Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2010
Review[Presence and future of emergency medicine in Germany].
Health care policy has changed duties and responsibilities of hospitals in Germany. The transition zone of in- and outpatient care has been recognized as a critical gateway for the success of hospitals, subsequently leading to the appreciation of the value of professionalized emergency departments. ⋯ Furthermore, those strategies are accompanied with the improvement of economic characteristics. Summing up, professionalisation of hospital-based emergency medicine in Germany is urgently needed and may improve medical and economic success of hospital-based patient care.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2010
Case Reports[Case-Report: Reversal of a deep neuromuscular block with sugammadex after rapid sequence induction with high-dose rocuronium bromide].
Sugammadex can reverse rocuronium-induced muscular relaxation by encapsulation of steroidal muscle relaxants without muscarinergic side effects. Clinical studies show effective dose-dependent reversal of neuromuscular blockades after rocuronium and vecuronium. We report on a patient with deep neuromuscular block at the end of surgery following rapid sequence induction of anesthesia with high-dose rocuronium, who could rapidly be reversed without side effects after adequate i.v. sugammadex application.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2010
Review[Damage control in trauma patients with hemodynamic instability].
The term "Damage-control" is borrowed from naval terminology. It means the initial control of a damaged ship. Because of the lethal triad in multiple injured patients the classical concept of definitive surgically therapy in the acute phase of the injury has a high rate of complications such as exsanguination, sepsis, heart failure and multiple organ failure. ⋯ This means temporary control of a hemorrhage and measures for stopping abdominal contamination. After 24 - 48 hours in the intensive care unit and correction of physiological disturbances further interventions are performed for definitively treatment of the injuries. Summarized, the damage control strategy comprises an abbreviated operation, intensive care unit resuscitation, and a return to the operating room for the definitive operation after hemodynamic stabilisation of the patient.
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Drug dependence of anaesthetists occurs more often than in other physicians, especially the noxious usage of common substances in anaesthesiology and pain management like opioids and anaesthetics. Opioids are the most frequent abusively taken medication followed by benzodiazepines, illegal drugs, Propofol and Ketamine. Determining for the behavioral pattern is the easy access to the drugs. ⋯ At least 16% of all cases and 37% of the Propofol-addiction cases proceed deadly. American studies with structured therapy-, rehabilitation- and follow-up surveillance-programs show a positive prognosis for anaesthetists. In Germany it requires rethinking and the establishment of comparable therapy-offers and facilities.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2010
Review[Anaesthesia for children with epidermolysis bullosa].
Epidermolysis bullosa (EB) is a heterogeneous group of inherited rare diseases, which are characterized by trauma-induced blister formation of the skin and mucosa. The underlying cause is a functional deficiency of structural proteins of the epidermis or the dermis. Depending on the level of the blister formation, EB is divided into EB simplex (intra-epidermal), junctional EB (within the lamina lucida), dystrophic EB (below the lamina lucida) and Kindler syndrome (variable level of split formation). ⋯ Since causal therapies are not available strict prevention of friction and trauma is essential to avoid blister formation. Anaesthesia challenges exist in the field of bedding procedures, care of the skin, monitoring, airway management und analgesia. This article gives a review over the EB and highlights in detail the corresponding anaesthesia characteristics.