Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2010
Review[Systematic reviews and metaanalyses. Basic knowledge, strengths and weaknesses of an important tool for healthcare professionals].
Once rather a niche business, evidence-based medicine (EBM) as an approach to clinical decision-making requiring the integration of the best available research evidence with individual clinical expertise and patient values, has gained widespread acceptance and support within the healthcare community. This review article covers the basic principles of systematic reviews and meta-analyses, and their role in the process of evidence-based decision-making. ⋯ Special emphasis is put on important issues that need to be considered when appraising a systematic review or meta-analysis, thus providing a description on how to use systematic reviews for clinical decision-making. Some of the terms that are frequently used in the reporting of systematic reviews and meta-analyses, such as relative risk, confidence interval, Forest plot or L'Abbé plot, will be introduced and explained.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2010
Review[Prevention and therapy of prolonged, chronic pain after surgery].
Prolonged, chronic pain after surgery is a very common phenomenon that has been underrecognized until recently. A number of risk factors and predictors (including the surgical procedure, age, gender, pre- and postoperative pain, psychosocial factors, genes and pain modulation variables) have been identified in the past years. Together with an increased knowledge about the pathophysiology of chronic pain after surgery, we may be able to develop successful drugs or interventions modifying the disease in subgroups of patients in the near future. ⋯ However, again, convincing evidence for certain treatment protocols (start and duration of regional anesthesia techniques) to get optimal results are limited at most. Thus, we are left with speculative effects after certain surgeries and may rely--at least to date--more on analgesic rather than disease related treatment approaches. Future studies with a standardized study design recognizing patient characteristics are highly needed to make progress and find drugs, strategies and approaches which can be applied to certain groups of patients to prevent the development of chronic pain after surgery successfully.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2010
Review[Chronic postoperative pain. Epidemiology and psychological risk factors].
Acute postoperative pain is a still inevitable accompaniment of surgery. Up to 50% of the patients undergoing surgery--depending on its type--develop later on chronic postoperative pain. Psychological variables as minor depression, anxiety and pain-related catastrophizing as well as full-blown mental disorders are known risk factors. The relationship between such variables and postoperative pain is likely reciprocal.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2010
Review[Neurological complications following anesthesia--part I. Perioperative stroke, postoperative visual loss, anticholinergic syndrome].
Neurological complications following anesthesia deteriorate patients' outcome, and increase hospital costs because of prolonged hospitalization and supplemental medical care. Moreover, patients' satisfaction is negatively influenced by neurological sequelae after anesthesia. ⋯ In case of neurological complications in the perioperative phase an interdisciplinary approach in immediate diagnosis and treatment may prevent patients from permanent damage. The present review article gives an overview over incidences, diagnostic and therapeutic issues of neurologic complications in operative patients, such as perioperative stroke, postoperative visual loss and the anticholinergic syndrome.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2010
Case Reports[Intensive care treatment for neuroleptic malignant syndrome].
We report a case of severe neuroleptic malignant syndrome developing in a 28-year-old female patient following deliberate self-poisoning with atypical antipsychotic drugs and serotonin reuptake inhibitors. Because of an increasing loss of consciousness she was rapidly transferred to an Intensive Care Unit. ⋯ This article describes etiology, pathophysiology and symptoms of neuroleptic malignant syndrome. In addition therapeutic options are discussed.