Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2007
Review[Monitoring of perioperative fluid management in children].
Invasive monitoring is rarely used in children undergoing routine anaesthesia. Therefore the management of fluid therapy and its maintenance depends often on the experience of the anaesthetist. In situations of high volume uptake and during critical surgical procedures haemodynamic state can easily be underestimated and hypovolaemic episodes remain undetected. This article summarises recent developments of less invasive and continuous monitoring techniques available for paediatric use which probably represent a useful addition in optimising the perioperative haemodynamic performance.
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Adequate nutrition of the critically ill patient is a cornerstone of intensive care medicine. While the enteral route should be used whenever possible, parenteral supplementation of insufficient enteral nutrition has been shown to be beneficial and is not considered to be lethal anymore. The daily energy supply should not exceed 20-30 kcal/kgBW in the acute phase of the illness. Vitamins and trace elements should be supplied daily to avoid any deficiency.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2007
Review[Regional anesthesia in preterm, newborns and small infants].
Regional anesthesia has many advantages as intraoperative and more important as postoperative analgesia in pediatric anesthesia. There are special requirements for a sufficient acute pain management in preterms, newborns and small infants. This review focuses these special features regarding to local anesthetics and supplements, caudal and spinal anesthesia, and peripheral blockades.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2007
Review[Perioperative fluid guideline in preterms, newborns, toddlers and infants].
The purposes of perioperative fluid therapy are to balance deficits that have occurred preoperatively, to realize the continuous infusion of maintenance requirements referred to body weight an to effect a correction of the intraoperative losses of water, electrolytes and blood components. Premature and new-born infants as well as children at risk for hypoglycaemia should additionally receive glucose in order to stabilise the glucose concentration and metabolism. ⋯ Also in the cases of small children, artificial colloids may also be administered additionally. The efficacy of fluid and volume therapy should be controlled by an appropriately adapted circulation monitoring and regular blood gas analyses, especially for major interventions.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2007
Review[Rapid Sequence Induction in pediatric anesthesia].
The induction of anesthesia in patients who are at risk for pulmonal aspiration is a challenge for the anesthetist. The anesthesiological management of adult patients includes strategies to avoid pulmonal aspiration in addition to a rapid, competent protection of the airway without the danger of hypoxia. The well established Rapid Sequence Induction (RSI) in adults cannot be transmitted to children for some reasons. ⋯ Consistent recommendations concerning the anesthesiological management of children at risk for pulmonal aspiration do not yet exist. The "Wissenschaftlicher Arbeitskreis Kinderanästhesie" of the "Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin" has elaborated recommendations based on scientific investigations, systemic literature review and clinical experience of experts. According to these recommendations, the anesthesiological management of children at risk for pulmonal aspiration will be reviewed in the following, in order to simplify the implementation of individual institutional algorithms.