Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2020
Review[Recommendations on Hygiene in Regional Anaesthesia].
The true incidence of infectious complications related to regional anaesthesia and analgesia is not known but like any invasive procedure is has the potential for severe sequelae. This article gives an overview on hygiene requirements based on the S1-guideline "Hygiene recommendations on regional anaesthesia", current recommendations of the Robert Koch-Institute and current scientific insights. Basic hygienic standards (removal of jewellery, accurate hand disinfection, clean environment) are to be applied. ⋯ Skin disinfectant should be alcohol-based and contain a remanent ingredient (chlorhexidine or octenidine). Catheter tunneling may be protective when thoracic epidural catheters are used. When patient related factors (diabetes, obesity, immune suppression) and procedural factors (intended catheter use > 4 days, catheter site) are carefully weighed, an antibiotic prophylaxis may be taken into consideration.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2020
[Brain Death and Treatment of (Potential) Organ Donors and Interactions with their Relatives].
In recent years, the diagnosis of irreversible brain function loss in severely brain-damaged patients has gained in importance. Brain death, defined as an irreversible loss of the overall function of the cerebrum, cerebellum and brain stem, is a prerequisite for organ removal in the context of organ donation. The article presents the legal and organizational framework. ⋯ The DSO supports hospitals in many ways during the organ donation process, but also in training courses for medical staff on organ donation. The main contact person of the DSO is the transplant officer in the hospitals. The care of the relatives of a potential organ donor is of great importance.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2020
Review[Perioperative Anaesthetic Management of Patients after Heart and Lung Transplantation].
The outcome after heart and lung transplantation has improved significantly. Consequently, many patients are admitted to the hospital for routine surgical interventions that are initially non-transplant-specific. Some disorders lead to hospital admissions that affect other organ systems due to late consequences of the underlying disease or can be seen as early and late complications of the transplantation itself. ⋯ In these situations, the understanding of the physiology of the transplanted heart and lung, the consequences of the underlying disease and the post-transplant treatment with its peculiarities and risks is paramount. The anaesthetic management of these patients requires preoperative risk stratification and perioperative anaesthetic planning, but also responsibility for a suitable post-operative monitoring. This review article deals with the special anaesthetic consideration in patients after heart and lung transplantation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2020
[Infection Prevention in Anesthesiology during the SARS-CoV 2-pandemic].
It is necessary to discuss the sometimes competing goals of sufficient critical care capacity, maintenance of regular patient care, protection of medical staff, interruption of infectious chains within the general public and individual aspects of patient care in anesthesia and the operating room in times of the SARS CoV-2 pandemic, given the uncertainty of many data on which decisions need to be based. Basic hygiene remains the cornerstone of infection prevention especially when resources are sparse and SARS-CoV-2 specific additional measures need to be taken according to a risk analysis taking the dynamic of the pandemic as well as local factors into account.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2020
[Anaesthesia in Patients after Transplantation of Solid Abdominal Organs].
An ever-evolving and successful transplantation medicine is providing a large number of living patients after solid organ transplantation. Anaesthetists should therefore be prepared to come into contact with such a patient. In addition to the preoperative assessment of the pre-existing diseases, including the function of the transplanted organ, immunosuppression also plays an important role. ⋯ This includes the strict risk-benefit assessment of all invasive procedures. There are no significant differences between the anaesthetic approaches and agents in transplant and non-transplant patients. However, in the first group, homeostasis of all organ systems should be more focused on.