Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2004
Review[New insights in postoperative pain therapy].
In this review, novel clinical studies on postoperative pain therapy are summarized. Based on these studies, several conclusions can be drawn: i) following tonsillectomy, postoperative therapy with NSAIDs leads to a significant increase in the number of reoperations; thus NSAIDs should be used with caution; ii) COX-2 inhibitors in combination with intravenous opioids improve recovery and functional outcome after knee replacement surgery; iii) the combination therapy of different non-opioid analgesics has no proven clinical efficacy and should not be used routinely; iv) patients' age is not a determinant in postoperative opioid titration after surgery; in contrast, it does predict opioid consumption during the first postoperative day; v) morphine and piritramide have identical analgesic efficacy and induce nausea and vomiting with the incidence; opioid selection can, thus, be based on economic considerations and vi) if tramadol is ineffective in postoperative pain therapy, this might be caused by an allelic variant of one of the cytochrome P450 enzymes (CYP2D6); these patients should be treated with a different opioid.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2004
Comparative Study[Warming efficacy and blood damaging of blood and infusion warmers].
Inadequately warmed blood or infusions contribute to the development of perioperative hypothermia. Therefore we analysed the efficiency of several infusion warmers. ⋯ The warming capacity of the system and the length of the uninsulated infusion system determine the efficiency of an infusion warmer. The range of effective warming of an infusion warmer should be known for proper application.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2004
Case Reports[Delayed onset of malignant hyperthermia crisis during a living donor liver transplantation caused by sevoflurane].
We report on a 25-year old ASA physical status I patient, who developed within 20 minutes a full-blown malignant hyperthermia (MH) in the context of a living donor liver transplantation after 180 minutes of uneventful anaesthesia. The only trigger substance applied was Sevoflurane. The patient had already received a short, uneventful anaesthesia with Isoflurane a couple of years ago. ⋯ The post-operative in vitro caffeine halothane contracture testing confirmed that son and mother were susceptible to MH, contracture testing in the father was negative. All known triggers may cause life-threatening MH crisis - even after hours and after inconspicuous multiple exposures to known trigger substances. Therefore all trigger substances must be avoided in all patients susceptible to MH.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2004
Randomized Controlled Trial Comparative Study Clinical Trial[ProSeal-laryngeal mask versus endotracheal intubation in patients undergoing gynaecologic laparoscopy].
The aim of this study was to assess the practicality of the ProSeal laryngeal mask (PS-LMA) airway during laparoscopic surgery with capnoperitoneum compared to endotracheal intubation (ET). ⋯ The PS-LMA is a convenient and practicable approach for anaesthesia in patients undergoing laparoscopic surgery.