Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2018
Review[Placebo Responses in Chronic Pain: State of Research and Clinical Implications].
Placebo hypoalgesia has been found to play an important role in every health care by modulating patients' responses to pharmacologically active analgesic treatments. It may be seen as reflecting the capacity for endogenous pain modulation. Enhancing the efficacy of analgesic treatments by boosting endogenous pain modulation might be particularly relevant for chronic pain patients. ⋯ To our knowledge, placebo hypoalgesia to chronic pain has been investigated experimentally in chronic back and chronic musculoskeletal pain, neuropathic pain after thoracotomy, and episodic migraine. Results point towards a maintenance of placebo hypoalgesic responses in chronic pain populations, thus highlighting the potential benefit of boosting placebo hypoalgesic responses in the treatment of chronic pain. Strategies on boosting placebo hypoalgesic responses in every day healthcare are presented.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2018
Review[Placebo Nocebo Ethics in Communicating with Patients How Anaesthesiologists Should Handle the Psychosomatic Dimension of Briefing].
The briefing of patients is part of the daily routine of clinical anaesthesiologists and a central element for justification of medical treatment. It is increasingly apparent that such conversations can significantly affect the success of treatment by eliciting placebo and nocebo effects. Placebo effects are psychosocially caused clinical improvements, mediated by neurobiological mechanisms, which would be omitted in the case of hidden application. ⋯ We will examine the practical strategies that could be used to deal with the imminent conflict between profound information and optimising placebo and nocebo responses. One key stone of these strategies is the pilot model. It helps to shape briefings as individually required and to promote the wellbeing and autonomy of our patients at the very same time.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2018
Review[Placebo Effects in Acute Pain Therapy].
Placebo and nocebo effects are currently within the focus of clinical and experimental pain research. Neurophysiological and psychophysiological mechanisms might play an important role. ⋯ Apart from that three different psychological mechanisms might be relevant for placebo and nocebo effects: classical conditioning, social learning and pain expectation. An open analgesic drug application, detailed patient information about efficacy and possible adverse events (without an extensive focus on it) of perioperative analgesic drugs and interventions and an active involvement of the patient in pain therapy (e.g. by using patient-controlled analgesia) might improve acute pain therapy via an additive placebo effect (by around 30%).
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2018
Review[Synopsis Neuroanesthesia: Brain, Anesthetics and Skills].
Central aspects of anesthesia management of intracranial interventions are the maintenance of cerebral homeostasis and the prevention of secondary brain damage. The focus is on cerebral metabolism and perfusion pressure, cerebral blood flow and intracranial pressure. ⋯ These include clinical cases of elective tumor resection to wake craniotomy. Furthermore this review covers emergencies with acute intracranial pressure increase and intracranial hemorrhage.
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A Rapid Sequence Induction and Intubation (RSI oder RSII) is a standard technique for emergency airway management and anaesthesia. The aim of an RSI is to prevent aspiration by fast endotracheal intubation without the use of facemask ventilation. Today, only few European countries have specific guidelines for RSI. ⋯ A gastric tube should be left in place; it is not necessary to remove it. If no gastric tube is in place, it can be positioned after intubation. An opioid should be administered prior to RSI since it may reduce the dosage of the hypnotic drug and, therefore, side effects, too.