Medicine - Hospital Clinics: Treatment Concepts at the Clinic for Anaesthesiology and Intensive Medicine, Pain Therapy

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Schön Klinik Vogtareuth

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Anaesthesiology. Intensive Medicine. Pain Therapy. Our Treatment Concepts

Anaesthesia

Modern anaesthesia makes it possible to perform surgeries and other invasive procedures in a safe and painless manner, either with a temporary nerve blockade in a specific area of the body (local anaesthesia) or by completely blocking out consciousness for the duration of the surgery (general anaesthesia). The two forms of anaesthesia are also frequently used in combination. Which form is used in each individual case will depend firstly on the nature and extent of the planned surgical procedure and secondly on factors specific to each individual patient (e.g. prior illnesses, medications taken). Each year, anaesthetic procedures are performed about 8000 times at the Schön Klinik Vogtareuth, with a third of these consisting of a combination of general and local anaesthesia.

Preparing for anaesthesia

In our anaesthesia consulting hours or on the ward, the anaesthesiologist will speak to the patient in advance. Based on specific questions, a physical examination and findings brought in by the patient, the anaesthesiologist will assess the risks associated with anaesthesia for each individual patient, determine the type of anaesthesia to be used in conjunction with the patient and explain the selected procedure in detail. If necessary, additional assessments or treatments still required before the actual surgery will be initiated.

General anaesthesia

General anaesthesia blocks pain, perception, consciousness, memory and reactions to stressful perioperative stimulations. It achieves this effect with a combination of several drugs that have different pharmacodynamic profiles (i.e. that have different types of effects on the body). These drugs are either injected intravenously or absorbed via the respiratory tract. Once the patient has gone to sleep, the anaesthesiologist places a mask in the throat on the larynx (a laryngeal mask) or a breathing tube between the vocal cords (intubation) to provide air and permit the patient to inhale anaesthetic gases. These are removed before the patient wakes up again.

Regional anaesthesia (local anaesthesia)

Local anaesthesia of nerves ensures the elimination of pain directly at the site of the surgery. By infusing a local anaesthetic into a pain catheter placed in the immediate vicinity of the nerve, pain can be blocked not only during surgery but also in the first few days thereafter. This promotes more rapid, pain-free mobility and recovery. An acute pain service run by specially trained anaesthetists around the clock provides patients with pain catheter procedures after surgeries on our wards. With over 2500 pain catheters per year, the Clinic for Anaesthesiology at the Schön Klinik Vogtareuth is among the leading institutions in Germany. The experience gained as a result of this work and the constant development of our pain catheter procedures provide a new dimension in terms of safety and the elimination of pain during and after surgery.

Preoperative autologous blood donation

In order to reduce the need for homologous blood transfusions (transfusions of blood from other people), we offer autologous blood donation (the donation of blood by patients themselves) before surgeries scheduled well in advance that may involve significant blood loss (such as hip replacements). During the surgery itself, blood from wounds will also be specially processed and transfused back into the patient. Our Outpatient Blood Donation Department has experience from more than 30,000 autologous blood donations. Patient's are registered for this through the Anaesthesia Consulting Hours.

Perioperative Monitoring

To ensure the highest possible levels of patient safety, the Schön Klinik Vogtareuth has state of the art technologies available to monitor patients before and after surgery.

The Philips IntelliVue®-System (48 beds) enables seamless patient monitoring (ECG, pulse oximetry, non-invasive/invasive blood pressure, central venous pressure, pulmonary artery pressure, cardiac output, wedge pressure, PICCO, temperature, EEG and ICP) from admission to the trauma room or anaesthetic room, through surgery, in the post-anaesthesia room and recovery room/intermediate care/ICU, right up to telemetry on the regular cardiac surgery ward. In this process, the data for each individual patient is gathered from the various areas in a single computer and can be viewed or evaluated at any time.
Transoesophageal echocardiography (TOE: Vivid I®) is used for the haemodynamic monitoring of cardiac surgery patients and to rule out any atrial septal defect with the patient in a seated position for neurosurgical procedures.
Monitoring oxygen saturation in the brain (Invos® Cerebral Oximeter) makes it possible to identify problems with blood flow in the brain quickly and to measure changes in flows within the brain (bispectral analysis = BIS), an indicator of how deep the anaesthesia is.
Relaxometry (TOF Watch®) ensures complete recovery from the neuromuscular blockades that are an element of every case of endotracheal anaesthesia.
The operating theatre has a blood gas analysis device to provide intraoperative monitoring of respiration and haemoglobin concentration, as well as acid-base and electrolyte balance. ACT and ROTEM® analysis are used to monitor blood clotting at the patient's bedside.
Fiber optic bronchoscopies are used for diagnostic and interventional examination of the airways during and after surgery and in patients with more complex anatomical conditions, to enable safe access to the upper airways (intubation).