Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2015
["Symptomatic Treatment of Delirium, Anxiety and Stress, and Protocol Based Analgesia, Sedation and Management of Sleep in Intensive Care Patients"].
Critically ill patients suffer from anxiety, stress, pain, sleep disturbance and delirium. The updated version of the German evidence and consensus based guideline "Analgesia, Sedation and Delirium management in Intensive Care - DAS 2015" contributes an improved therapeutic management and is aimed to improve clinical outcome based on the current state of evidence. The task force members were representatives from 17 national medical societies therefore have consented following guiding principle in common: "Patients in intensive care shall be awake, alert and free of pain, anxiety and delirium, to be able to participate in the healing process actively."
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2015
[Transcatheter aortic valve implantation - What does the anaesthetist need to know and pay attention to?]
Recent advancements in the field of cardiovascular surgery have been dominated by 3 aspects that comparably challenge a sophisticated cardiological, surgical and anaesthesiological management of this patient population. The proportion of elderly patients with relevant comorbidities increases steadily, and the number of combined cardiac surgical procedures is rising in this elderly population. ⋯ These patients relevant comorbidities accounting for a high risk of perioperative complications and moreover for a high mortality. The combination of a patient at high risk with the specific characteristics of the TAVI procedure necessitates to update the required skills of anaesthetists responsible for providing care for this kind of procedure.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2015
[Analgesia, sedation and delir-Treatment of patients in the neuro intensive care unit].
Analgesia and sedation of patients in the neuro intensive care unit, in particular in case of intracranial hypertension, remains a challenge even today. A goal for analgesia and sedation should be set for each individual patient (RASS -5 in case of intracranial hypertension) and should be re-evaluated repeatedly based on standardized scores (RASS plus EEG monitoring where appropriate, NCS). There are no sufficient evidence-based sedation algorithms in this patient cohort. ⋯ Propofol and benzodiazepines are equally safe and effective with shorter wake up times for propofol. The use of barbitarutes is restricted to intractable intracranial hypertension or status epilepicus. Evidence for alpha-2-adrenoceptoragonists and inhalative sedation is poor and requires further research.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2015
[Mind the explosion? The evolution of safety at work in anaesthesiology].
The evolution of safety in anaesthesiology is characterized by 2 aspects: exposure of anaesthetic staff by volatile anaesthetics and fire as well as explosions in combination with those. In the 20th century, the exposure of staff in the operating room became more and more important. Trigger for the fatal complications were gas lights in combination with chloroform. ⋯ Therefore safety rules were implemented in the 1980s in the Federal Republic of Germany. These were valid for application anaesthetics including apparatus and configuration of operating rooms. The only imponderability is still the human factor.