Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Sepsis as a development of an acute infection-related organ dysfunction significantly increases the risk of death for the patient. Therefore, fast and consistent management is required. The sepsis bundle is a convenient algorithm for initial sepsis therapy within the first hour of sepsis diagnosis consisting of blood cultures, lactate measurement, antibiotics, fluid resuscitation, and vasopressor therapy. ⋯ Goal of resuscitation is to achieve lactate clearance. In shock refractory to therapy, addition of hydrocortisone (200 mg/day) should be considered. Further additional therapies such as immunoglobulins, blood purification, and metabolic resuscitation (combination of hydrocortisone, thiamine, vitamine C) are currently not supported by studies and should not be considered as standard therapy.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2022
[Prehabilitation for Preparing Older People with Frailty for Surgery].
Older people demonstrate a higher risk for the occurrence of peri- and postsurgical complications. A frequent risk factor for this is the prevalence of a status called "frailty". ⋯ In this article, we describe the concept of prehabilitation, its options to adapt and design this new form of intervention, as well as presenting current evidence. An actual project and a case example on prehabilitation provide an example and outlook.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2022
Review[Caudal Anesthesia: Overview and Practical Recommendations].
Caudal anesthesia is one of the most commonly performed forms of regional anesthesia in childhood, which is relatively easy to learn and very effective. Indications for sacral block are all interventions below the costal arch. The puncture can be performed on premature babies and children up to 50 kg body weight. ⋯ Bupivacaine and ropivacaine can be combined with adjuvants such as clonidine, morphine or ketamine, which lead to a prolonged effect. In selected patient groups, the operation can also be performed under caudal anesthesia with sedation in order to maintain spontaneous breathing and avoid respiratory complications. This review article gives an overview of caudal anesthesia and offers practical instructions for blocks during general anesthesia and sedation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2022
Review[Frailty Diagnosis in Different Settings].
Frailty Syndrome has been recognized in several settings as a major predictor of negative outcomes. A frailty diagnosis can have important consequences for clinical decision-making and provides the opportunity to implement preventive strategies. ⋯ Diagnostic tools must be based on the resources available and on their relevance for the particular setting. The current review offers insights on current models and the most successful diagnostic instruments used in the anesthesia, intensive care, emergency, and palliative settings.