Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2005
[Autologous transfusion - from euphoria to reason: clinical practice based on scientific knowledge. (Part IV). Artificial oxygen carriers: cell-free hemoglobin solutions -- current status 2004].
Because of an impending shortfall of allogeneic blood products within the next decades and ongoing problems such as transfusion reactions, immunomodulating side effects and the risk of bacterial, viral and prion transmission associated with relevant costs for testing and storage of banked RBC units which, additionally, suffer from aging processes, the development of alternatives has been intensified during the last 15 years. Modern chemically modified hemoglobin-based oxygen carriers (HBOC) are free of red blood cell membrane remnants eliminating renal toxicity, and they do not possess AB0 antigens which allows transfusion without knowledge of the respective blood group of a patient. Bovine polymerized cell-free hemoglobin can be stored at room temperature for three years. ⋯ Clinical studies have shown that the peri-operative use of different HBOC (Hemopure, PolyHeme, Hemolink and HemAssist) can reduce the number of allogeneic RBC units and increase the avoidance rate of allogeneic transfusion in emergency bleeding, vascular, cardiac and non-cardiac surgery. Polymerized HBOC appear to have a lower potential of side effects in comparison to intra-molecularly cross-linked preparations. However, HBOC-201 (Hemopure) is the only substance which has been licensed for the treatment of patients with acute peri-operative anemia in South Africa until now.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2005
Randomized Controlled Trial Comparative Study Clinical Trial[Are peripheral nerve blocks of the leg (femoralis in combination with anterior sciatic blockade) as sole anaesthetic technique an alternative to epidural anaesthesia].
We compared peripheral nerve blocks (PNB, femoral nerve block together with anterior sciatic nerve block) as sole anaesthetic with epidural anaesthesia (EA) in a randomised study in patients undergoing elective arthroscopic knee surgery with respect to patient satisfaction and time required to perform each procedure. ⋯ Patients in the PNB and EA group both were satisfied with their anaesthetic procedure. While there are obviously differences in favour of the EA, PNB is an alternative in the case of contraindication or patient rejection to EA.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2005
Review["Highlights" in emergency medicine -- severe head trauma, polytrauma and cardiac arrest].
According to scientific publications focusing on emergency medicine and published in international journals in the past few months, new and clinically important results can be identified. In patients with severe head trauma (SHT), application of hypertonic solutions is possible; long term outcome, however, is not improved by this measure. Prehospital capnometry is important, because otherwise up to 40 % of all mechanically ventilated patients are hypoventilated. ⋯ In a very clear advisory statement, the "International Liaison Committee on Resuscitation" (ILCOR) has recommended mild therapeutic hypothermia (i. e., cooling of cardiac arrest victims to 32 - 34 degrees C central body temperature for 12 - 24 h following cardiac arrest of cardiac etiology) not only for unconciuous patients with ventricular fibrillation as initial prehospital rhythm, but also for all other adult patients (other rhythms, intrahospital CPR) following cardiac arrest. In randomised controlled clinical trials, this therapy has markedly improved survival rate and neurological outcome. Such therapeutic cooling can be initiated nearly everywhere and with simple methods - like the infusion of ice-cold cristalloid solutions.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2005
Case Reports[Spontaneous breathing and stable hemodynamics during severe accidental hypothermia (22 degrees C)].
We present a case of severe accidental hypothermia (core temperature 22 degrees C) after a suicide attempt. The initial symptoms and the pre-hospital and hospital treatment are discussed. Additionally, different rewarming strategies for patients with severe accidental hypothermia are compared.