Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2017
Review[How to Reduce the Rate of Postoperative Complications in Frail Patients?]
Frail patients are more prone to develop complications during and after surgery. As the syndrome becomes more common, recognition and special management of frail patients in the perioperative setting is becoming crucial to improve short- and long-term outcomes. Based on current literature and guidelines, we present a compilation of strategies that could be employed to reduce postoperative complication rates in frail patients. ⋯ This includes the risk of dehydration, hypothermia, cardiovascular decompensation, unusual drug reactions, and delirium. The benefits of early mobilization and nutritional support are also discussed. If frailty is detected preoperatively, thus alerting the team about the increased risk of complications, strategies can be implemented in the perioperative setting to improve the chances of successful recovery.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2017
Review[Update in Obstetric Anesthesia - Tried and Trusted Methods, Controversies and New Perspectives].
Since 1975, a plethora of lectures within the context of annual meetings relevant for the clinical care has been summarized in "what's new in obstetric anesthesia" by the society for Obstetric anesthesia and Perinatology which can be recommended to everyone interested in anaesthesiology in the delivery room. After the death of Gerard W. Ostheimer, Professor of Anaesthesiology at Brigham and Women's Hospital in Boston, Massachusetts, it became renamed the Gerard W. ⋯ This manuscript summarizes important findings from the last symposium held in 2016. Part I focuses on relevant causes for maternal morbidity and mortality as well as preventive measures, pregnancy in obese patients and sepsis in obstetric anaesthesia. Part II addresses established standards and new perspectives in the direct obstetric setting regarding epidural analgesia, post-dural puncture headache, anaesthesia and analgesia during and after caesarean section, haemodynamic monitoring during cesarean section and postpartum haemorrhage.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2017
[Perioperative Intravenous Fluid Therapy in Children].
The objective of this consensus-based S1 Guideline for perioperative fluid therapy in children is to maintain or re-establish the child's homeostasis. Therefore, the perioperative fasting times should be as short as possible to prevent patient discomfort, dehydration, and ketoacidosis. ⋯ The additional use of colloids is recommended to recover normovolemia and to avoid fluid overload when crystalloids alone are not sufficient and blood products are not indicated. Monitoring should be extended in cases with major surgery.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2017
Review[Why and How Should I Assess Frailty? A Guide for the Preoperative Anesthesia Clinic].
Introduction: Frailty is a condition of decreased physiological reserves seen in approx. one third of elderly anesthesiological patients, and affecting many aspects of treatment as well as outcome. Although there are over 60 measurement instruments, frailty assessment is still poorly implemented. Understanding why and how to assess frailty is key to its implementation in preoperative anesthesia clinics. ⋯ Conclusion: Frailty assessments vary immensely in terms of required time, equipment, and expertise. We recommend at least one test for each domain of frailty, so as to obtain a more holistic view of the patient's physiological reserve. The implementation of an adequate and consistent preoperative frailty assessment has the potential to improve patient safety as well as short and long term outcomes.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2017
Review[Interventions for Assisting Geriatric Patients with Frailty Before Surgery].
Frailty is a complex syndrome leading to a higher vulnerability in elderly patients, especially during and after surgery. It is characterized by the simultaneous presence of at least three of five phenotypical symptoms: unintentional weight loss, exhaustion, muscle weakness, slow walking speed, and low activity levels. The presence of two of these symptoms is often labelled as pre-frailty. ⋯ Examples for these interventions are pre-surgery rehabilitation and Delirium Management Units (DMU). This article describes the frailty syndrome and its associated consequences for complications during and after surgery. Additionally, clinical assessments for identifying frailty symptoms as well as pre- and post-surgical interventions to reduce these risk factors are presented.