Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2011
Review[Patient blood management (part 1) - patient-specific concept to reduce and avoid anemia, blood loss and transfusion].
Patient blood management (PBM) is a patient-specific multidisciplinary, multimodal, evidence-based concept to appropriately conserve and manage a patient's own blood as a vital resource. PBM is based on 3 pillars: the first is the optimization of the patient's endogenous red cell mass, the second is the minimization of bleeding and blood loss and the third involves harnessing and optimizing the patient-specific physiological tolerance of anemia, including adopting more restrictive transfusion thresholds. ⋯ PBM is applicable to surgical and medical patients. The application of PBM systematically reduces the impact of 3 major contributors to negative outcome: anemia, blood loss and transfusion.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2011
Review[Technical possibilities and limitations of mechanical circulatory support].
Ventricular assist devices (VAD) to support the left (LVAD), the right (RVAD) or both ventricles (BVAD) have emerged as one standard of care for advanced heart failure patients. Initially used to bridge patients to transplantation (BTT) they are now more frequently implanted as permanent support (destination therapy, DT). Bridge to recovery (BTR) is a valid option for only a small number of patients. Although there are different devices available, patient selection, preoperative and intraoperative management, and the timing of VAD implantation are the elements critical to successful circulatory support.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2011
Review[Transport with ongoing cardiopulmonary resuscitation - when does is it make sense?].
The currently valid guidelines for resuscitation of the European Resuscitation Council (ERC) do not give any unambiguous recommendations for "transport with ongoing cardiopulmonary resuscitation". Furthermore, up to now there are no generally accepted criteria for terminating cardiopulmonary resuscitation, apart from certain signs of death. ⋯ The use of mechanical chest compression devices with a better quality of chest compression, also under transport conditions, may have an influence on the number transports but this has not yet been evaluated sufficiently with regard to patient outcome. However, the decision to transport a patient resides with the responsible emergency physician who has to evaluate the prognosis for the patient on an individual basis.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2011
Review[Awake craniotomy for brain tumor resection - what does the anaesthesist do?].
The numbers of awake craniotomies performed worldwide are rising. The technique allows a maximum of brain tumor resection with a minimal risk of functional damage in patients, where the tumor is growing close to functional relevant brain areas. ⋯ After adequate patient selection and intense (psychological) preparation a careful anaesthesiologist will be able to accompany the patient throughout this procedure safe and comfortable. This article describes the anaesthesiological management at Erasmus MC, University Medical Centre Rotterdam, The Netherlands, in detail.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2011
Review[Current success and risks of mechanichal circulatory support].
The growing number of patients suffering from severe congestive heart failure (HF) worldwide still means a challenge for the therapeutic options, mainly in the older population. According to the rapid development in the possibilities for mechanical circulatory support (MCS), the increasing use of left ventricular assist devices (LVADs) as bridge to transplantation (BTT) or destination therapy (DT) reflects a change in the up-to-date therapy of HF. This article gives a broad overview concerning indications, patient selection, choice of the device and mainly a study update. It is clearly shown, that VAD therapy has become an effective tool in the treatment of HF, and that the modern continuous flow pumps have replaced the older, bulky, pulsatile devices, especially in the LVAD sector.