Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2001
ReviewThe anemic patient in the ICU: How much does the heart tolerate?
Anemia in the critical care setting is a common condition frequently resulting in the use of red cell transfusions. Of particular concern are those anemic, critically ill patients with ischemic heart disease. This critically ill population may be predisposed to the adverse consequences of anemia, by the very nature of their underlying cardiac disease. ⋯ Research to date has provided opposing views in terms of the optimal transfusion strategies for use in this "at risk" population. While observational studies have indicated that a liberal strategy is more beneficial, a recent RCT found that a strategy maintaining hemoglobin concentrations between 70 and 90 g/L may result in similar, if not better, outcomes. Further studies are needed, however, to clarify whether the results of this trial can be generalized to patients with cardiovascular disease.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2001
Review Comparative Study[Is measuring the depth of anesthesia sensible? An overview on the currently available monitoring systems].
Without any doubt there is an increasing need for accurately measuring depth of anesthesia - from the viewpoint of the anesthesiologist and also of the patient. The ideal monitoring should fulfill the following criteria: It should be applicable for any type of anesthesia (intravenous as well as inhalative anesthesia); the monitor must have an extremely high sensitivity (each patient being awake must be recognized by the device). If the monitor does not have a high sensitivity, the monitor itself might lead to an increasing number of patients being awake during anaesthesia, because the anesthesiologist might rely on the monitor and does not deepen anesthesia while the patient is awake. ⋯ They can only monitor the anesthetic state at the time of measurement. There is no "golden number" predicting absolutely safely that the patient is in adequate anesthesia. The anesthetist must consider any technique for monitoring of the depth of anesthesia as an additional help in improving care for his patient.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2001
[Cerebral monitoring in carotid surgery. Results of a questionnaire in the Federal Republic of Germany].
A standardized questionnaire was used to find out if and what kind of intraoperative cerebral monitoring method, respectively, is practised for carotid surgery in Germany. Out of 351 hospitals having received the questionnaire, 251 (75.1 %) answered the questions. 43 hospitals had not performed any carotid surgery in 1998, so 208 questionnaires remained for further analysis. In 43.3 % (n = 90), hospitals did not practise any kind of cerebral monitoring. ⋯ TCD and cerebral oximetry are less suitable for this purpose. Measuring carotid stump pressure is not recommendable to reflect the status of cerebral haemodynamics, however this method is still in frequent use. Recommendations whether to practise cerebral monitoring or not, and what method should be used for this purpose, cannot be given presently.