Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2013
[Perioperative fluid management in infants and toddlers].
The more than 50 years ago of Holiday and Segar created fundamentals of fluid therapy with sodium hypotonic solutions require revision. Hypotonic electrolyte solutions should not be longer used perioperatively. To maintain the water balance in the perioperative phase stable, children need balanced electrolyte solutions, corresponding to the composition of the extracellular space. ⋯ Fasting deficit and intraoperative maintenance requirement will be covered by an increased rate of infusion of a balanced electrolyte solution. Intraoperative losses and correction needs to be replaced according to clinical criteria. Balanced electrolyte solution with and without 1% glucose are very safe with respect to hyponatremia, hypo-and hyperglycemia, and accidental overinfusion.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2013
[Perioperative thermal management in children].
Perioperative temperature monitoring is a pre-requisite for successful prevention of inadvertent hypothermia in children. To achieve this goal, besides of pre-warming, active warming measures have to be intensified the younger and immature infants are. ⋯ Forced-air warming in combination with fluid warming has been proven effective in children. Postoperative shivering should be treated, e.g. with pethidin or clonidine.
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Venipunctures in children are difficult. Some factors can hardly be influenced, for example, a well-developed subcutaneous fat tissue. Technical devices may help to identify invisible veins. ⋯ Missing practice venipuncture and inadequate knowledge of appropriate puncture sites can be met easily by practicing and reading. The possibility of intraosseous puncture today is standard of anesthesia care for children. Within in a few seconds, a secure access to the vein system can be created.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2013
[Clinical basics of supraglottic airway management in paediatric anaesthesia].
The low invasiveness and simplicity of use of the LMA-Classic™ contributed substantially to the supraglottic airway management acquiring a special role in the anaesthesia care of neonates and children. Due to the introduction of new supraglottic airway devices and the expansion of indications, this form of airway management has a predominant role in paediatric anaesthesia in many institutions nowadays. As securing the airway "above the glottis" differs substantially in some aspects from securing the airway using the endotracheal tube it is mandatory to acknowledge special aspects in routine clinical practice in order to avoid complications. The following article describes basic aspects of supraglottic airway management in paediatric anaesthesia and illustrates, where possible, the available scientific evidence in the use of different supraglottic airway devices in this regard.
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Animal data, that could show a correlation between anesthetic exposure and longterm damage to the developing brain, have raised concern within the international anesthesiology community, but also in patients, parents and media. The evaluation of the available literature does not provide evidence for changes in routine anesthetic practice associated with the order, to establish evidence through increased basic and clinical research about the mechanisms and possible effects in humans.