Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2008
Review[Modification of perioperative drug therapy in cardiovascular, pulmonary or metabolic disease].
Almost 50 % of all patients that are evaluated preoperatively by an anesthesiologist are receiving concurrent medication. Many of the prescribed drugs can be omitted during the perioperative period. However, perioperative cessation of certain drug therapies may cause decompensation of primarily compensated diseases. After reading this CME article, the reader should be able to decide whether any cardiovascular, pulmonary or antidiabetic drug therapy should be continued or ceased during the perioperative period, respectively.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2008
[The Nursing Delirium Screening Scale (NU-DESC)].
Both in the recovery room as well as in the intensive care unit post-operative delirium is the most common psychiatric disease. The post-operative delirium is stated in literature to occur in 15 % to 50 % of patients, whereby up to 80 % of patients requiring intensive care with artificial respiration develop a delirium. The delirium correlates with the length of hospital stay and leads to a tripple rate of the six-month-mortality. Nu-DESC, developed by Gaudreau et al. is a measuring instrument for the clinical diagnostics of deliriums which is quickly operable, care-based and which can thus be easily integrated in everyday routine. The aim of this study was the translation of Nu-DESC from English as basis for the use in clinical research and routine. ⋯ The German version of Nu-DESC provides an instrument for evaluating the delirium in the area of clinical routine and research.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2008
Review[Inter-hospital transfer of patients in intensive care treatment. A systematic review].
An obvious trend of concentrating treatment options on specialized centres may take effect later in an increased need for inter-hospital transfer. Patients initially referred to secondary or tertiary hospitals require a safe and systematically organised transport in order to ensure a continuation of initiated actions in intensive care. This review will focus of appropriate preparations, equipment and transport modalities, possible sources of shortcomings as well as solutions of conflicts during inter-hospital transfers.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2008
Review[Neurological diseases in pregnancy: implications for anesthesia care--Part 1].
In the parturient as well as in the pregnant patient with neurological disease, surgery is necessary more frequently than in healthy pregnants. Most pregnancies of these patients will result in a slightly increased rate for cesarean section. The focus of anesthesia care is mostly to avoid damage to the fetus, in some pathologies to protect the mother. ⋯ Subarachnoidal hemorrhage and intracranial bleeding contribute to 65 % of maternal mortality. Finally, pregnancy induced conditions such as eclampsia and HELLP syndrome and its management are reviewed where the concerns for the nervous system have high relevance for anesthesiological management. Anesthesia care for the pregnant and the parturient presenting with a neurological disease requires 1.) expertise with neuroanesthesia and obstetric anesthesia care, 2.) accurate physical examination of the neurological system preoperatively, 3.) safe choice and conductance of the anesthesia technique (mostly regional anesthesia) 4.) avoidance of unfavorable drug effects for the fetus and the nervous system of the mother and 5.) intraoperative neuromonitoring together with the control of the fetal heart rate.
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Acute stress-related hyperglycemia is a condition, commonly observed in patients following major surgical procedures, trauma as well as life-threatening illness. This may result in organic dysfunction in the critically ill. Intensive Insulin Therapy (IIT) describes intravenous application of insulin to sustain a defined level of blood glucose to reduce negative effects of hyperglycemia. IIT requires close monitoring regimes.