Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2013
Case Reports[Modification of perioperative psychiatric drug therapy].
Apart from cardiovascular, pulmonary and metabolic drugs, many patients scheduled for surgery are taking antidepressive or antipsychotic drugs. Some of these psychiatric drugs may interfere with anesthetics. The anesthesiologist has to decide whether or not to continue the psychiatric medication during the perioperative period. ⋯ Prospective randomized data about the perioperative modification of psychiatric drugs are scarce. Thus, recommendations in this regard must rely on physiological and pharmacological principles, case reports and published expert opinions. In this article we use the available data to answer the question of a journal reader regarding the perioperative modification of Opipramol therapy for a 59-year-old patient scheduled for elective shoulder surgery.
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Awareness is a rare but in some cases severe complication of general anesthesia. In clinical practice vegetative signs such as sweating, lacrimation, tachycardia and hypertension are used to assess the anesthetic depth. Awareness however may also occur without any of these signs. ⋯ A similar reduction of the incidence was reached in studies using protocols based on concentrations of volatile anesthetics. Other systems to monitor anesthetic depth have been developed, but their influence on awareness has not yet been investigated sufficiently. Further studies are needed to clarify their impact concerning the incidence of awareness.
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Awareness is a rare but typical complication during general anesthesia, with a reported incidence of 0.1- 0.2% to 1% (high risk patients) in adults and probably much higher in children with 0.2 -1.2%. Awareness is defined as consciousness during general anesthesia with explicit (conscious) recall of memories. ⋯ Recommendations of the German Society of Anesthesiologists have been developed according to the ASA Task Force for intraoperative awareness and brain function monitoring. The article focuses on risk factors and sequelae of awareness, explains the options for detection of intraoperative wakefulness and postoperative memories and makes recommendations for prevention and handling of awareness.