Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2011
Review[Prophylaxis and therapy of postdural puncture headache--a critical evaluation of treatment options].
Since the first description of spinal and epidural anaesthesia, postdural puncture headache (PDPH) is a well known complication. Its prophylaxis and treatment has been studied and discussed for more than 100 years, but the evidence is still limited. Due to relatively low prevalence of PDPH, prospective RCTs are often missing, and the frequently self-limiting character of PDPH impedes an adequate interpretation of results from studies without a control group. ⋯ Noninvasive therapies like theophylline, sumatriptan and ACTH can be an alternative. However, an evidence-based recommendation is lacking. The development of standard operating procedures for accidental dural punctures and PDPH is recommended.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2011
[Obstetric anaesthesia and analgesia--new aspects from the literature].
This review summarises the current (and controversial) topics in the field of anaesthesia and analgesia in obstetrics. In the British report "Saving mothers' lives 2006-2008" it is shown that the direct causes of maternal deaths are as before mainly sepsis, preeclampsia and eclampsia, thrombosis, thromboembolisms, and amniotic fluid embolism as well as haemorrhagic complications. ⋯ S. American statistics, in the meantime ones finds maternal and perinatal deaths and brain damage to be less frequent whereas liability claims due to nerve damage and back pain have increased, presumably as a result of the change away from the use of general anaesthesia to the use of regional anaesthesia in obstetrics.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2011
Review[In-hospital resuscitation--definitely better than in the field?].
Despite favorable conditions, in-hospital resuscitations do not lead to higher survival rates than those in the field. Recent studies show an average survival rate of 18%. One of the most important predictors for an unfavorable survival is a delay of defibrillation of greater than 2 minutes, which leads to a reduction of ROSC, 24-hour survival and survival to discharge. ⋯ A Medical Emergency Teams (MET) could intervene in such cases and thus decrease the likelihood of cardiac arrest. METs are more time-consuming and more labor-intensive than simple resuscitation teams, but these resources are well spent, as unexpected admissions to the intensive care unit can be avoided and patients receive treatment before their conditions deteriorate. Hospitals should therefore analyze and evaluate their internal emergency response plans.