Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Neuromuscular blockade in ICU patients has become less popular, in particular since non-invasive methods of artificial respiration have been introduced. Succinylcholine has numerous side effects. ⋯ In ICU patients, neuromuscular monitoring should be applied. Prolonged action and critical illness neuropathy are the most prominent side effects of neuromuscular blockade.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2009
[The development of vaporizers. A question of precise dose].
Since the beginning of anaesthesia it was well known that anaesthetic agents administered by inhalation must be capable of existing in gaseous form. For vaporization various types tried to work accurately. ⋯ With Copper Kettle (1948) for ether and chloroform and Draeger Vapor (1958) for Halothane accurate administration of volatile anaesthetics was available. Today vaporizers are part of anaesthetic machines.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2009
[Short acting muscle relaxants: is neuromuscular monitoring still necessary?].
Neuromuscular blocking agents are used to facilitate intubation and to establish muscle paralysis during surgery. However, postoperative residual blocks are a significant complication following the use of neuromuscular blocking agents with an incidence of approximately 30 % at arrival in the post operative care unit. If they are not identified and adequately treated, residual neuromuscular blocks would increase the risk for muscle fatigue, hypoventilation, swallowing disorders, and aspiration. ⋯ Sugammadex, the newly developed steroidal muscle relaxant encapsulator, is another important step to optimize treatment with neuromuscular blocking agents but will not replace neuromuscular monitoring. Since qualitative assessment has been shown to be insufficient to validly measure neuromuscular block in the anesthetized patient, it should be monitored quantitatively. Only using this technique and treating residual blocks where required, life threatening complications can certainly be avoided.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2009
Case Reports[Severe methemoglobinaemia following sodium nitrite ingestion].
We report the case of a patient suffering from a severe methemoglobinaemia following accidental sodium nitrite intoxication, a substance frequently used as a preservation agent for animal feed. On base of this case report, pathophysiology, clinical symptoms, diagnostical and therapeutical options with methylene blue (1-2 mg/kg of body weight) are discussed. Recently, pulse oximeters capable to measure 4 different hemoglobins have been introduced. These may be helpful for diagnosis especially in the prehospital setting.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2009
[Withholding and withdrawing therapy--how does the physician make a decision?].
To make a decision concerning the withholding and/or withdrawing of therapy is one of the most difficult tasks in medical care. Similar to other treatment decisions, initiation and interruption of therapy should be guided by the medical indication and, in principle, requires informed patient consent even during end-of-life care. However, especially in this situation, patients are frequently not able to give informed consent or to clearly express their wishes regarding therapy. ⋯ In order to reach a unanimous decision with relatives and also within the medical team, it may be helpful as a first step to withhold an escalation of therapy for a limited time, while daily reassessing the situation, before it is actively reduced. In Germany, health-care professionals do not always feel certain about the question of whether an active reduction of medical therapy is, in fact, active or passive euthanasia. The German Federal Court of Justice, however, has explicitly stated that withholding and withdrawing therapy is passive euthanasia and as such is legal.