Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2010
[Perioperative coagulation monitoring - medical and economic aspects].
For preoperative haemostatic assessment a structured questionnaire for the bleeding history of the patient should be primarily used. Only in case of abnormalities an additional laboratory coagulation testing is recommended. ⋯ In the event of acute acquired perioperative coagulopathy laboratory coagulation testing is a prerequisite for sophisticated and precise diagnosis and therapy. Points of care techniques like thrombelastography are capable to provide fast and extensive information.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2010
Review[Organ protection by conditioning].
Recent demographic developments challenge anaesthesiologists with an increasing number of elderly patients with cardiovascular comorbidities undergoing major surgery. Interventions that are capable to increase tissue tolerance against ischemia are of paramount importance. In this context, conditioning is defined as a mechanism that fosters tissue by specific adaptive processes to develop tolerance against a subsequent ischaemia. ⋯ Effective conditioning has been unequivocal demonstrated for various tissues in animal experiments. Clinical trials in patients undergoing cardiac surgery have provided evidence for organ protection by conditioning. Large scale multicenter randomised trials, however, are still needed.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2010
Review Case Reports[Neuromonitoring in anaesthesia].
Modern computer-based methods to monitor anesthesia are widespread. They are used in order to avoid awareness, to reduce consumption of anesthetics, to optimize recovery times and to detect prolonged times of deep anesthesia and associated immunsuppression, mortality and morbidity. ⋯ The useage of EEG-monitoring may help to avoid awareness and allows a reduced of consumption of anesthetics. The question if a cumulated time of deep anesthesia is associated with elevated mortality might be of a certain importance in the future.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2010
Review[Dental injury in anaesthesiology--risk group and liability].
Dental injury is one of the most anaesthesia-related complications. It can cause a patient's functional, esthetic, financial, and emotional annoyance. The incidence of dental injury is said to range from 1:6000 to 1:1000. ⋯ A tooth guard can be used as a prophylactic measure. However, with that tracheal intubation can be complicated because of the reduced view at the epiglottis and the vocal cords. If a dental injury occurred, the patient should be seen by a dentist as soon as possible to undergo appropriate treatment with no delay.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2010
Review[Organprotection in cardiac risk patients--rational of perioperative beta-adrenoceptor-antagonists and statins].
The number of patients with limited organ function is steadily increasing due to the aging of the population. Consequently, a growing number of patients needing surgery is accompanied by serious comorbidities. These patients are at high risk of perioperative organ dysfunction. ⋯ It should not exceed 60-70bpm at rest; (iii) the Revised Cardiac Risk Index (RCRI) is a widely accepted score to estimate the patient's perioperative cardiac risk; (iv) patients with a RCRI > or =3 should not be scheduled for routine surgery without sufficient beta-adrenergic-receptor blockade; (v) in patients at high cardiac risk based on the RCRI who are scheduled for emergency surgery beta-blocker-therapy should not be initiated de novo perioperatively. However, for perioperative treatment of tachycardia or hypertension beta-blockers are the drug of first choice. Concerning perioperative statin-therapy the following recommendations are suggested: (i) chronic statin-therapy should be continued throughout surgery and the perioperative period; (ii) in patients without chronic statin-therapy scheduled for vascular surgery this treatment should be started perioperativly; (iii) no data is available concerning other patient populations; (iv) if statin-therapy is indicated it should be started independently from baseline serum LDL-C-concentration; (v) side effects of statin-therapy are rare and usually not live threatening, thus treatment is considered to be without serious risks to the patient.