very year, an estimated 8000 severe fractures of the thoracic and the lumbar spine occur in Germany (1). In more than two-thirds of these cases, the thoracolumbar junction, i.e. the thoracic vertebral bodies T11/T12 or the lumbar vertebral bodies L1/L2 are affected (2). For the classification of the various types of fracture, the AOSpine classification of the AO Foundation (Arbeitsgemeinschaft Osteosynthese) has become the established standard (3). It differentiates between compression fractures (Type A), flexion-distraction fractures (Type B), and the highly unstable displaced fractures (Type C) (Table 1). Complete paraplegia was observed in 2% and incomplete neurological deficits in 11% of patients with type-A fractures (2). The indications for conservative and surgical management remain the subject of international controversy (4, 5). Box 1 provides a summary of the treatment recommendations of the Spine Working Group of the German Society for Orthopedics and Trauma (DGOU, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie) (4). Overall, a conservative treatment strategy can be applied in many cases with promising long-term outcomes (6, 7). However, the type of conservative treatment is usually poorly defined. This applies to both the intensity and type of the therapeutic measures and the timing of the clinical and radiographic follow-ups (5, 8). The aim of this review, which was initiated by the committee for conservative spine treatment of the German Spine Society (DWG, Deutsche Wirbelsäulengesellschaft), is to systematically screen the literature for content related to conservative management. From this, the current state of evidence shall be described for a standardized conservative treatment of traumatic vertebral fractures of the thoracic and lumbar spine. Based on these results, prospective studies could be created to increase the evidence in this field and to produce data that can be used to further scientifically support the therapeutic strategy. Materials and methods The literature search included recent vertebral fractures (<4 weeks) of the thoracic and lumbar spine of adults with adequate trauma history and without neurological deficits. Children and adolescents (age <18 years) and Summary Background: The conservative treatment of traumatic thoracolumbar vertebral fractures is often not clearly defined. Methods: This review is based on articles retrieved by a systematic search in the PubMed and Web of Science databases for publications up to February 2018 dealing with the conservative treatment of traumatic thoracolumbar vertebral fractures. The search initially yielded 3345 hits, of which 35 were suitable for use in this review. Results: It can be concluded from the available original clinical research on the subject, including three randomized controlled trials (RCTs), that the primary diagnostic evaluation should be with plain x-rays, in the standing position if possible. If a fracture is suspected on the plain films, computed tomography (CT) is indicated. Magnetic resonance imaging (MRI) ...

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There is lack of studies investigating procedures aiming at a decrease in perioperative mortality in patients with obstructive sleep apnoea (OSA). During anesthetic evaluation, identification of patients with OSA as well as using a risk score has been recommended by the American Society of Anesthesiology in order to identify the best perioperative strategy. Perioperative attention should be focused on a secure airway and the duration of monitoring that is necessary regarding severity of OSA, surgical stress and respiratory function. Postoperatively, residual neuromuscular blockade and a supine position have to be avoided. Continuous pulse oximetry should be used as long as patients remain at increased risk and should be applied until oxygen saturation remains above 90% with room air during sleep. Opioids should be excluded for pain management whenever possible, and CPAP or NIPPV should be administered as soon as feasible after surgery to patients who have been receiving it preoperatively.

Propofol caused a decrease in arterial pressure as well as autonomic HR modulation, but xenon did not. The higher arterial pressure with xenon anaesthesia may be explained by less suppression of sympatho-vagal balance.

BackgroundThe acronym LASA (look-alike sound-alike) denotes the problem of confusing similar- looking and/or sounding drugs accidentally. The most common causes of medication error jeopardizing patient safety are LASA as well as high workload.Case presentationA critical incident report of medication errors of opioids for postoperative analgesia by look-alike packaging highlights the LASA aspects in everyday scenarios. A change to a generic brand of medication saved costs of up to 16% per annum. Consequently, confusion of medication incidents occurred due to the similar appearance of the newly introduced generic opioid. Due to consecutive underdosing no life-threatening situation arose out of this LASA based medication error.ConclusionsCurrent recommendations for the prevention of LASA are quite extensive; still, in a system with a lump sum payment per case not all of these security measures may be feasible. This issue remains to be approached on an individual basis, taking into consideration local set ups as well as financial issues.Electronic supplementary materialThe online version of this article (doi:10.1186/s13037-014-0047-0) contains supplementary material, which is available to authorized users.