Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2006
Case Reports[Post-operative pain therapy of a chronic pain patient].
Post-operative pain therapy of chronic pain patients poses a challenge. Here we report the perioperative management of a 39-year-old male under chronic therapy with oxycodon, gabapentin and tolperison. Particular the pharmacointeractions regarding premedication and postoperative dose finding of opioids with intravenous PCIA are discussed.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2006
Review[Ultrasound in anesthesiology--ultrasound in interventional pain therapy].
Ultrasound is an emerging new imaging and guiding technique for diagnostic or therapeutic interventional pain procedures. Advantages are the real time monitoring of the targeted structures, the placement of the instruments and the visualization of local anaesthetic spread without exposing patients and personal to radiation. Pain specialists need a large anatomical knowledge and training to use the new method safely and distinctively. The increasing published data available and the personal experience of the authors suggest a potential usefulness in interventional pain therapy, but also limitations.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2006
Review[Arginine-vasopressin in septic and vasodilatorial shock].
Current therapy of septic/vasodilatory cardiovascular failure includes volume resuscitation and infusion of inotropic and vasopressor agents. Norepinephrine is the first-line vasoconstrictor, and can stabilize hemodynamic variables in most patients. Nonetheless, irreversible cardiovascular failure which is resistant to conventional hemodynamic therapies still is the main cause of death in patients with severe sepsis and septic shock. ⋯ A transient increase in hepatic transaminases during AVP infusion is most likely related to preceding hypotensive episodes. Important points which must be considered when using AVP as a "rescue vasopressor" in septic/vasodilatory shock states are: 1) AVP infusion only in advanced shock states that can not be adequately reversed by conventional hemodynamic therapy (e.g. norepinephrine >0,5-0,6 mug/kg/min), 2) presence of normovolemia, 3) AVP infusion only in combination with norepinephrine, 4) strict avoidance of bolus injections and dosages >4 IU/h. Effects of a supplementary AVP infusion in advanced vasodilatory shock on survival are currently examined in a large, prospective multicenter trial in North America and Australia.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2006
Review[Ultrasound techniques in anesthesiology--guided vascular access using sonography].
In anaesthetic practise ultrasound can facilitate cannulation of veins and arteries not only in adults but also in children. It is the main advantage and safety feature of this technique, that the targeted vessels and the surrounding anatomical structures are visualized and that the needle is advanced under continuous observation. ⋯ Ultrasound guided vascular cannulation can decrease complication rates and might improve patients safety e.g. by avoiding puncture of the carotid artery. However, in order to pass on these potential benefits to the patient and justify the increased expenses related to the purchasing of preferably portable ultrasound systems, it is mandatory to offer an appropriate ultrasound training programs for physicians using this technique.