Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2009
[Withholding and withdrawing therapy--how does the physician make a decision?].
To make a decision concerning the withholding and/or withdrawing of therapy is one of the most difficult tasks in medical care. Similar to other treatment decisions, initiation and interruption of therapy should be guided by the medical indication and, in principle, requires informed patient consent even during end-of-life care. However, especially in this situation, patients are frequently not able to give informed consent or to clearly express their wishes regarding therapy. ⋯ In order to reach a unanimous decision with relatives and also within the medical team, it may be helpful as a first step to withhold an escalation of therapy for a limited time, while daily reassessing the situation, before it is actively reduced. In Germany, health-care professionals do not always feel certain about the question of whether an active reduction of medical therapy is, in fact, active or passive euthanasia. The German Federal Court of Justice, however, has explicitly stated that withholding and withdrawing therapy is passive euthanasia and as such is legal.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2009
[Sugammadex--a new era in the antagonsim of muscle relaxants].
Cyclodextrins consist of rings of sugar molecules with a lipophilic core and a hydrophilic periphery. Thus they are well soluble in water and possess the ability to bind (encapsulate) steroid molecules. ⋯ It is now possible to terminate a neuromuscular blockade via an intravasal encapsulation of rocuronium far distant from the neuromuscular endplates and avoiding the side effects associated with acetylcholinestase inhibitors instead of by an intervention in the acetylcholine system. Furthermore, it has been found that even deep neuromuscular blockades can be reversed within 2 minutes by means of this novel mechanism.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2009
Review[Cerebral microdialysis. Options and limits].
Cerebral microdialysis (CMD) is a minimal-invasive monitoring technique for patients with subarachnoidal haemorrhage or severe traumatic brain injury, which allows the investigation of a wide spectrum of compounds in the brain tissue. The aim is a precocious identification of cerebral ischemia and secondary brain damage. ⋯ By using commercial equipment it is nowadays possible to conduct on-line analysis at the bedside in the intensive care unit. The following article discusses the principles of CMD, the most commonly used biomarkers and the options during neurointensive care.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2009
Review[Postoperative nausea and vomiting: rational algorithms for prevention and treatment based on current evidence].
Postoperative nausea and vomiting (PONV) constitutes a major unpleasant symptom in the postoperative period. The prevention of PONV is judged equally important as the prevention of postoperative pain. Therefore, a working PONV-algorithm should be as self-evident as the approach to prevent and treat postoperative pain. ⋯ However, due to the difficulties associated with the implementation of risk-score based algorithms and the inherent weaknesses of clinical risk scores to predict PONV in an individual patient, a general (multimodal) approach seem to be justified as well. Considering the fact that the currently available antiemetics are associated with few side effects, the administration of prophylactic antiemetics should not be associated with a high hurdle in the clinical setting. In case of any doubts regarding the individual risk, it seems justified to expand the (multimodal) prophylaxis rather than to wait until PONV occurs and impairs patient comfort.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2009
Review[Postoperative nausea and vomiting. Identification of patients with risk factors for PONV].
This review discusses the clinical relevance of risk stratification to determine measures to prevent postoperative nausea and vomiting. The key question is whether PU&E is a problem related only to a small group of risk patients and whether risk stratification is a reasonable approach to deal with this problem. The application of risk scores to predict PU&E has been strongly advocated in the past years. ⋯ Prophylaxis against PU&E should be as self-evident as measures to limit postoperative pain. Omitting antiemetic prevention should only be considered if the estimated risk for PU&E is extremely low. All other patients in whom PU&E cannot be ruled out with high confidence should receive routine antiemetic prophylaxis.