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Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 22-year-old patient underwent surgery for a glass wound incision of the hand and anesthesia was carried out using an axillary brachial plexus block with prilocaine. Following surgery the patient developed methemoglobinemia which was treated with tolonium chloride. After administration of the drug the sinus rhythm changed into ventricular fibrillation. The current treatment options of methemoglobinemia will be discussed. [ABSTRACT FROM AUTHOR]

Anamnesis: We saw a previously healthy 30-year-old Southeast-Asian sailor with progredient coughing and fever., Examination: We found an atypical pneumonia along with a positive HIV-test. We performed a bronchial lavage and further diagnostics for opportunistic infections. The lab work showed a viral load of 3340 000 copies/ml and a CD4-cell-count of 36/µl., Diagnosis: HIV late presenter in CDC stadium C3 with Pneumocystis jirovecii and CMV pneumonia., Therapy: We treated with Meropenem, Moxifloxacin, Cotrimoxazol, Ganciclovir and Genvoya., Clinical Course: Due to a cardio-pulmonal deterioration invasive ventilation was necessary. In the end the patient died of multi organ failure twelve days after admission despite intensive care, hemodialysis and prone positioning., Conclusion: This case demonstrates the difficulties in the pharmacotherapy and with drug interactions in a HIV late presenter with multi organ failure. Consultation and advice of the hospital pharmacy and the antibiotic stewardship team was vital for treating this patient. In the end cases like the portrayed should be treated in specialized clinics., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objectives: The purpose of this study was to determine if pain level was associated with demographic or surgery-specific characteristics among patients recovering from ambulatory surgery; and to assess the relationship between pain level and nausea over the 7-day postoperative period, controlling for demographic and surgery-related covariates., Materials and Methods: This longitudinal study assessed the pain and nausea of 248 eligible patients during the day of surgery (DOS) and the 7 days following ambulatory surgery. Postoperative data were assessed using standardized questions about severity of pain and nausea symptoms. Participants who had a cumulative pain score of ≥24 over the 8-day period were categorized as having high pain. Repeated-measures analysis of variance was used to assess differences in nausea by pain group over time, controlling for demographic, surgical variables, and antiemetic and analgesic use., Results: There were significant differences between 2 pain groups in age, surgical procedure, cumulative morphine equivalent dose, and use of antiemetics postdischarge. The longitudinal analysis demonstrated that patients in the high-pain group reported a greater degree of nausea on DOS and on each of the first 5 days postsurgery, controlling for differences in age, sex, education, use of antiemetics presurgery and postsurgery, use of acetaminophen postsurgery, daily morphine equivalent dose, and surgical procedure., Discussion: Younger patients and those receiving orthopedic procedures may be at greatest risk for postoperative pain. Patients with high pain reported a significantly greater degree of nausea on DOS through the first 5 days postdischarge. As the majority of surgeries are now conducted in the ambulatory setting, it is imperative that we determine pain management regimens and patient education practices that will allow for a more comfortable recovery for our patients.

Headache following dural puncture is a typical complication of neuraxial analgesia and can impair the ability to perform activities of daily living up to incapacitation. The use of thin, atraumatic needles and special puncture techniques (e.g. reinsertion of the stylet) can prevent the majority of post-dural puncture headaches (PDPH). One of the most effective measures to prevent headache after accidental dural puncture is the intrathecal or epidural administration of morphine. When the diagnosis of PDPH is confirmed after excluding relevant differential diagnoses, some of which are potentially life-threatening, caffeine, theophylline and non-opioid analgesics are effective agents to reduce the severity of the symptoms. Traditional measures, such as strict bed rest and hyperhydration can no longer be recommended. If invasive treatment of the headache is warranted an epidural blood patch is still the method of choice with a high rate of success.

Background: Two anaesthetic machines, the "Primus®" and the "Zeus®" (Draeger AG, Lübeck, Germany), were subjected to a cost analysis by evaluating the various expenses that go into using each machine., Methods: These expenses included the acquisition, maintenance, training and device-specific accessory costs. In addition, oxygen, medical air and volatile anaesthetic consumption were determined for each machine., Results: Anaesthesia duration was 278 ± 140 and 208 ± 112 minutes in the Primus® and the Zeus®, respectively. The purchase cost was €3.28 and €4.58 per hour of operation in the Primus® and the Zeus®, respectively. The maintenance cost was €0.90 and €1.20 per hour of operation in the Primus® and the Zeus®, respectively. We found that the O2 cost was €0.015 ± 0.013 and €0.056 ± 0.121 per hour of operation in the Primus® and the Zeus®, respectively. The medical air cost was €0.005 ± 0.003 and €0.016 ± 0.027 per hour of operation in the Primus® and the Zeus®, respectively. The volatile anaesthetic cost was €2.40 ± 2.40 and €4.80 ± 4.80 per hour of operation in the Primus® and the Zeus®, respectively., Conclusion: This study showed that the "Zeus®" generates a higher cost per hour of operation compared to the "Primus®".

A 22-year-old patient underwent surgery for a glass wound incision of the hand and anesthesia was carried out using an axillary brachial plexus block with prilocaine. Following surgery the patient developed methemoglobinemia which was treated with tolonium chloride. After administration of the drug the sinus rhythm changed into ventricular fibrillation. The current treatment options of methemoglobinemia will be discussed.

Objective: To systematically determine the most efficacious approach for preventing pain on injection of propofol., Design: Systematic review and meta-analysis., Data Sources: PubMed, Embase, Cochrane Library, www.clinicaltrials.gov, and hand searching from the reference lists of identified papers., Study Selection: Randomised controlled trials comparing drug and non-drug interventions with placebo or another intervention to alleviate pain on injection of propofol in adults., Results: Data were analysed from 177 randomised controlled trials totalling 25,260 adults. The overall risk of pain from propofol injection alone was about 60%. Using an antecubital vein instead of a hand vein was the most effective single intervention (relative risk 0.14, 95% confidence interval 0.07 to 0.30). Pretreatment using lidocaine (lignocaine) in conjunction with venous occlusion was similarly effective (0.29, 0.22 to 0.38). Other effective interventions were a lidocaine-propofol admixture (0.40, 0.33 to 0.48); pretreatment with lidocaine (0.47, 0.40 to 0.56), opioids (0.49, 0.41 to 0.59), ketamine (0.52, 0.46 to 0.57), or non-steroidal anti-inflammatory drugs (0.67, 0.49 to 0.91); and propofol emulsions containing medium and long chain triglycerides (0.75, 0.67 to 0.84). Statistical testing of indirect comparisons showed that use of the antecubital vein and pretreatment using lidocaine along with venous occlusion to be more efficacious than the other interventions., Conclusions: The two most efficacious interventions to reduce pain on injection of propofol were use of the antecubital vein, or pretreatment using lidocaine in conjunction with venous occlusion when the hand vein was chosen. Under the assumption of independent efficacy a third practical alternative could be pretreatment of the hand vein with lidocaine or ketamine and use of a propofol emulsion containing medium and long chain triglycerides. Although not the most effective intervention on its own, a small dose of opioids before induction halved the risk of pain from the injection and thus can generally be recommended unless contraindicated.

We present a case of severe accidental hypothermia (core temperature 22 degrees C) after a suicide attempt. The initial symptoms and the pre-hospital and hospital treatment are discussed. Additionally, different rewarming strategies for patients with severe accidental hypothermia are compared.

Remifentanil may be an alternative to conventional opioids for minimally invasive direct coronary artery bypass surgery because of its extremely short duration of action. The aim of this study was to investigate the effects of remifentanil on myocardial blood flow, metabolism and systemic haemodynamic variables in patients with coronary artery disease. After approval by the local ethics committee, 12 male patients were investigated before elective coronary artery bypass grafting. Systemic haemodynamic variables, myocardial blood flow and metabolism were measured when patients were awake and when they were anaesthetized with high-dose remifentanil (2.0 micrograms kg-1 min-1), or with remifentanil 0.5 microgram kg-1 min-1 combined with propofol (target-controlled infusion aiming at a plasma concentration of 2.0 micrograms ml-1). Myocardial blood flow was measured using a modified Kety-Schmidt technique. High-dose remifentanil anaesthesia significantly reduced cardiac index (CI) (-25%) as a consequence of a decrease in stroke volume index (SVI) (-14%) and heart rate (-13%). Mean arterial pressure (MAP) was 30% lower than that in the awake patient. Myocardial blood flow and myocardial oxygen uptake (MVO2) decreased by 30% and 42%, respectively. In contrast to high-dose remifentanil anaesthesia, systemic vascular resistance index (-14%) during remifentanil/propofol anaesthesia was significantly lower than that in the awake patient. Other haemodynamic variables, and myocardial blood flow and MVO2, did not significantly differ from the high-dose remifentanil period. In conclusion, high-dose remifentanil reduces SVI, heart rate, MAP, myocardial blood flow and MVO2 and its effects do not differ from those of remifentanil/propofol anaesthesia.