Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2019
[Stroke Thrombectomy: Anaesthesiologic Aspects].
Ischemic Stroke is a focal neurological deficit based on an acute ischemia. rt-PA lysis and thrombectomy are therapeutic options. Thrombectomy can be performed under local anaesthesia, sedation or general anaesthesia. ⋯ The following prospective, randomized trials could not detect harmful effects of general anaesthesia. Nonetheless in anaesthesia care of ischemic stroke patients many (patho-)physiological and pharmacological aspects should be taken into account for the best neurological outcome.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2019
Case Reports[Intrahepatic Hematoma and Pulmonary Embolism in a Young Woman with Oral Contraceptives Complicated by Type II Heparin Induced Thrombocytopenia Requiring ECMO-Therapy: a Case Report].
A 46-year-old woman on oral contraceptives developed an intrahepatic hematoma due to a benign hepatic tumor. As an incidental finding, a computed tomography showed a pulmonary embolism. Unfractionated heparin was given in a prophylactic dosing in an attempt to balance the risk of further intrahepatic bleeding with that of thrombosis. ⋯ After hemodynamic and pulmonary stabilization, six days after ECMO-support the cannula was scheduled to be removed. On removal of the venous cannula the patient developed another massive pulmonary embolism with cardiac arrest which led to immediate reinstallation of va-ECMO. Under therapeutic anticoagulation using argatroban the ECMO support continued until the patient was on day 17 successfully weaned.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2019
[Anaesthesia in Adult Patients with Obesity].
The prevalence of obesity has substantially increased worldwide during the last ten years. Hence, more anaesthetic procedures will be performed in obese patients in the future and more hospitals have to be prepared for the perioperative treatment of extremely obese patients including medical, technical and organisational issues. These include not only the management of the perioperative problems of adiposity, but also of its numerous concomitant diseases. ⋯ Preoxygenation is improved by continuous positive airway pressure (CPAP). In this educational review, a summary of the currently known facts regarding anaesthesia in obese patients is outlined together with future perspectives. Regional anaesthesia is also recommended for postoperative pain therapy.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2019
[The Critically Ill Obese Patient: Too Big to Fail?]
Worldwide, currently more than 1.9 billion adults are overweight, 650 million of them are obese. Hereby they pose a significant burden on the budget of the health system and on the workload of intensive care units. Mechanical ventilation of critically ill obese patients needs to take into account the characteristic pathologic alterations of their respiratory system. ⋯ Failure to do so may result in obesity supine death syndrome. Finally, latest research documented lower mortality rates in obese individuals who require intensive care. This represents another hard to explain obesity paradox.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2019
[Ultrasound-Guided Regional Anaesthesia in Obesity].
Obesity is associated with a number of anaesthesia-relevant risks. Regional anaesthesia procedures offer a number of advantages, but they also pose an anaesthetic challenge. ⋯ The use of ultrasound (US) technology with the ability to visualize the target structures may be helpful in performing neuraxial and peripheral blockades. However, a lot of experience and training is required because the ultrasound imaging of very low-lying nerves in obese patients is limited due to the physical limitations of US technology.