Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2014
[Perioperative management and therapy of bleeding complications].
The new oral anticoagulants directly inhibit either thrombin (Dabigatran, Pradaxa®,) or activated Factor X (rivaroxaban, Xarelto®, and apixaban, Eliquis®) and have been approved for thromboprophylaxis after hip and knee replacement surgery and stroke prevention in non-valvular atrial fibrillation. Moreover, rivaroxaban has been approved for the treatment of deep venous thrombosis, prevention of pulmonary embolism and anticoagulation after acute myocardial infarction. The direct FXa-inhibitor edoxaban (Lixiana®) expects approval for the prevention of stroke in atrial fibrillation in Germany in 2014. ⋯ Due to the high protein binding the direkt FXa-inhibitors rivaroxaban (Xarelto®) and apixaban (Eliquis®) can not be hemodialysed. For edoxaban (Lixiana®) no data on elimination by renal replacement therapy are available. In case of life-threatening bleeding the replacement of a prothrombin complex preparation (PCC) containing the factors II, VII, IX and X and, second line, activated factor concentrates as recombinant factor VIIa or activated prothrombin complex preparations are recommended.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2014
Review[Advanced indications of the laryngeal mask - Limitations of use].
The use of extraglottic airway devices (EGA) is well accepted for airway management for certain classic indications such as general anaesthesia during limb surgery in the supine position. Furthermore, EGA have been deemed a useful tool during the management of an unrecognized difficult airway. ⋯ This article provides an evidence based review of the role of EGA during a variety of indications and is designed to assist with the decision making process of whether an EGA may or may not be appropriate for a particular indication. Moreover, recommendations are given for advanced indications.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2014
[Children with respiratory infections - How and when to perform anesthesia].
Infections of the upper respiratory tract ( URI) are the most common preoperative encountered comorbidity in childhood. Whether anesthesia for a child with respiratory infection should be performed or better be canceled, is still a dilemma for many anesthetists. The reasons for this are understandable: respiratory infections are associated with an increased incidence of perioperative respiratory adverse events, and there have been no evidence-based recommendations for the procedure in the individual case. ⋯ Although most of them remain without serious sequelae they have potential for serious morbidity and mortality when not immediately diagnosed and treated. Risk factors for respiratory complications include age <1 year , pulmonary comorbidity, invasive airway and airway surgery. Hence the individual decision is dependant on the risk but also the benefit factors and the expertise of the medical team.