Vaskulärer Zugang in der Kindernotfallanästhesie

Zusammenfassung: Zum Thema des schwierigen intervenösen Zugangs bei pädiatrischen Notfallsituationen existieren erstaunlich wenige Angaben in der Literatur. "Wie machen es die Anderen?" war die Motivationsgrundlage für eine Umfrage bei in Kinderanästhesie erfahrenen Anästhesisten. Insgesamt 89Fragebögen wurden an die Leiter der Weiterbildungsstätten für Anästhesie in der Schweiz und an alle Mitglieder der Schweizerischen Gesellschaft für Kinderanästhesie verschickt. Anhand von 2Fallbeispielen (FallA: nicht nüchternes Kleinkind mit einer Radiusfraktur, FallB: Säugling mit hohem Ileus) wurde das weitere Vorgehen nach 2-3 erfolglosen peripheren Punktionsversuchen erfragt. Die Beantwortung ergab, dass die meisten der Befragten in beiden Situationen zunächst weitere periphere Venenpunktionen vornehmen werden. Falls diese Versuche erfolglos bleiben, wird beim Kleinkind mit der Radiusfraktur eine intramuskuläre oder inhalative Anästhesieeinleitung befürwortet. Bei dem Säugling mit Ileus wird versucht, für die Anästhesieeinleitung einen intraossären oder zentralvenösen Zugang (V.femoralis) zu legen. Aufgrund der Resultate der Umfrage und einer Literaturrecherche wird eine Prioritätenliste zu den wichtigsten vaskulären Zugängen und alternativen Anästhesieeinleitungsmethoden in der pädiatrischen Notfallsituation vorgeschlage

Kindersimulation heute und morgen: Perspektiven und Konzepte

Zusammenfassung: Die Konfrontation mit kritisch kranken Neugeborenen, Säuglingen und Kleinkindern ist selten und stellt ein Behandlungsteam vor besondere Herausforderungen. Für eine erfolgreiche Notfallbehandlung sind sichere technische und nichttechnische Fertigkeiten essenziell. Kindersimulatoren ermöglichen die Schaffung einer didaktischen Infrastruktur zur Vernetzung von Lehrbuchtheorie mit erfahrungsaktiver Praxis. Zur Erfassung des aktuellen Status der Kindersimulation in Deutschland, Österreich und der Schweiz wurde eine Onlinebefragung aller entsprechend aktiven Zentren durchgeführt. Derzeit wird Kindersimulation in 24Zentren betrieben. Diese verfügen über 39 pädiatrische Simulatoren: 8 für Neugeborene, 26 für Säuglinge und 5 für Kinder. Eine gewisse Kongruenz im Standard ist unter den Zentren feststellbar. Die meisten Instruktoren verfügen über eine spezialisierte Instruktorenausbildung. Von den Instruktoren sind 26% Pflegefachkräfte und 67% Ärzte, davon haben Pädiater und Anästhesisten den größten Anteil. Viele Zentren (38%) funktionieren lediglich durch das spezielle Engagement ihrer Mitarbeiter, die diverse Aktivitäten in ihrer Freizeit organisieren. Videogestützte Nachbesprechungen gelten als Grundlage für ein effektives Training. Einen besonderen inhaltlichen Schwerpunkt legen fast alle Zentren (92%) auf die Vermittlung von nichttechnischen Fertigkeiten (interpersonelle Aspekte des Zwischenfallmanagements). Im Rahmen des kürzlich etablierten PaedSim-Projekts sollen die Curricula von Kindersimulationskursen noch klarer strukturiert sowie international standardisiert werden, um dadurch Trainingseffektivität und -nachhaltigkeit zu erhöhe

[Paediatric simulation today and tomorrow. Perspectives and concepts]

The confrontation with critically ill newborns, infants and small children is rare and poses a particular challenge for the medical team. Confident technical and non-technical skills are essential for successful emergency treatment. Paediatric simulators facilitate a didactic infrastructure, linking textbook theory with experience-based practice. To summarize the current status of paediatric simulation in Germany, Austria and Switzerland an online survey of all associated centres was conducted. Paediatric simulation is currently available at 24 centres, which have 39 paediatric simulators available, including 8 for newborns, 26 for infants and 5 for children. A certain congruence of standards is detectable among these centres and most instructors have completed a specialized instructor training. Of the instructors 26% are specialized nursing personnel and 67% are physicians of which most are paediatricians and anaesthesiologists. Many centres (38%) operate solely by means of the enthusiastic dedication of the employees who organize various activities during their free time. Nearly all centres (92%) place particular emphasis on non-technical skills which include the interpersonal aspects of crisis resource management. Video-supported debriefing is considered to be the basis for effective training. Within the scope of the recently established PaedSim project the curricula of paediatric simulation courses should be more structured and internationally standardized, thereby increasing both efficacy and sustainability of these training programs

Environmental exposure assessment in European birth cohorts: results from the ENRIECO project

Environmental exposures during pregnancy and early life may have adverse health effects. Single birth cohort studies often lack statistical power to tease out such effects reliably. To improve the use of existing data and to facilitate collaboration among these studies, an inventory of the environmental exposure and health data in these studies was made as part of the ENRIECO (Environmental Health Risks in European Birth Cohorts) project. The focus with regard to exposure was on outdoor air pollution, water contamination, allergens and biological organisms, metals, pesticides, smoking and second hand tobacco smoke (SHS), persistent organic pollutants (POPs), noise, radiation, and occupational exposures. The review lists methods and data on environmental exposures in 37 European birth cohort studies. Most data is currently available for smoking and SHS (N=37 cohorts), occupational exposures (N=33), outdoor air pollution, and allergens and microbial agents (N=27). Exposure modeling is increasingly used for long-term air pollution exposure assessment; biomonitoring is used for assessment of exposure to metals, POPs and other chemicals; and environmental monitoring for house dust mite exposure assessment. Collaborative analyses with data from several birth cohorts have already been performed successfully for outdoor air pollution, water contamination, allergens, biological contaminants, molds, POPs and SHS. Key success factors for collaborative analyses are common definitions of main exposure and health variables. Our review emphasizes that such common definitions need ideally be arrived at in the study design phase. However, careful comparison of methods used in existing studies also offers excellent opportunities for collaborative analyses. Investigators can use this review to evaluate the potential for future collaborative analyses with respect to data availability and methods used in the different cohorts and to identify potential partners for a specific research question.This work was supported by ENRIECO (Environmental Health Risks in European Birth Cohorts), a project conducted within the European Union's 7th Framework Programme (Theme 6, Environment (Including Climate Change)) [Grant agreement number: 226285

Cocaine inhibits dopamine D2 receptor signaling via sigma-1-D2 receptor heteromers

Under normal conditions the brain maintains a delicate balance between inputs of reward seeking controlled by neurons containing the D1-like family of dopamine receptors and inputs of aversion coming from neurons containing the D2-like family of dopamine receptors. Cocaine is able to subvert these balanced inputs by altering the cell signaling of these two pathways such that D1 reward seeking pathway dominates. Here, we provide an explanation at the cellular and biochemical level how cocaine may achieve this. Exploring the effect of cocaine on dopamine D2 receptors function, we present evidence of σ1 receptor molecular and functional interaction with dopamine D2 receptors. Using biophysical, biochemical, and cell biology approaches, we discovered that D2 receptors (the long isoform of the D2 receptor) can complex with σ1 receptors, a result that is specific to D2 receptors, as D3 and D4 receptors did not form heteromers. We demonstrate that the σ1-D2 receptor heteromers consist of higher order oligomers, are found in mouse striatum and that cocaine, by binding to σ1 -D2 receptor heteromers, inhibits downstream signaling in both cultured cells and in mouse striatum. In contrast, in striatum from σ1 knockout animals these complexes are not found and this inhibition is not seen. Taken together, these data illuminate the mechanism by which the initial exposure to cocaine can inhibit signaling via D2 receptor containing neurons, destabilizing the delicate signaling balance influencing drug seeking that emanates from the D1 and D2 receptor containing neurons in the brain

Prone equals prone? Impact of positioning techniques on respiratory function in anesthetized and paralyzed healthy children

OBJECTIVES: Although the prone position is effectively used to improve oxygenation, its impact on functional residual capacity is controversial. Different techniques of body positioning might be an important confounding factor. The aim of this study was to determine the impact of two different prone positioning techniques on functional residual capacity and ventilation distribution in anesthetized, preschool-aged children. DESIGN: Functional residual capacity and lung clearance index, a measure of ventilation homogeneity, were calculated using a sulfur-hexafluoride multibreath washout technique. After intubation, measurements were taken in the supine position and, in random order, in the flat prone position and the augmented prone position (gel pads supporting the pelvis and the upper thorax). SETTING: Pediatric anesthesia unit of university hospital. PATIENTS AND PARTICIPANTS: Thirty preschool children without cardiopulmonary disease undergoing elective surgery. MEASUREMENTS AND RESULTS: Mean (range) age was 48.5 (24-80) months, weight 17.2 (10.5-26.9) kg, functional residual capacity (mean +/- SD) 22.9+/- 6.2 ml.kg (-1) in the supine position and 23.3 +/- 5.6 ml.kg (-1) in the flat prone position, while lung clearance indices were 8.1 +/- 2.3 vs. 7.9 +/- 2.3, respectively. In contrast, functional residual capacity increased to 27.6 +/- 6.5 ml.kg (-1) (p> 0.001) in the augmented prone position while at the same time the lung clearance index decreased to 6.7 +/- 0.9 (p> 0.001). CONCLUSIONS: Functional residual capacity and ventilation distribution were similar in the supine and flat prone positions, while these parameters improved significantly in the augmented prone position, suggesting that the technique of prone positioning has major implications for pulmonary function

Year in review in intensive care medicine, 2005. III. Nutrition, pediatric and neonatal critical care, and experimental

This review intends to summarize all articles published in Intensive Care Medicine in 2005, grouped by specific topics