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Bekanntermaßen hat der Begriff des Hybriden in den Kulturwissenschaften in den letzten drei Jahrzehnten eine beeindruckende Konjunktur erlebt. In Reaktion auf die virulenten Anforderungen der voranschreitenden Pluralisierung von Lebenswelten erschien die Öffnung und Verflüssigung vormals statischer Konzepte als geeignetes Mittel, unangemessenen, simplifizierenden Kategorisierungen entgegenzuwirken. Zwanzig Jahre nach dem Aufkommen des Bhabha'schen Hybriditätsverständnisses läuft der Begriff jedoch Gefahr, selbst zu einer mondial einsetzbaren Universalkategorie zu werden und birgt somit Risiken, die insbesondere in den postcolonial studies weiterhin zu diskutieren sein werden. Obwohl somit im folgenden Beitrag das kritische Bewusstsein ob generalisierender kulturtheoretischer Konzeptualisierungen mitschwingt, wird anhand des Verantwortlichkeitsdiskurses im Anthropozän eine Modellierung des Hybriden analysiert und als (unmittelbar kontextbedingtes) probates 'Behelfs- mittel' ausgewiesen. Das Gegenwirken der bipolaren Narrative und deren Einwirkungen auf ontologische Ebenen des menschlichen Subjektes im Anthropozän erfordert tragfähige Analyseinstrumente; die Denkfigur der Chimäre wird hierbei als ein Versuch fungieren, variable Vernetzungen von Subjekt(en) und 'Natur(en)', nivellierter als dies Hybriditätskonzepte leisten, zu analysieren. Der folgende Ansatz soll es erlauben, Plausibilitäten von Dichotomien infrage zu stellen und das menschliche Subjekt als 'Mischwesen' aus kantischer Vernunft und somatischer Determinante zu diskutieren.
Introduction Patients undergoing heart valve surgery are predominantly transferred postoperatively to the intensive care unit (ICU) under continuous sedation. Volatile anaesthetics are an increasingly used treatment alternative to intravenous substances in the ICU. As subject to inhalational uptake and elimination, the resulting pharmacological benefits have been repeatedly demonstrated. Therefore, volatile anaesthetics appear suitable to meet the growing demands of fast-track cardiac surgery. However, their use requires special preparation at the bedside and trained medical and nursing staff, which might limit the pharmacological benefits. The aim of our work is to assess whether the temporal advantages of recovery under volatile sedation outweigh the higher effort of special preparation.
Methods and analysis The study is designed to evaluate the differences between intravenous sedatives (n=48) and volatile sedatives (n=48) in continued intensive care sedation. This study will be conducted as a prospective, randomised, controlled, single-blinded, monocentre trial at a German university hospital in consenting adult patients undergoing heart valve surgery at a university hospital. This observational study will examine the necessary preparation time, staff consultation and overall feasibility of the chosen sedation method. For this purpose, the continuation of sedation in the ICU with volatile sedatives is considered as one study arm and with intravenous sedatives as the comparison group. Due to rapid elimination and quick awakening after the termination of sedation, closer consultation between the attending physician and the ICU nursing staff is required, in addition to a prolonged setup time. Study analysis will include the required setup time, time from admission to extubation as primary outcome and neurocognitive assessability. In addition, possible operation-specific (blood loss, complications), treatment parameters (catecholamine dosages, lung function) and laboratory results (acute kidney injury, acid base balance (lactataemia), liver failure) as influencing factors will be collected. The study-relevant data will be extracted from the continuous digital records of the patient data management system after the patient has been discharged from the ICU. For statistical evaluation, 95% CIs will be calculated for the median time to extubation and neurocognitive assessability, and the association will be assessed with a Cox regression model. In addition, secondary binary outcome measures will be evaluated using Fisher’s exact tests. Further descriptive and exploratory statistical analyses are also planned.
Ethics and dissemination The study was approved by the Institutional Ethics Board of the University of Frankfurt, Germany (#20-1050). Informed consent of all individual patients will be obtained before randomisation. Results will be disseminated via publication in peer-reviewed journals.
Estimating intraoperative blood loss is one of the daily challenges for clinicians. Despite the knowledge of the inaccuracy of visual estimation by anaesthetists and surgeons, this is still the mainstay to estimate surgical blood loss. This review aims at highlighting the strengths and weaknesses of currently used measurement methods. A systematic review of studies on estimation of blood loss was carried out. Studies were included investigating the accuracy of techniques for quantifying blood loss in vivo and in vitro. We excluded nonhuman trials and studies using only monitoring parameters to estimate blood loss. A meta-analysis was performed to evaluate systematic measurement errors of the different methods. Only studies that were compared with a validated reference e.g. Haemoglobin extraction assay were included. 90 studies met the inclusion criteria for systematic review and were analyzed. Six studies were included in the meta-analysis, as only these were conducted with a validated reference. The mixed effect meta-analysis showed the highest correlation to the reference for colorimetric methods (0.93 95% CI 0.91–0.96), followed by gravimetric (0.77 95% CI 0.61–0.93) and finally visual methods (0.61 95% CI 0.40–0.82). The bias for estimated blood loss (ml) was lowest for colorimetric methods (57.59 95% CI 23.88–91.3) compared to the reference, followed by gravimetric (326.36 95% CI 201.65–450.86) and visual methods (456.51 95% CI 395.19–517.83). Of the many studies included, only a few were compared with a validated reference. The majority of the studies chose known imprecise procedures as the method of comparison. Colorimetric methods offer the highest degree of accuracy in blood loss estimation. Systems that use colorimetric techniques have a significant advantage in the real-time assessment of blood loss.