Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2010
Review[Hygiene standards for spinal anaesthesia].
Infections after performance of a spinal anaesthesia (SPA) are rare. Reports in the literature on the frequency of cases of meningitis that occur after a spinal anaesthesia vary between 3.7/100,000 and 7.2/100,000. Spinal abscesses after SPA have a calculated incidence of 1/1,260,000. ⋯ In 2006 the scientific working group "Regional Anaesthesia" of the German Society for Anaesthesiology and Intensive Care Medicine (Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI) published hygiene recommendations for the execution and further management of regional anaesthetic procedures that can be used for orientation. These recommendations are based to a large extent on guidelines of the Robert Koch Institute (RKI) for the prevention of infections associated with vessel catheters. When an infection occurs, a timely diagnosis with the help of MRI studies and, if necessary, liquor puncture as well as a rapid initiation of treatment is of decisive importance for the prevention of late squeals.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2010
Review[Spinal anaesthesia in day case surgery--Old technique--new trends].
Day case surgery is becoming more and more important. In order to perform these services cost-efficiently it is of primary importance to ensure that procedures can be scheduled with the largest possible patient satisfaction. Up to now spinal anaesthesia was of little importance in day case surgery due to prolonged nerve block and negative side effects especially when using long acting local anaesthetics. Since prilocaine and 2-chloroprocaine, two short acting local anaesthetics with a known low incidence of side effects, were recently introduced into clinical practice a reevaluation of spinal anaesthesia in a day case setting according to EMB guidelines still has to be done.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2010
[Opioid induced cough: Do we know its pathophysiology and can it be eliminated?].
The (intravenous) administration of opioids is frequently associated with the induction of cough. This phenomenon is usually neither harmful for the patient nor bothersome. ⋯ Based on experimental investigations in accordance with clinical findings this systematic review of the existing evidence helps to guide the management strategy if opioid induced cough should be avoided. Promising strategies - among others - in order to achieve this aim consist for instance of decreasing the injection speed in conjunction with pre-administration of lidocaine or clonidine.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2010
Review[Prevention of perioperative hypothermia].
Inadvertent perioperative hypothermia impairs postoperative outcome in surgical patients due to ischemic myocardial events, wound infections and coagulation disorders. Body core temperature should be assessed 1-2h preoperatively and continuously during surgery. ⋯ Warming of IV fluids is effective if infusion rates are above 1l/h. Core temperature should be measured in the recovery room and active warming should be started when patients are hypothermic or if they feel cold.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2010
Review[Complications of spinal anesthesia and how to avoid them].
Spinal anesthesia is a safe procedure. The knowledge of complications may support efforts to minimize risks, speed up the recognition process and lead to adequate timely therapeutic approaches. Pain during insertion of the needle can be a warning signal for potential conus damage. ⋯ In case of a high degree of suffering the best currently available treatment is the epidural blood patch. Further complications like intracranial bleeding, infection, cauda equina syndrome or spinal hematoma need immediate differential diagnosis and therapeutic approaches. The residual risk for permanent harm can be estimated to be around 0,02 per thousand.