Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2021
[Fluid and Volume Therapy with Crystalloid and Colloidal Infusion Solutions].
A rational infusion therapy orchestrates fluid- and volume therapy based on the individual indication and situation. The principle of fluid replacement is to substitute ongoing fluid losses such as insensible perspiration and urine output or to treat dehydration with balanced crystalloid solutions. Volume therapy in contrast is the quick restoration of intravascular losses such as an acute blood loss through application of balanced colloids or crystalloids. ⋯ Whether colloid or crystalloid infusions are most suitable for volume therapy remains unclear. Most trials in this field are either underpowered or used colloids in inadequate situations, patients and amounts. Two major trials from the European Society of Anaesthesiology and Intensive Care (ESAIC) are underway that seem promising to provide evidence in this emotional debate.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2021
[Solutions for Fluid Treatment and Outcome - an Update].
Fluid therapy is one of the most frequently used medical interventions with the aim of normalizing the fluid balance. A decisive criterion for the efficiency of fluid or volume replacement is the functionality of the glycocalyx, a thin endothelial glycoprotein layer. Its solidity is an essential factor for fluid exchange and transport from the vascular system to the tissue. ⋯ At least in Europe, some synthetic colloids shall therefore no longer be used in critically ill patients. In contrast, treatment with albumin 20% in hypalbuminemic patients with cardiovascular disease leads to a reduced incidence of acute kidney injury and has also been associated with other clinical benefits. To what extent future, individualized therapeutic approaches employing colloids will influence the outcome is currently speculative.
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Fluid and volume therapy is of paramount importance in anaesthesia and intensive care medicine. Fluid replacement as well as volume therapy can cause hypervolemia with deleterious consequences. ⋯ However, there are several limitations of the different monitoring techniques that the user should be aware of. An algorithm can be helpful for a structured approach in monitoring volume therapy.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2021
Case Reports[Sectio Caesarea under Gitelman Syndrome].
Gitelman syndrome is a rare inherited renal tubulopathy characterized by hypokalemia, hypomagnesemia and metabolic alcalosis. It is caused by a mutation in the SLC12A3 gene leading to a dysfunction of the thiazide-sensitive sodium chloride cotransporter and the magnesium transporters in the distal convoluted tubules. ⋯ Due to many unsolved questions about the impact on pregnancy and the maternal and fetal outcome, the obstetric and anesthesiological management remains a challenge. We discuss the case of a primary cesarean delivery in a 22-year-old woman with a new diagnosed Gitelman syndrome focusing on the anesthesiological approach.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2021
[Cannabis as Medicine: Safe Use of Special Regulations].
In 2017, the legislator created a special regulation for medical cannabis in Germany. Medical cannabis can also be prescribed without marketing authorization at the expense of the statutory health insurance, if other forms of therapy are not sufficiently effective. Before starting therapy with a cannabis medicine outside of approved indications, an application for reimbursement must be submitted to the health insurance company. ⋯ According to first interim results of this survey, many side effects have an influence on the vigilance of patients. The risk of falling is increased, especially in older patients. In the medium term, the special regulation described above should become dispensable due to the approval of cannabis-based finished medicinal products.