Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Management of ischemic stroke is targeted on four therapeutic objectives: limitation of neurological deficit, prevention of earyl stroke recurrence, protection against complications, and secondary prevention. Intravenous thrombolysis within 4.5h of stroke onset is the only proven therapy to improvefunctional outcome. ⋯ Subcutaneous heparin/low molecular weight heparin, mobilisation, nasogastric tube, and decompressive craniectomy may protect from venous thromboembolism, aspiration pneumonia, and malignant brain edema, respectively. Secondary prevention is guided by stroke etiology, e.g. oral anticoagulation in the presence atrial fibrillation or endarterectomy in case of sympomatic high-grade carotid stenosis.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2014
Review[Ischemic stroke - Interventional therapy].
In addition to the long-established local thrombolysis by means of a catheter, other mechanical procedures for the interventional treatment of acute ischemic stroke have been introduced over the last ten years. These new methods have proved to be effective for the recanalization of occluded vessels supplying the brain and can, in principle, also be employed outside of the therapeutic window valid for intravenous thrombolysis. ⋯ Since this is still a very new therapeutic procedure it has not yet been conclusively demonstrated that the interventional method, in spite of all theoretical advantages in comparison with intravenous thrombolysis, really does lead to a better outcome for the patients. The indication must thus be made on an individual basis at the interdisciplinary level.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2014
Case Reports[Risk factors for adverse reactions after protamine administration in adult patients undergoing cardiac surgery- a case report and literature review].
Protamine is a protein mainly used to reverse anticoagulant effects of heparin during cardiac or vascular surgery with extracorporeal circulation. Adverse events after protamine administration are rare but if they occur they can be catastrophic. Based on a case report with an elective cardiac surgery patient with known allergy to fish, we discuss the related events and risk factors for an adverse reaction after protamine. The patient management and its outcome are presented.