Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2004
Review[Volume replacement with hydroxyethyl starch: is there an influence on kidney function?].
Hydroxyethyl starch (HES) solutions are synthetic colloids with the pharmacological properties that are closest to natural colloids. In Germany, numerous types of HES preparations with different combinations of concentration, weight-averaged mean molecular weight (Mw), and hydroxyethylation pattern are available. They differ with regard to their volume-supporting capacity, intravascular half-life, and side effect profile. ⋯ In the case of HES, the risk of high plasma colloid osmotic pressure and thus the risk of acute renal failure are probably increased by high concentrations of the colloid or repeated administration of slowly degradable HES with a high Mw and DS. With adequate hydration, using sufficient amounts of crystalloids, HES has little if any adverse effects on renal function. Furthermore, modern -rapidly degradable HES solutions with a low Mw and DS, such as HES 130/0.4, do not increase the risk for renal dysfunction even when used in large amounts perioperatively.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2004
Clinical Trial[Spinal anaesthesia in 50 patients with previous lumbar spinal surgery].
In anaesthesia textbooks, spinal anaesthesia is described as relatively contraindicated in patients with a history of lumbar spinal surgery. In order to assess the feasibility of spinal anaesthesia in these patients, we performed 56 spinal anaesthetics in 50 consecutive patients with previous lumbar spinal surgery. ⋯ Side effects were only minor and had a low incidence. We conclude that spinal anaesthesia is a viable technique in these patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2004
[Cricothyroidotomy training on cadavers - experiences in the education of medical students, anaesthetists, and emergency physicians].
Should the technique of surgical cricothyroidotomy be practiced on cadavers and should it be a compulsory part of the teaching curriculum? Is it wise to use a speculum for the insertion of the endotracheal tube? What is the optimum size of the tube? ⋯ In our opinion it is highly recommended that the technique of cricothyroidotomy should be practiced on cadavers and that the course should become a compulsory part in a future educational curriculum. In addition the incision of the ligamentum conicum using dilators or a speculum is not to be recommended from the point of view of this study. The tracheal tube used in this study (reinforced wire tube, ID 6.0) was best suited for surgical cricothyroidotomy.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2004
[On the use of ultrasound to assist central vein cannulation in Germany: a surgery of 817 departments of anesthesia].
A survey on the current practice in using portable ultrasound machines to assist central vein cannulation was performed by sending a questionnaire to 817 departments of anaesthesiology and intensive care medicine in Germany. Also, incomplete questionnaires were included in the analysis. ⋯ In Germany, placement of central venous catheters is usually based on anatomical landmarks. Every anaesthetist and intensive care physician should be able to place central venous catheters without an ultrasound device. Still there is not a doubt that ultrasound assistance is useful for beginners, in children, and when blind cannulation fails. Also in patients in whom catheterisation is likely to be difficult (e. g. patients, with previous central venous catheters, with abnormal anatomy etc.) Due to our data a promotion of ultrasound assistance seems urgently required.