Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2001
Randomized Controlled Trial Clinical Trial[Sevoflurane augments the degree and speeds the onset of rocuronium evoked neuromuscular blockade in children].
In adults, sevoflurane augments the intensity of rocuronium evoked neuromuscular blockade. However, in children effective doses and onset of action of rocuronium have not been reported during sevoflurane anaesthesia. To test in children the hypothesis that sevoflurane speeds the onset and potentiates the degree of rocuronium induced neuromuscular blockade we studied 50 children aged 2 - 7 years following approval by the local ethics committee. ⋯ In young children during steady state anaesthesia onset of action of rocuronium is halved and the degree of neuromuscular blockade is markedly augmented during sevoflurane/N(2)O anaesthesia compared to propofol.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2001
Review[Intensive care - palliative care. Contradiction or supplement? Considerations on ethical issues and principles in the treatment of dying patients].
Over the last five decades the progress in intensive care has extended the limitations of controlling the process of dying and given doctors more influence in determining the time of death. More recently, palliative care has emerged as a new approach in response to the ethical dilemmas of modern medicine, which accepts that dying is a natural process that should not be hastened or delayed through medical interventions. While in Germany in 1999 more than 50 000 people have died in intensive care units, only a small number of 8000 patients have died in palliative care. ⋯ The approach of palliative care with its strong focus on alleviating the suffering of the terminally ill, has influenced the ethical debate of dying in intensive care. Although intensive care and palliative care have different aims and priorities, there are common problems of decision-making which could benefit from a shared orientation and interdisciplinary debate. Both the interpretation of a dying parent's will as well as withdrawing or withholding treatment in patients who are unable to decide for themselves should not merely be guided by the debate on active and passive euthanasia, but rather take into account the appropriateness or inappropriateness of medical actions in the specific situation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2001
[Optimized logistics in the prehospital management of acute stroke].
Current management of acute stroke is characterised by an aggressive approach including specific therapy i. e. reperfusion therapy. However currently stroke patients often arrive too late in hospitals offering adequate treatment. Therefore optimized logistics play a predominant role in modern stroke management. ⋯ This study demonstrates the efficacy of educational efforts in reducing latencies and in screening patients potentially suitable for thrombolysis. Future efforts will comprise more intense education of a high risk subpopulation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2001
[The importance of access-to-patient-period in the emergency service].
The "period-to-help" (Hilfsfrist) is defined by the federal states as a measure for further planning and structure the emergency services. This period is composed of distinct time intervals and ends with the arrival of the rescue team at the emergency. From a physician's point of view it is merely the time to the first contact with the patient that is of vital interest. Data on the discrepancy between arrival at the emergency scene and the first contact with the patient are lacking. ⋯ If we consider that road accidents count for merely 10 % of all emergencies it seems appropriate to re-define the so-called "period-to-help" (Hilfsfrist) that takes into account the "access-to-patient" period (Zugangszeit) that is on average 50 seconds. The primary goal of any further planning must be to keep the interval without sufficient therapy as short as possible.