Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2012
[Mental disorders in intensive care medicine - Part 2: Prevention and therapeutic approaches].
This two part article "Mental disorders in intensive care medicine" aims to give an understanding of the most frequent mental disorders in critical care medicine. Part 1 highlights the basics, disturbances and diagnostics, part 2 prevention and therapeutic approaches.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2012
[Opioid effects - galenics make the difference].
The galenics of extended-release opioids is highly variable and often insufficently. The quality of retard formulations can roughly be evaluated by means of 3 parameters: 1. PTF-Value (peak-trough fluctuation) [PTF (%) = [Cmax - Cmin] ×100/Cav] which should be as small as possible in order to minimize the fluctuation of plasma levels e.g. ⋯ A too short HVD can induce end-of-dose-failure. HVD of most opioid formulations (b.i.d.) is only 6h, better are Morphin-KREWEL® with a HVD of 8,4h and especially Jurnista® (q.d.) with HVD =21,8h. These different galenics ban a so-called "Aut-idem-Substitution" of extended-release opioids.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2012
[Pharmacologic thromboprophylaxis in critically ill patients].
Critical care patients have to be considered at high risk patients for thromboembolic events. The recommendations and guidelines support strongly a pharmacologic anticoagulant prophylaxis. ⋯ In case of acutely suspected or diagnosed HIT type II Argatroban seems to be a reasonable choice for anticoagulation. The new orally available anticoagulant drugs are not yet indicated in ICU patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2012
[Antiplatelet drugs - implications for the anesthesiologist].
Aspirin and thienopyridines are the mainstay of platelet aggregation inhibition in patients with acute coronary syndromes and patients receiving coronary artery stents. After elective coronary artery stenting, they are prescribed for up to 3 months after bare metall stents and for at least 12 months after drug-eluting stents, thereby significantly reducing the risk of acute stent thrombosis. During this time period, patients should not undergo elective surgery. ⋯ In these cases a careful risk-benefit analysis is required to elucidate the risk of major surgical bleeding versus the risk of major cardiovascular events with aspirin to be continued throughout the perioperative period. Current evidence does not suggest to use platelet function tests to guide therapy under these circumstances. If major bleeding occurs under dual platelet aggregation inhibition, the most appropriate interventions are antifibrinolytics such as tranexamic acid and transfusion of platelets to counteract the platelet aggregation inhibitory effects.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2012
[Novel oral anticoagulants and their use in the perioperative setting].
Novel oral anticoagulants (NOACs) have become available for prevention of venous thromboembolism after major orthopaedic surgery, treatment of venous thromboembolism, and stroke prevention in patients with atrial fibrillation. The thrombin inhibitor Dabigatran has a plasma half life of 11-14 hours which prolongs significantly in renal insufficiency. The two Xa-inhibitors Rivaroxaban and Apixaban have slightly shorter half lifes, and renal elimination is confined to about 30% of active drug. ⋯ Bridging anticoagulation is not necessary. The management of bleeding complications does not differ from that in other anticoagulants. The most uncertainties in clinical practice will arise from the fact that NOACs derange the global clotting tests without any conclusive information about the actual intensity of anticoagulation.