsillectomy, sub-umbilical surgery, and MRI scanning. Two trained observers simultaneously applied the Face, Legs, Activity, Cry, Consolability Scale; the Children's Hospital Eastern Ontario Pain Scale; the Children's and Infants' Postoperative Pain Scale or the Paediatric Anaesthesia Emergence Delirium (PAED) scale. Data from each domain of the scales were available at awakening and at five, 10, and 15 min after anaesthesia. Each patient was analysed over time, and subsequently, each evaluation was considered as a single event. The descriptive behaviour items overlapping in the assessed scales were identified as dichotomous variable ('true/false') and then were applied for each evaluation.
ResultsChildren (n=512) were assessed for a total of 2048 evaluations. Most children (69%) displayed at least one episode of ED and/or pain. Almost 15% of children demonstrated both ED and pain. Children with ED showed 'no eye contact' and 'no awareness of surroundings'. Children with pain displayed 'abnormal facial expression', 'crying', and 'inconsolability'.
Conclusions'No eye contact' and 'no awareness of surroundings' identifies ED. 'Abnormal facial expression', 'crying', and 'inconsolability' indicate acute pain in children in the early postoperative period.
