Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2017
Review[Anesthesiology and Outcome - Impact of the Perioperative Process].
In recent years, the role of the anesthesiologist has turned tremendously from the "anaesthesia doctor" into a perioperative physician and risk specialist. Patients are older, multimorbid, and are called up for more and more extensive surgery and interventions. Socioeconomic aspects have grown in importance. ⋯ The individual perioperative process steps in this way are examined in accordance with established guidelines and the increase in current requirements. Finally, a special emphasis is placed on the perception that the perioperative process has not been completed with the end of surgery - postoperative outcome is not least adversely affected by postoperative complications on the normal ward. The risk of death after complications, "failure to rescue", should be identified early and treated promptly.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2017
Review[Impact of Cardiac Anaesthesia on Patient Outcome].
The perioperative management of complex patients in a highly technical and subspecialized environment is the domain of the cardiac anesthesiologist. Evidence suggests that hemodynamic management using goal directed hemodynamic therapy (GDHT) improves patient outcome. ⋯ Mortality can be decreased when remote ischemic preconditioning techniques (RIPC) are being used. Neurological outcomes can be improved with near-infrared-spectometry (NIRS), volatile anesthetics increase myocardial protection through preconditioning and perioperative echocardiography increases overall patient survival.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2017
Review[The Influence of Anesthesia On Perioperative Outcome in Children - Institutional and Individual Factors].
The perioperative care of children is challenging for health care providers. Since anesthetists cannot affect the nature of the disease and have hardly an impact on the decision for surgery we summarized in this review individual and institutional factors for improving perioperative outcome by anesthetists. ⋯ A behaviorally oriented preoperative preparation of parents and children also affects the postoperative course of the pediatric patients positively as well as institutional concepts for the reduction of perioperative medication errors and adverse drug events. We believe that perspectively pediatric surgery will be increasingly performed in high volume hospitals which are able to guarantee beneficial institutional structures as well as a high educational level and high professional experience of the employed anesthetists.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2017
Review[Development of Anaesthesia-Related Mortality and Impact On Perioperative Outcome].
Achievements in anaesthesiology form the basis for the tremendous development of surgical therapy. Reliable monitoring technology, which is scrutinized on a regular basis using checklists, is allowing anaesthesia at the borders of physiology. ⋯ Furthermore, postoperative care in specialised units and intensive care wards is a key factor of improved patient outcome after surgery. In the future, unravelling the interactions of anaesthesia, surgical trauma and postoperative complications will further contribute to improved patient safety.
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Remifentanil is a short-acting opioid of high analgetic potency and superior controllability. It is widely used in day-case surgery, procedural sedation, for reduction of recovery-times and obstetrics and whenever excellent controllability of opioid effects is needed. Especially in combination with Propofol it is used for target-controlled infusion (TCI). The first part of the article provides readers with information about historical aspects, pharmacological characteristics, effects and side effects of remifentanil.