Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2015
[Perioperative heart failure - Preoperative Approach].
Heart failure is a common disease which is associated with an increased perioperative risk. In the following, we summarize pathophysiology, momentary treatment options and a preoperative approach to patients with heart failure.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2015
[Perioperative heart failure - Anesthetic management and monitoring].
Due to the demographic and medical development, the number of patients with heart failure needing anaesthesiological care will continue to grow in the upcoming years. For the optimal care of these patients close coordination between the surgically treating, the cardiology and the anesthesiological department is important. Cardiac function and structural characters, such as cardiac valve defects should be known preoperatively. ⋯ Especially in high-risk patients goal directed hemodynamic therapy is useful. For this, in addition to the established monitoring procedures, less invasive monitoring devices areincreasingly used. During an acutehaemodynamic instability, thetransoesophageal echocardiography is gaining importance due to its wide diagnostic evaluation.
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Endobronchial ultrasound-guided transbronchial needle aspiration can be used efficiently for pathological diagnosis of bronchial walls and surrounding structures. Patients with hemoptysis, fistulas or foreign-body-aspiration can be treated bronchoscopically, but remain a challenge for the hospital team involved.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2015
[Can anaesthetic management improve the outcome?].
Despite anaesthesia-specific pharmacological and technological innovations in the last decades we are definitely aware that anaesthesia per se has the potential to induce changes in the balance of human physiology that in turn may have relevant consequences, i.e. an increase in postoperative morbidity and mortality. Today anaesthesia appears to be extremely safe, with the number of deaths solely attributed to anaesthesia having reached its lowest point in history (0.055 per 10 000 anaesthetics). However, the available data regarding anaesthesia-related mortality, solely or contributory, are not consistent and the interpretation and legibility is limited. ⋯ Since most of the ideas are focused on intraoperative safety improvement strategies, it seems to be reasonable in the near future to expand to the complete perioperative period, especially the postoperative care on the ward in high-risk patients. This knowledge, combined with an ongoing promotion of patient safety in anaesthesiology and provision of adequate resources definitely will increase patient safety. Hopefully, in the end, our efforts will contribute to integrate the "patient safety in anaesthesiology concept" in daily clinical routine.