Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2012
Review[Fluid management: goal-directed therapy].
Goal-directed fluid therapy (GDT) is one important step in perioperative therapy as it improves complication rate and mortality by optimisation of oxygen delivery. There is a convincing evidence for GDT when used early, before organ failure occurs, and in high-risk patients. Moderne algorithms use goals derived from advanced haemodynamic monitoring and are based on the concept of fluid responsiveness and optimisation of global perfusion. Future investigations will have to prove the advantage of using the new less or non-invasive haemodynamic monitoring devices or automatic closed-loop fluid administration systems for GDT.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2012
Review[Anesthesia in endoscopic and percutaneous procedures in cardio-thoracic and cardiovascular interventions, Part 1-- percutaneous aortic valve replacement and mitral valve repair].
Further development of surgical techniques and instruments provide complex endoscopic or transcatheter guided interventions in thoracic organs. However, minimalinvasive surgery does not mean minimalinvasive anaesthesia. ⋯ Considering the surgical procedures, this review describes the anaesthesiological management for transcatheter aortic valve implantation (TAVI) and percutaneous mitral valve repair. Furthermore it focuses on the anaesthesiological management of pitfalls and complications related to the surgical procedure.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2012
[Retrograde intubation in an emergency situation - indication, technical performance, risks and pitfalls].
Retrograde intubation is an alternative technique to endotracheal intubation. It is used for the management of expected or unexpected difficult intubation. The indication for use of this technique is, above all, a situation in which a flexible bronchoscope, a video laryngoscope or other alternative devices are not available or, respectively, when their use is - or appears to be - not possible due to bleeding and secretions or other particular anatomic pathological conditions. ⋯ The present article describes the technical steps of retrograde intubation and discusses its possible risks and pitfalls. Furthermore, modifications that facilitate the technical procedure are presented. This contribution is intended to promote the acceptance and use of this less invasive technique in order to avoid possible injury to the patient due to hypoxia, trauma of the airways, and surgical emergency procedures or tracheotomies during the management of difficult airway conditions.