Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2010
[Opioid induced cough: Do we know its pathophysiology and can it be eliminated?].
The (intravenous) administration of opioids is frequently associated with the induction of cough. This phenomenon is usually neither harmful for the patient nor bothersome. ⋯ Based on experimental investigations in accordance with clinical findings this systematic review of the existing evidence helps to guide the management strategy if opioid induced cough should be avoided. Promising strategies - among others - in order to achieve this aim consist for instance of decreasing the injection speed in conjunction with pre-administration of lidocaine or clonidine.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2010
Review[Prevention of perioperative hypothermia].
Inadvertent perioperative hypothermia impairs postoperative outcome in surgical patients due to ischemic myocardial events, wound infections and coagulation disorders. Body core temperature should be assessed 1-2h preoperatively and continuously during surgery. ⋯ Warming of IV fluids is effective if infusion rates are above 1l/h. Core temperature should be measured in the recovery room and active warming should be started when patients are hypothermic or if they feel cold.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2010
Review[Complications of spinal anesthesia and how to avoid them].
Spinal anesthesia is a safe procedure. The knowledge of complications may support efforts to minimize risks, speed up the recognition process and lead to adequate timely therapeutic approaches. Pain during insertion of the needle can be a warning signal for potential conus damage. ⋯ In case of a high degree of suffering the best currently available treatment is the epidural blood patch. Further complications like intracranial bleeding, infection, cauda equina syndrome or spinal hematoma need immediate differential diagnosis and therapeutic approaches. The residual risk for permanent harm can be estimated to be around 0,02 per thousand.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2010
Comparative Study[Cost-effectiveness of peridural and intravenous analgesic schemes].
Compared to patient controlled intravenous analgesia (PCIA) peridural analgesia is considered as more effective but more expensive for the treatment of postoperative pain after major abdominal surgery. The aim of the analysis was to assess the incremental cost-effectiveness ratio and to relate the cost to time (per 1 day) and pain reduction (per 1 step on a pain scale). Systematic literature research on Medline and the Cochrane library were conducted. ⋯ The cumulative weighted mean difference for 4.5 days of therapy was 63.33 mm on a VAS in favour of the PDA. The overall costs of the PDA amounted to 305.35 euro and of the PCIA to 137.74 euro. The incremental costs came to 26.48 euro per day and one unit of pain reduction.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2010
Review[If delirium is not monitored it will often be not detected].
The reported incidence of delirium in critically ill patients ranges widely - from 11% to 87%. Both in the recovery room as well as in the intensive care unit postoperative delirium is the most common psychiatric disease. ⋯ Recent studies could show that the use of a validated delirium assessment tool significantly improves the ability of physicians and nurses to detect delirium in ICU patients. The following article gives a review about different assessment tools of ICU delirium and focuses on the differences between validated delirium scores.