Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2019
Review[Anaesthesia in Patients with Pulmonary Hypertension].
The perioperative management of patients with pulmonary hypertension requires an in-depth knowledge of the underlying disease, its related pathophysiology, effects of anaesthesia and surgery, as well as the appropriate pharmacotherapy. With respect to preoperative assessment, it is essential to review all available diagnostic findings, evaluate the patient's physical state, and to plan the anaesthetic procedure. Intraoperatively, the prevention of increases in pulmonary resistance and right ventricular decompensation appears essential. ⋯ If the pulmonary artery pressure exacerbates, application of inhaled nitric oxide or prostacyclins (iloprost), phosphodiesterase-III-inhibitors (milrinone) and phosphodiesterase-V-inhibitors (sildenafil), reflect first-line treatment options. In order to support the right ventricle, inotropes (adrenalin, dobutamine, levosimendan) or inodilators (milrinone) increase its contractility. Dependent on severity of disease and the magnitude of surgical intervention, patients with pulmonary hypertension require a specific continuous monitoring as well as trained staff in the postoperative period.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2019
[Speckle Tracking Echocardiography - a New Tool for the Intensive Care Unit?]
The noninvasive evaluation of cardiac morphology and function by echocardiography is an essential part of modern intensive care therapy. However, this procedure can be challenging and beginners often lack the ability to objectively state the correct global and regional myocardial function. Recent developments allow a semi-automatic deformation (strain) analysis by a couple of more objective respective parametric techniques. ⋯ At the moment, a task force of leading echocardiography experts and industry personal is working on a solution. Normal values have been published for healthy collectives and STE has been in use in the majority of cardiac diseases. Besides from a few research studies, the usage in critically ill patients actually is still limited.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2019
Case Reports[A Fatal Case of Fulminant Necrotising Fasciitis in a 47-Year-Old Male].
Necrotising fasciitis (NF) is a rare soft tissue infection characterized by rapid progressive necrosis. Initially patients usually present with nonspecific symptoms like fever, severe pain and skin lesions that progress rapidly. It requires prompt recognition and early treatment with extensive surgical debridement and intravenous antibiotics. ⋯ NF has previously been reported in literature. Some assumed premorbid conditions associated with NF are diabetes mellitus, chronic kidney injury, adiposity, peripheral artery occlusive disease, arterial hypertension, intravenous drug abuse and immunocompromised state. Here we present a fatal case of NF in a 47-year-old male patient without any comorbidity after minor trauma with a fulminant septic course.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2019
[Increased Arterial Blood-Pressure Previous to Elective Surgery - How to Proceed?]
Guidelines concerning the widespread disease "essential arterial hypertension" have been available for a long time. Recently, the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and the British Hypertension Society (BHS) presented a guideline that is focused on the handling of patients suffering arterial hypertension previous to elective surgery. Is there any effort and/or benefit in postponing the operation? Within this guideline we find a concrete statement and recommendation how to deal with this question and how to evaluate the cardiovascular risk regarding this parameter.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2019
[Pulmonary Hypertension: Diagnostics, Classification and Therapy].
Pulmonary hypertension is a chronic, incurable disease with poor prognosis. The therapeutic aim is a stabilization of patients showing signs of right heart failure as well as disease progression. A pulmonary hypertension is diagnosed in patients displaying a mean pulmonary arterial pressure of > 25 mmHg in resting state. ⋯ For patients with atypical PAH, an initial monotherapy is to be introduced. In case of chronic thromboembolic pulmonary hypertension, the possibility of an operative pulmonary endarterectomy should be evaluated. To date, the only approved drug is Riociguat, a stimulator of the soluble guanylate cyclase.