Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2010
Review[Resistance to antibiotics and multiresistant pathogens].
Resistance to antibiotics and the directly related proportion of multiresistant bacterial pathogens (MRP) is increasing continuously. This applies particularly for intensive care units. ⋯ The reasons for this development are considered to be the increased morbidity of patients as well as the too frequent, too long-enduring and often inappropriate usage of antimicrobial substances. But also the increasing number of invasive measures and interventions as well as the still existing inadequate maintenance of hygiene standards and the inadequate establishment of non-medicamentous measures (e.g. hand disinfection) for infection prophylaxis play a significant role.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2010
[Regional anaesthesia and organ protection--the role of thoracic epidural anaesthesia].
Epidural anaesthesia results in a significant reduction of postoperative pain, opioid requirement and opioid related side effects. Additionally a reduction of duration of postoperative ileus and pulmonary complication has been shown, but influence on cardiac morbidity remains contradictory. Effects on mortality and long term outcome after tumor surgery is still a topic of intensive research. Positive effects of epidural anaesthesia should be intensively used in terms of intensive physiotherapy and postoperative mobilisation as well as early enteral nutrition to further improve outcome of the patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2010
Review[Hygiene standards for spinal anaesthesia].
Infections after performance of a spinal anaesthesia (SPA) are rare. Reports in the literature on the frequency of cases of meningitis that occur after a spinal anaesthesia vary between 3.7/100,000 and 7.2/100,000. Spinal abscesses after SPA have a calculated incidence of 1/1,260,000. ⋯ In 2006 the scientific working group "Regional Anaesthesia" of the German Society for Anaesthesiology and Intensive Care Medicine (Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI) published hygiene recommendations for the execution and further management of regional anaesthetic procedures that can be used for orientation. These recommendations are based to a large extent on guidelines of the Robert Koch Institute (RKI) for the prevention of infections associated with vessel catheters. When an infection occurs, a timely diagnosis with the help of MRI studies and, if necessary, liquor puncture as well as a rapid initiation of treatment is of decisive importance for the prevention of late squeals.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2010
Review[Spinal anaesthesia in day case surgery--Old technique--new trends].
Day case surgery is becoming more and more important. In order to perform these services cost-efficiently it is of primary importance to ensure that procedures can be scheduled with the largest possible patient satisfaction. Up to now spinal anaesthesia was of little importance in day case surgery due to prolonged nerve block and negative side effects especially when using long acting local anaesthetics. Since prilocaine and 2-chloroprocaine, two short acting local anaesthetics with a known low incidence of side effects, were recently introduced into clinical practice a reevaluation of spinal anaesthesia in a day case setting according to EMB guidelines still has to be done.