Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2018
Review[Disturbances of Sodium Homeostasis].
Sodium is the most important osmotically effective cation in the extracellular space and very important for the water balance of the organism. Disturbances in the sodium homeostasis are therefore usually closely associated with disturbances in the water balance. The most important organs involved in the regulation of the sodium homeostasis are the kidneys and the brain. ⋯ Central pontine myelinolysis is a dangerous complication of a too fast compensation of hyponatremia. Exercise-associated hyponatremia (EHA) is a severe complication due to an inappropriately high intake of hypotonic fluids (mineral water, "isotonic sports drinks") during endurance sports. Due to the increasing popularity of endurance sports competitions (marathon, triathlon), an increasing incidence of this potentially life-threatening electrolyte disorder is to be expected.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2018
Review[New Antibiotics for Treatment of Highly Resistant Gram-negative Bacteria].
New β-lactam/β-lactamase inhibitor (BLI) combinations (ceftolozan/tazobactam, ceftazidim/avibactam, meropenem/vaborbactam, imipenem/relebactam, aztreonam/avibactam) are the focus of newly approved antibiotics or those currently in advanced clinical testing. In contrast to the BLI currently available, the new inhibitors avibactam, vaborbactam and relebactam are not structurally β-lactams. The combination with a BLI protects β-lactam from degradation by broad-spectrum β-lactamases from gram-negative pathogens. ⋯ Cefiderocol is the first representative of the siderophore cephalosporin antibiotic group to enter phase II clinical testing. Eravacyclin (tetracycline derivative) and plazomicin (aminoglycoside) are new non-β-lactam antibiotics in advanced clinical testing (phase III). In order to maintain the efficacy of new reserve antibiotics for as long as possible, a prescription should only be made if an additional benefit in comparison to established substances has been proven, e.g. by a resistance test.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2018
Review[Oral Anticoagulants: Management of Elective and Emergency Surgery].
In most patients, oral anticoagulation is performed with vitamin K antagonists (VKA) or non-vitamin K antagonist oral anticoagulants (NOAC). Because of a long half-life, VKA are dosed by measuring INR. In standard cases coagulation tests for NOAC are not necessary; application is performed in a fixed dose. ⋯ If required, a transition from NOAC to parenteral anticoagulation can be made. Severe bleeding complications can be treated for VKA and NOAC as well by application of prothrombin complex concentrate. A specific antidote to dabigatran is available.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2018
Review[Disturbances of Calcium Homeostasis].
Disturbances of calcium homeostasis are common. Their pathophysiological causes are very heterogeneous and clinical symptoms are often non-specific. Therefore, an exact diagnosis is indispensable and a rapid compensation of the calcium homeostasis essential. This article discusses the pathophysiological, diagnostic and therapeutic principles of hypocalcemia and hypercalcemia and their implications for anaesthesia and intensive care.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2018
Review[Disturbances of the Potassium Homeostasis].
Potassium is a key cation in the human organism and largely responsible for the resting membrane potential of excitable cells. 98% of the potassium pool resides within the cells and only 2% in the extracellular space. Thus, blood sample measurements of potassium do not necessarily reflect the total potassium state. The extracellular potassium concentration however is tightly regulated, either through potassium elimination via the kidney or shift between the intra- or extracellular compartment. ⋯ Acute alteration of the extracellular potassium concentration should spark immediate action by the perioperative physician. In particular, hyperkalemic states require immediate attention and therapeutic interventions. In this review, we give an overview of the pathophysiology of potassium changes and provide a practical approach to their management.