Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2015
[Adjuvants in modern anesthesia - lidocaine].
Local anesthetics (LA) are well known for their antinociceptive and antiarrhythmic properties, but exert alternative effects, i.e. anti-inflammatory activity, as well. These immunomodulatory properties might contribute to the beneficial effects observed in the clinical setting, when intravenous lidocaine is given perioperatively. Systemic LA were shown to attenuate postoperative pain, accelerate the return of bowel function and shorten length of hospital stay in patients undergoing abdominal surgery.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2015
[Perioperative heart failure - Acute intraoperative heart failure].
With respect to the fact that - with the notable exception of patients undergoing cardiac surgery - only sparse data and limited guideline recommendations on optimal treatment strategies in patients with intraoperative acute heart failure are available. Consecutively it is rather difficult to make clear suggestions for the optimal treatment of this complication. ⋯ Importantly, one has to to take into account that the use of beta-mimetic drugs for the treatment of acute heart failure is increasingly recognized as an isolated mortality factor. This suggests to use inotropes as restrictive as possible, and if inotropic treatment becomes inevitable, to use levosimendan as the only inotrope that has been shown to improve mortality in several meta-analyses.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2015
[Part-time concepts in anaesthesia -example of a department of anaesthesiology at a university hospitel in Germany].
Part-time work concepts are requested for different reasons from an increasing number of employees. Despite this fact there are no systematic part-time work concepts published in the German literature, especially for physicians working in hospitals. ⋯ We are convinced that a transparent part-time work concept is a good argument for job-seeking physicians when deciding for an employer. The benefit for the already employed colleagues has at least the same value.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2015
[Perioperative heart failure - Preoperative Approach].
Heart failure is a common disease which is associated with an increased perioperative risk. In the following, we summarize pathophysiology, momentary treatment options and a preoperative approach to patients with heart failure.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2015
[Perioperative heart failure - Anesthetic management and monitoring].
Due to the demographic and medical development, the number of patients with heart failure needing anaesthesiological care will continue to grow in the upcoming years. For the optimal care of these patients close coordination between the surgically treating, the cardiology and the anesthesiological department is important. Cardiac function and structural characters, such as cardiac valve defects should be known preoperatively. ⋯ Especially in high-risk patients goal directed hemodynamic therapy is useful. For this, in addition to the established monitoring procedures, less invasive monitoring devices areincreasingly used. During an acutehaemodynamic instability, thetransoesophageal echocardiography is gaining importance due to its wide diagnostic evaluation.