Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2009
Review[Remifentanil-PCA to alleviate labor-pain - a true and safe alternative to epidural labor analgesia?].
Labor-pain analgesia in the absence of epidural analgesia is difficult to achieve with the commonly used analgesic interventions. If epidural analgesia is not feasible due to coagulation disorders, anticoagulation, inability to insert an epidural catheter or on the mother?s request, there is a need for interventions to cope with labor-pain. For a decade, anaesthesiologists have experienced the unique properties of remifentanil in the settings of surgical anaesthesia, sedation and postoperative analgesia since its introduction into labor analgesia. ⋯ Therefore it is the onus on us to justify the use of remifentanil as off-label drug for obstetric analgesia on the basis that the benefit outweighs the risk. Proper informed consent, appropriate monitoring for the mother and the newborn, one-to-one nursing or midwifery care as well as the availability of an attending physician experienced in neonatal resuscitation and an anaesthesiologist with experience regarding the use of remifentanil is important to ensure that this method retains its credit for obstetric analgesia. These issues are discussed in an interdisciplinary approach.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2009
Review[Anaesthesia for interventional procedures].
Interventional radiologists perform a wide range of procedures. The anaesthesiologist takes care for provision of a physiologically stable and immobile patient, alteration of arterial blood pressure as necessary, and appropriate and timely management of complications. In this article we discuss the anaesthetic considerations for procedures like embolization of arterio-venous malformations, coiling of cerebral aneurysms, kyphoplasty and vertebroplasty including the preprocedure preparation, monitoring requirements, suitable anaesthetic techniques, postprocedure management and complication.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2009
Review[Treatment of herpes zoster and postherpetic neuralgia].
Herpes zoster, a biphasic disease with different kinds of pain is a challenge for pain therapy. The acute illness with mixed pain (nociceptive - neuropathic) requires antivirals for risk patients and pain treatment according to rules of acute pain therapy. For treatment of postherpetic neuralgia (PHN) an example of neuropathic pain, antidepressants, anticonvulsants and topical lidocaine are today the first line therapeutics, further opioids are of a certain therapeutic value.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2009
Review[Special anaesthesiological requirements in bariatric surgery].
Obesity is a growing healthcare problem in all industrial countries, which occurs with increasing frequency in young people and indicates bariatric surgery. Obesity increases the risk for pulmonary and cardiovasculary side effects and also the anaesthesiologist is confronted with significantly more problems when the patient is overweight and obese. The present review focuses on the surgical techniques and the anaesthetic implications of bariatric surgery.