Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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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
[Hospital hygiene - outbreak management of nosocomial infections].
According to §6, section 3 of the German Protection against Infections Act [Infektionsschutzgesetz (IfSG)] an outbreak is defined as the occurrence in large numbers of nosocomial infections for which an epidemiological relationship is probable or can be assumed. About 2-10% of nosocomial infections in hospitals (about 5% in intensive care wards) occur within the framework of an outbreak. The heaped occurrence of nosocomial infections can be declared according to the prescribed surveillance of nosocomial infections (§23 IfSG) when, in the course of this assessment, a statistically significant increase in the rate of infections becomes apparent. ⋯ The names of patients involved in outbreaks need not be reported to the responsible health authorities. As a consequence of the report the health authorities become involved in the investigation to determine the cause and its elimination, and to provide support and advice. The outbreak management should be oriented on the respective recommendations of the Robert Koch Institute.
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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
[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.