Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2022
[Anaesthetic Management of Non-intubated Video-assisted Thoracic Surgery].
Non-intubated thoracic surgery is currently gaining popularity. In select patients and in experienced centres, non-intubated approaches may enable patients to safely undergo thoracic surgical procedures, who would otherwise be considered at high risk from general anaesthesia. While non-intubated techniques have been widely adopted for minor surgical procedures, its role in major thoracic surgery is a topic of controversial debate. ⋯ This includes surgical and anaesthetic criteria for patient selection, suitable regional anaesthetic techniques, concepts for sedation and maintenance of airway patency as well as the management of perioperative complications. Non-intubated thoracic surgery has the potential to reduce postoperative morbidity and hospital length of stay. Successful non-intubated management depends on a standardised and well-trained interdisciplinary approach, especially regarding patient selection and perioperative complications.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2022
[Ultrasound Guided Regional Anesthesia in Thoracic Surgery].
Perioperative analgesia plays an important role in thoracic surgery, regarding not only patient satisfaction, but also in preventing postoperative complications such as pneumonia. Ultrasound-guided thoracic wall blocks close the gap between opiate based and neuraxial pain management concepts. ⋯ In summary, the anterolateral blocks are supplementary blocks in an opiate sparing, multimodal anaesthesia concept, whereas the dorsal procedures, as they include visceral anaesthesia, are an alternative to neuraxial anaesthesia, as they have a comparable analgetic potency. For minimally invasive thoracic surgery, where due to risk-benefit considerations epidural anaesthesia is omitted, thoracic wall blocks can be utilized in a single shot or a continuous, catheter-based approach.
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In the last decade robotic-assisted thoracoscopic surgery (RATS) emerged as a new minimally invasive surgical modality to operate pulmonary, mediastinal and esophageal diseases. Superior to video-assisted thoracoscopic surgery (VATS), RATS affords accurate surgical manipulation in spatially confined anatomical regions. Numerous surgical case studies demonstrated technical reliability and oncological equivalence of RATS compared to open surgery and VATS. ⋯ The lacking evidence of therapy improvement in the context of significantly increased treatment costs slows the development. Currently, various new companies introduce new robotic surgical platforms into the market and it is expected that market competition will change the costs of these modern therapies. This article summarizes the technical features of RATS and its anesthesiologic implications for patient management.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2022
[The Stadium analgeticum - Historical Highlights on the Ether Rush].
For decades, the term ether rush was synonymous with the practice of short-term anaesthesia, among patients and doctors. The term was first used shortly after the discovery of the anaesthetic properties of ether by Hamburg-based physician Elias Salomon Nathan in an article about the newly discovered ether anaesthesia. Decades later, the surgeon Paul Sudeck, who also worked in Hamburg, also described an anaesthetic technique he practiced as an ether rush and met with great approval from his surgical colleagues, as well as for his anaesthetic mask developed for carrying out the ether rush and the anaesthetic dropper, specified for this purpose. ⋯ Nevertheless, Sudeck's ether rush remained a well-known, widespread analgesic method in German-speaking countries until the end of the 1940s, and it proved its worth many times during the World War. After 1945, when ether lost its pre-dominant role as an inhalation anaesthetic and was replaced by other, new agents and short-acting i. v. administered analgesics, the ether rush was also fell into oblivion and was no longer used. Against the background of the first successfully performed ether anaesthesia on October 16th, 1846 - 175 years ago - at the Massachusetts General Hospital in Boston, the description of the ether rush should be recalled in this context.