Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2013
Review[Status quo in radical prostate surgery].
Radical prostatectomy (RP) is a treatment option with an excellent cure rate in patients with localized prostate cancer but is accompanied by increased side effects. Particularly laparoscopic techniques developed in the last decade and are widespread. The operation techniques (retropubic(RRP), laparoscopic (LRP) and robot assisted laparoscopic (RALP) radical prostatectomy) and the comparative literature available are presented. ⋯ At present RALP seems not to be usable in an economically reasonable way. RRP, LRP and RALP show similar oncologic outcomes and comparable side effects. RP is the gold standard in the treatment of localized prostate cancer.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2013
Review[Current strategies to minimize of blood loss during radical prostatectomy].
Prostate cancer is a frequently diagnosed cancer in men with a high incidence. Despite enhancements of surgical techniques in prostatectomyperioperative blood loss is still the most frequent complication. Controlled hypotension (MAP 60-70mmHg) consisting of thoracal epidural anaesthesia und restrictive fluid management is a safe method to minimize blood loss. 25 degrees Trendelenburg position supports the multimodal treatment of controlled hypotension. Tranexamic acid is a safe drug to treat hyperfibrinolysis during prostate resection.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2013
Review[Anaesthesia for urological surgery - Anaesthesia for robotic assisted prostatectomies].
Because of excellent results, high patient satisfaction, and extraordinary surgical conditions robotic assisted prostatectomies have found a wide spread acceptance. Trendelenburg positioning, CO2-Insufflation, and installation of the robot system cause moderate hemodynamic and respiratory changes. Respiration can be compromised by significantly reduced pulmonary compliance during surgery and a marked CO2 load. ⋯ Over hours edema of head and neck including the upper airways and an increase of the intraocular pressure can develop. There are no restrictions in the choice of the anesthetics. Careful positioning of the patient and critical intravenous fluid management are important determinants of a successful anesthetic management.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2013
[Emergency medicine interventions for psycho-social crisis].
Psycho-social crisis intervention has emerged to be a routine treatment application in the pre-hospital emergency medical system in Germany. It is applied to both patients with psychiatric disorders and in psycho-social crises. ⋯ Psycho-social crisis intervention for the emergency physician must be regarded as psychological first-aid and is characterised by an immediate start, a limited time frame, consideration of security aspects, flexibility and a determination to pre-set goals and their achievements. We recommend to adequately document this complex service.