Absinthism: a fictitious 19th century syndrome with present impact

Absinthe, a bitter spirit containing wormwood (Artemisia absinthium L.), was banned at the beginning of the 20th century as consequence of its supposed unique adverse effects. After nearly century-long prohibition, absinthe has seen a resurgence after recent de-restriction in many European countries. This review provides information on the history of absinthe and one of its constituent, thujone. Medical and toxicological aspects experienced and discovered before the prohibition of absinthe are discussed in detail, along with their impact on the current situation. The only consistent conclusion that can be drawn from those 19th century studies about absinthism is that wormwood oil but not absinthe is a potent agent to cause seizures. Neither can it be concluded that the beverage itself was epileptogenic nor that the so-called absinthism can exactly be distinguished as a distinct syndrome from chronic alcoholism. The theory of a previous gross overestimation of the thujone content of absinthe may have been verified by a number of independent studies. Based on the current available evidence, thujone concentrations of both pre-ban and modern absinthes may not have been able to cause detrimental health effects other than those encountered in common alcoholism. Today, a questionable tendency of absinthe manufacturers can be ascertained that use the ancient theories of absinthism as a targeted marketing strategy to bring absinthe into the spheres of a legal drug-of-abuse. Misleading advertisements of aphrodisiac or psychotropic effects of absinthe try to re-establish absinthe's former reputation. In distinction from commercially manufactured absinthes with limited thujone content, a health risk to consumers is the uncontrolled trade of potentially unsafe herbal products such as absinthe essences that are readily available over the internet

Therapeutic Hypothermia after Peri-Interventional In-Hospital Cardiac Arrest

Background: Therapeutic hypothermia is recommended by international guidelines for patients after out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation. However, data for patients after in-hospital cardiac arrest (IHCA) are still scarce. Guidelines leave it to the attending physician to decide on the use of hypothermia in IHCA patients.Objective: To determine the use of therapeutic hypothermia in-hospital cardiac arrest.Design: Retrospective case series.Setting: University Hospital of colgne, intensive care units.Subjects: Seven patients admitted to the intensive care unit after peri-interventional IHCA between January and December 2009.Interventions: Therapeutic hypothermia was initiated in all patients with a median delay of five hours.Results: Four out of seven patients (57 %) survived cardiac arrest, but one of these later died due to her primary cause of hospitalisation. The other three patients were discharged without neurological sequelae. There were no serious adverse effects of therapeutic hypothermia.Conclusion: Therapeutic hypothermia after peri-interventional IHCA IHCA is safe and might benefit the patient. This treatment strategy should be taken into consideration until further data are available

Detonation of aerial bombs

Introduction. Even today aerial bombs and unexploded ordnance from World War II are still common. For deactivation many relevant factors must be noted by emergency medical service personnel. The aim of the present review is to summarize resulting problems and to assess organizational challenges for deactivation procedures of aerial bombs. Materials and methods. Detonations were analyzed only for Germany and Austria for the years 1990-2010. For the review an extensive Internet search on explosions and unexpected detonations was performed independently from deactivation procedures. Results. In the last years a total of 5 detonations during deactivation procedures were identified for Germany and Austria (in each case 0-4 killed and 0-6 injured persons). Additionally, 20 unexpected detonations independent from deactivation procedures (in each case 0-3 killed and 0-17 injured persons) were found. Discussion. During intended or performed deactivation of aerial bombs the emergency medical strategy, organizational assessment and coordination of the medical mission are the responsibility of the chief emergency physician. These missions are rare and therefore the personnel usually have very limited experience. The number of injured and killed persons may be considerable and represents a significant organizational challenge for the emergency physicians at the scene

Hypothermia after reanimation

The use of induced hypothermia is the only therapeutic method currently known to improve neurologic outcome and reduce mortality following cardiac arrest and return of spontaneous circulation. Therapeutic hypothermia can be implemented using various procedures. For the induction of preclinical therapeutic hypothermia in out-of-hospital cardiac arrest patients, surface cooling and infusion of + 4A degrees C ice-cold intravenous fluid have been successfully tested. The aim of the article is to provide an overview of the current standard of knowledge of preclinical therapeutic hypothermia and to provide practical guidance for the induction of therapeutic hypothermia

Incidence and risk factors of anaesthesia-related perioperative cardiac arrest: A 6-year observational study from a tertiary care university hospital

BACKGROUNDIn recent decades, the incidences of anaesthesia-related perioperative mortality and adverse outcomes have decreased drastically. However, to date, data on perioperative cardiac arrest and risk factors of perioperative cardiac arrest from European countries are scarce.OBJECTIVESTo determine the incidences of perioperative cardiac arrest and rates of anaesthesia-related and anaesthesia-contributory cardiac arrest. Identification of pre-existing risk factors leading to perioperative cardiac arrest.DESIGNRetrospective cohort study.SETTINGDepartment of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany.INTERVENTIONSPerioperative critical incident reports between 2007 and 2012 were screened, and reports on cardiac arrest within 24h postoperatively were identified. Cardiac arrests were classified as anaesthesia-related', anaesthesia-contributory' or anaesthesia-unrelated' by two reviewers independently. Univariate and multi-variate logistic regression analysis was used to identify risk factors associated with perioperative cardiac arrest.RESULTSAnalysis of 318 critical incidents from 169500 anaesthetics revealed 99 perioperative cardiac arrests. This is an overall incidence of perioperative cardiac arrest of 5.8/10000 anaesthetics [95% confidence interval (CI), 4.7 to 7.0]. The rate of anaesthesia-related cardiac arrest was 0.7/10000 (95% CI, 0.3 to 1.1), and the rate of anaesthesia-contributory cardiac arrest was 1.7/10000 (95% CI, 1.1 to 2.3). Most cardiac arrests related to anaesthesia were due to respiratory events. From the multi-variate analysis, American Society of Anesthesiologists physical status grade at least 3 [P=0.007, odds ratio (OR) 2.59 (95% CI, 1.29 to 5.19)], emergency surgery [P<0.001, OR 4.00 (95% CI, 2.15 to 7.54)] and pre-existing cardiomyopathy [P<0.001, OR 17.48 (95% CI, 6.18 to 51.51)] emerged as predictors of cardiac arrest.CONCLUSIONThese first available European data on perioperative cardiac arrest from a large unselected cohort indicate that the overall perioperative incidence of cardiac arrest at our institution was slightly lower than published in the literature, whereas rates of anaesthesia-related and anaesthesia-contributory cardiac arrest were comparable. Most cardiac arrests related to anaesthesia were due to respiratory events. American Society of Anesthesiologists physical status grade at least 3, emergency surgery and pre-existing cardiomyopathy appear to be relevant risk factors for cardiac arrest

Specific aspects of anesthesiological management of laser surgery in otorhinolaryngology

Transoral laser surgery has become a standard procedure in the treatment of benign and malignant neoplasms of the upper aerodigestive tract. As the laser cuts and coagulates simultaneously, intraoperative bleeding is reduced, thus improving visualization of the operative field. However, the specific risks for patients and personnel that are associated with this technique necessitate strict compliance with safety regulations and precautions. The safe anesthesiological and surgical management of such procedures requires explicit knowledge of the risks inherent to laser use, as well as close communication between surgeon and anesthesiologist throughout all operative and perioperative procedures. Although potentially fatal complications are rare, surgeon and anesthesiologist need to be aware of the dangers at all times and have exact knowledge of emergency measures. The use of suitable laser-resistant endotracheal tubes, total intravenous anesthesia and an optimized breathing gas mixture can contribute to minimize the occurrence of complications in otorhinolaryngology laser surgery