Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2012
Review[Muscle relaxants and neuromuscular monitoring - Introduction for a safe clinical application].
The use of muscle relaxants facilitates endotracheal intubation and ameliorates the conditions of surgery. But, their use should be controlled - otherwise there will be postoperative residual curarisation which can lead to patient discomfort up to severe medical complications. Therefore, an appropriate surveillance via objective neuromuscular monitoring is essential. This article gives a review of the basic principles of muscle relaxants, their clinical application and the surveillance of their effects and degradation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2012
Review[Nerve injury due to peripheral nerve blocks: Pathophysiology and aetiology].
Permanent nerve injury as a complication of peripheral regional anaesthesia is fortunately rare with an estimated incidence of 0,03%. However, transient neurological symptoms are more frequent with an occurrence of 3-8%. ⋯ Regarding pathophysiology, trauma-related inflammation should be acknowledged as an important interference during nerve recovery. Needle-nerve contacts, nerve perforation and local cytotoxicity of local anaesthetics should be reduced to a minimum by application of nerve stimulation, ultrasound and an adequate dosage of local anaesthetics with less locotoxicity.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2012
Case Reports[Case Report: Recurrent postpartum haemorrhage after emergency caesarean section - Clipping, embolization and haemostaseological therapy].
Immediately after emergency caesarean section a 37 yr old patient suffered severe atonic bleeding requiring different operating procedures (Clipping of the uterine arteries) in combination with an uterotonic and haemostaseological medication as well as massive transfusion of blood components and recombinant factor VIIa. After a period of 17 days without any bleeding the patient presented to the emergency room with recurrent massive uterine bleeding. Transarterial embolization of the anterior bundles of the iliac arteries in combination with a second uterotonic and haemostaseological medication stopped the haemorrhage. Reasons and risk factors of a recurrent postpartum bleeding are discussed and a multidisciplinary algorithm for treatment is proposed.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2012
[Shortage of physicians in anaesthesiology and intensive care medicine - Causes, consequences and solutions].
74% of all hospitals had vacant positions in 2011, also departments of anaesthesiology and intensive care medicine. More than 50% of these departments work with locums. ⋯ To solve the shortage of physicians one has to solve the reasons. Main reasons are increasing feminization of medical profession and part-time-work, work-life-balance and a poor specialised education.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2012
Review[Nerve injuries associated with nerve blocks: clinic and incidence].
Persistent nerve injuries in context of peripheral nerve blocks are uncommon. Previous surveys and prospectively designed studies have specified neurological dysfunctions in different ways, which may cause the variability of data about incidence; so it has to be reckoned with about 5% after 1 week, 1% after 1 month and 0,01% after 6 months. ⋯ Dysfunctions manifest as numbness, parasthesia, tingling sensation and/or amyasthenia. Fortunately long-term lesions, caused by nerve blocks are a rarity.