Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2021
[Perioperative Anesthesiologic Management: Risk Assessment and Preoperative Improvement of Patient Conditions].
With patient safety being anesthesiologists' top priority, the focus of preoperative assessment must be to reduce perioperative morbidity and mortality of each patient entrusted to us. Perioperative risk is multifactorial and depends on the extent of surgery and the preoperative condition of the patient. The three main causes of unexpected perioperative death are cardiac arrest, hypoxemia and acute bleeding. ⋯ Prehabilitation strategies reduce perioperative mortality and morbidity by improving functional capacity. These include preoperative nutrition supplementation, physical exercise, correction of iron deficiency and optimized treatment of hyperglycemia. A combination of thorough risk stratification and prehabilitation strategies can improve preoperative conditions and reduce complications in the postoperative period.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2021
[The Guideline "Sedation for Gastrointestinal Endoscopy"].
The guideline "Sedation for gastrointestinal endoscopy" (AWMF-register-no. 021/014) was published initially in 2008. Because of new and developing evidence, the guideline was updated in 2015. ⋯ Essential aspects are the selection of sedatives/hypnotics, structural requirements, personnel requirements with regard to number, availability and training, management of complications and quality assurance. In this article, the development and evaluation of the evidence and its influence on the practical implementation, in particular for anaesthesia, are highlighted.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2021
[Perioperative Management: From the Operating Room to Postanesthesia Care Unit/to the Normal Ward].
The early postoperative period is of increasing importance in modern operative medicine with a continuously increasing surgical spectrum and patients with increasingly complex comorbidities. Even with optimal preoperative evaluation and intraoperative care, postoperative complications are not uncommon. ⋯ The qualification of the medical staff and spatial structure must meet the recommended minimum and must be in line with the existing operational structures. Good interdisciplinary and interprofessional communication reduces the loss of information and a good error reporting culture helps to reduce critical incidents.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2021
[Perioperative Management: from the OR to the ICU].
Patients who undergo high-risk surgical procedures represent a large proportion of admissions to intensive care units. Postoperative outcomes are a result of the complex interplay between the exact surgical procedure performed, the previous health of the patient, and specific intra- and postoperative events. Appropriate triage of patients to intensive care postoperatively may have a relevant impact on patient outcomes after high-risk surgery. ⋯ Intrahospital transports are prone to adverse events and need careful preparation to be executed safely. In addition, exchange of clinical information during the transfer of responsibility between anesthesiologist and the intensive care physician has been recognized as a high-risk area for medical errors to occur. Structured handover protocols can reduce communication breakdowns during postoperative transfer of patients from the OR to the ICU.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2021
[Spinal Analgesia - Cleverly Used for Vaginal Delivery].
Neuroaxial procedures are among the most effective ways of relieving pain during childbirth. Especially in the late phase of vaginal delivery, surprising moments, instrumental methods or special maneuvers require quick and sufficient analgesia. This refers to situations with a sudden, often unexpected and particularly pronounced intensity of pain. ⋯ There is no possibility of repetition without re-puncture, so that limited duration of action is a significant disadvantage. Applied drugs correspond to those described for combined spinal and epidural analgesia, such as a mixture of low-dose bupivacaine and sufentanil, and can be adapted to local conditions. In the future, longer acting substances could overcome the main limitation (temporary effect) of spinal analgesia and suitable adjuvants could further increase the attractiveness of the procedure.