Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2017
Review[Preoperative Evaluation and Arrangements: The Elderly Patient].
With a constantly growing portion of elderly within our population and the advances of modern medicine, surgery on aged and very aged patients has become a daily hospital routine. Due to the physical and mental features of ageing these patients face special perioperative risks. ⋯ Even in the healthy elderly, most organ functions are "physiologically" instable or deficient and the homeostasis of health and disease is fragile. The preoperative evaluation of the aged patient has to be extended towards risk factors and pathologic pre-conditions which derive especially from high age and are so far not determined by a mere "fit-for-anaesthesia?"
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2017
Review[Preoperative Preparation: Patient Blood Management - What is Optimal?]
Patient Blood Management (PBM) focusses on anemia management, the minimization of (unnecessary) iatrogenic blood loss and the exhaustion of natural tolerance to anemia with rational use of red blood cell transfusion. The focus of the current review article is now the preoperative phase with the following PBM components: management of anemia, pre-transfusion analytics and management of anticoagulants. Preoperative anemia is an independent risk factor for increased perioperative morbidity and mortality. ⋯ Preoperative pre-transfusion analytics should be performed by a step-wise approach depending on the transfusion probability (and the baseline hemoglobin) and current in-house data. Management of (oral) anticoagulants needs to consider an individual risk stratification for bleeding and thromboembolic events, should be initiated in the preoperative phase, and should specify whether the anticoagulant needs to be continued, stopped or bridged. Long-term success of the preoperative PBM program can only be guaranteed with clearly defined responsibilities in the preoperative PBM team, communication and training of all those involved in the process of care.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2017
Review[Preoperative Optimization of Pulmonary Diseases - an Approach].
Preoperative identification of patients with an increased risk for perioperative pulmonary complications is crucial for the anesthesiological management. These complications were underestimated in the past, but are associated with an increased morbidity and mortality when occuring. ⋯ The knowledge of pathophysiology and pharmacological treatment options in this special subset of patients is essential. It has been shown that preventive programs in the preoperative setting were able to reduce pulmonary complications.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2017
Case Reports[Hypercapnic Raised Intracerebral Pressure - Ecmo Therapy Despite Major Intracerebral Haemorrhage].
We report a case of a 29-year-old primigravida asian woman with severe peripartal HELLP-syndrome. During delivery she developed coma. ⋯ After 31 days of stabilization by extracorporeal membrane oxygenation (ECMO) and lung protective ventilation the patient was weaned of ECMO therapy. Following a period of 107 days including the weaning of respirator-therapy her neurologic status improved and she was able to follow commands, move upper and lower extremities on request, and recognize her relatives.
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The acute pain therapy in the setting of conventional or laparoscopic appendectomy has to be initiated by the surgeon. The success of acute pain therapy holds a direct relevance for quality of life, morbidity, chronification of pain, and economic aspects. ⋯ He becomes "part of the team". An efficient acute pain therapy always consists of a combination of non-medical procedures, technical operative aspects, and medical procedures.