Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2007
Review[Role of intraosseous access in emergency].
As alternative for drug administration, the intraosseous access is an important option in emergency medicine. Plasma concentrations of drugs, safety and rapidity as well as rate of complications are comparable to the intravenous access. ⋯ Rescuers should learn safe techniques of establishing an intraosseous access. Equipment of rescue vehicles with adequate devices for children and adults should be considered standard.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2007
Review[Considerations in ventilation of infants and children].
The oxygen reserves of infants are low because of high oxygen demand in combination with low transport capacity. Respiratory adverse events are one of the major causes of morbidity and mortality during paediatric anaesthesia. During the last years our knowledge has grown substantially about the influence of artificial airways on the airway of paediatric patients. Modern anaesthetic concepts in infants and children include the use of cuffed tubes as well as a spontaneous breathing child.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2007
Review[Airway pressure settings during general anaesthesia].
In volume-controlled mechanical ventilation with constant inspiratory gas flow, which is most often used during general anesthesia, only the end-expiratory airway pressure (PEEP) has to be set by the user. Inspiratory airway pressures result from the combination of tidal volume and respiratory compliance as well as instantaneous gas flow and respiratory resistance. Given a normal respiratory compliance of 50-60 ml/mbar in mechanically ventilated patients, a driving pressure of 7-10 mbar is necessary for a tidal volume of about 6 ml/kg predicted body weight. ⋯ Furthermore, PEEP increases the apnoea interval tolerated without desaturation and thereby increases the safety margin during induction of anesthesia. If atelectasis shall be completely recruited, an airway pressure of 40 cm H2O is needed for 40 seconds. In order to avoid a severe drop in arterial blood pressure which may be accompanied by cardiac arrhythmia, such a recruitment manoeuvre should only be performed in normovolemic patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2007
Review[Induction of general anesthesia, in the operation theatre, during extubation--what fraction of inspiratory oxygen is to choose?].
All patients receive oxygen perioperatively during general anesthesia. It is easy to provide and relatively inexpensive. However, the oxygen concentration varies widely not only between different operation procedures but also between different countries. ⋯ Supplemental oxygen improves immune function leading to a decreased rate of wound infections. In addition, a drop in the incidence of postoperative nausea and vomiting (PONV) was observed with a higher concentration of oxygen. Unfavourable but inevitable is the formation of atelectasis induced by a high oxygen concentration.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2007
Review[Abdominal compartment syndrome. A still underestimated problem?].
The abdominal compartment syndrome (ACS) is a life threatening disorder in critically ill patients caused by rapidly decreasing intra-abdominal pressure (IAP) > 12 mm Hg, which may result in multiple organ dysfunctions with a possibly fatal outcome. Under various causes for the development of an ACS, pelvic trauma, volume resuscitation after severe hemorrhage and reperfusion after aortic aneurysm repair as well as intra-abdominal packing figure at the first place. An increased BMI is a risk factor for patients to suffer from ACS. ⋯ Timely diagnosis of ACS remains sometimes difficult in spite of clinical indicators such as increased airway pressure, hypoxia, oliguria, shock and acidosis. For the early recognition of intra-abdominal hypertension repetitive measurement of the intra-vesical pressure (> 20 mm Hg) can be helpful. Besides intensive care treatment with artificial ventilation, circulatory support with volume and catecholamines, the decision for a prompt abdominal decompression and open abdominal treatment is life-saving and can preserve further functional damage to vital organ systems.