Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Obturator nerve block is commonly used for transurethral resections of the bladder in order to inhibit reflectory adductor muscle reaction during electrocoagulation and to reduce the risk of bladder wall perforation during transurethral surgery. Furthermore, obturator block is used to complete regional blocks for major knee surgery in addition to femoral and sciatic nerve blocks. Continuous techniques are sometimes used to treat chronic pain problems such as adductor spasm. ⋯ After laterocaudal redirection the canalis obturatorius is reached and the local anaesthetic is injected. The alternative approach is more often used: At the proximal tendon insertion of the adductor longus muscle the needle is introduced and advanced towards the anterior superior iliac spine. For both approaches a nerve stimulator is used and 15-20ml of local anaesthetic solution are injected.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2010
[Drug addiction and anaesthesia: most popular recreational drugs in Germany and anaesthesiological management of drug addicts].
Drug addicts need special anesthesiological care due to their co-morbidities, their modified need for analgesics and anesthetics and/or their specific substitution therapies. In spite of the high incidence of addiction worldwide controlled studies and evidence based recommendations for the anaesthesiological management of the patients are missing. ⋯ Inadequate analgesic treatment is known to be responsible for relapses into addiction and has strictly to be avoided. This holds true even for people with long term drug abstinence.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2010
[Perioperative coagulation monitoring - medical and economic aspects].
For preoperative haemostatic assessment a structured questionnaire for the bleeding history of the patient should be primarily used. Only in case of abnormalities an additional laboratory coagulation testing is recommended. ⋯ In the event of acute acquired perioperative coagulopathy laboratory coagulation testing is a prerequisite for sophisticated and precise diagnosis and therapy. Points of care techniques like thrombelastography are capable to provide fast and extensive information.