Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2021
[Myths and Legends: Electrocardiographic Position Control of Central Venous Catheters - Where Does the P Come from?]
Misplacement of central venous accesses can be associated with deleterious iatrogenic complications. Electrocardiography is often used to guide the placement of central venous catheters and to confirm the correct position of the catheter tip. ⋯ However, recent data show that intraarterial and even extravascular localisation might result in an increased amplitude. The peaked p-wave most likely detects the pericardial reflection rather than a right atrial catheter position, hence real-time ultrasound is to be recommended as a superior technique to confirm a correct catheter position.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2021
Review[Proper Perioperative Handling of Continuous Medication in Patients with Cardiac Comorbidities].
Cardiac comorbidities place a significant burden on the German population. Every third adult is diagnosed with arterial hypertension (AHT). In 2017 congestive heart failure (CHF) pertained approximately 2,5 million of mandatory health-insured patients. ⋯ Recommendations for the perioperative discontinuation or continuation of cardiac active drugs vary between countries and responsible medical societies. This article provides an in-depth review of the current medical therapies for cardiac conditions like AHT, CHF or CAD. The varying recommendations for the perioperative discontinuation/continuation of these therapies are also reviewed.
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Analysis of preoperative medication is used to assess the benefit and risk associated with continuing or discontinuing medication before and during surgery. Identifying adverse drug reactions and assessing its risks often leads to uncertainty. Typical challenges are medication underuse, but also overuse occurs and is often more difficult to recognize, especially in the context of drug interactions and individual patient characteristics. ⋯ Older, multi-morbid, and multi-medicated patients are often affected by adverse drug reactions. For drugs primarily metabolized via the phase I enzymes CYP2D6, CYP2C9, or CYP2C19, pharmacogenetically rapid or slow metabolism may result in altered drug exposures. Clinically relevant pharmacokinetic drug interactions frequently occur with drugs primarily metabolized via the phase I enzyme CYP3A4.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2021
Case Reports[Perioperative Ketoacidosis under SGLT2-Inhibitors].
Sodium-glucose cotransporter-2-inhibitors are relatively new substances for treating patients with diabetes mellitus. Not least because of their rare, but severe side effects - especially euglycemic ketoacidosis - anaesthesiologists and physicians in intensive care should know about the pharmacologic properties and risk profile of sodium-glucose cotransporter-inhibitors. ⋯ It describes the diagnostic and therapeutic steps and emphasizes the importance of withholding the substances under catabolic conditions. Especially in the perioperative setting it is highly relevant to consider euglycemic ketoacidosis as a differential diagnosis in the presence of a metabolic acidotic state, because a delayed diagnosis and treatment could be life-threatening for the affected person.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2021
[Perioperative Management of Long-term Antidiabetic Therapy in Patients with Diabetes Mellitus].
Drug therapy, as well as diabetes technology, e.g. insulin pumps or sensor glucose measurement, have developed enormously in recent years. Their use differs according to the type of diabetes, secondary or concomitant diseases, and individual factors and target values. In the perioperative phase, diabetic patients are generally at increased risk of complications, including a derailment of glucose metabolism, an increased rate of cardiovascular events, worsening of preexisting renal insufficiency, and increased incidence of wound infections. ⋯ Insulin therapy is also evolving; knowledge of new preparations and of insulin pump therapy facilitates perioperative management. Both hypoglycemia and hyperglycemia, possibly with ketoacidosis, must be avoided. The purpose of this article is to provide an overview of the management of long-term medication in patients with diabetes mellitus.