Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2009
Review[Modern airway management--current concepts for more patient safety].
Effective and safe airway management is one of the core skills among anaesthesiologists and all physicians involved in acute care medicine. However, failure in airway management is still the most frequent single incidence with the highest impact on patient's morbidity and mortality known from closed claims analyses. The anaesthesiologist has to manage the airway in elective patients providing a high level of safety with as little airway injury and interference with the cardio-vascular system as possible. ⋯ Supraglottic airway devices will be used more often in the daily clinical routine. This is not only due the multiple advantages of these devices compared to the tracheal tube, but also because of the new features of some supraglottic airways, which separate the airway from the gastric track and give information of the pharyngeal position. For the event of a difficult airway, new airway devices and concepts should be trained and applied in daily practice.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2009
[Postoperative nausea and vomiting--what's new in anti-emetic pharmacotherapy?].
Neurokinin-1 receptor antagonists represent a new approach in the prevention of postoperative nausea and vomiting (PONV) and show an efficacy comparable with those of common antiemetics with some evidence for superiority with regard to vomiting. Currently, only aprepitant is available as an oral preparation. ⋯ When using 5-HT (3)-receptor antagonists for the prevention of PONV, anaesthetists should be aware of negative interactions with analgesics. Low-dose droperidol has regained approval and should be considered as first choice among the current available neuroleptics.
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About 80 % of all extremity amputations suffer from phantom limb pain following the operation. In this context, it is important to differentiate between painful phantom limb sensations, non-painful phantom limb sensations and residual limb pain. The pathophysiology of phantom limb pain is not fully understood. ⋯ Another significant aspect of therapy is senso-motory training, important to mention here would be mirror therapy, lateralisation and motor imaging. In case of an elective amputation, an epidural or axiliar plexus catheter should be considered prior to the amputation. The perioperative treatment with ketamine is debated.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2009
[Hemostasis management in multiple trauma patients--value of near-patient diagnostic methods].
Massively transfused multiple trauma patients commonly develop a complex coagulopathy which needs immediate treatment. Near-patient diagnostic methods are available for the management of this coagulopathy and for the guidance of the therapeutic options with blood products and haemostatic drugs: conventional laboratory analysis methods adapted to the point-of-care (POC) situation (blood gas analysis, point of care PT, APTT and platelet count), and the complex whole blood methods used for near-patient coagulation monitoring (thromboelastometry and platelet function analysis). Based on the new Guidelines of the German Medical Association for the use of blood and plasma derivates, interventions with blood products and haemostatic drugs in multiple trauma patients are suggested. The diagnostic value of near-patient methods for coagulation monitoring is discussed.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2009
[Risk communication in anaesthesia consultations].
It is the responsibility of all anaesthesiologists to inform their patients about the risk and benefits of available treatment options. It is also our duty to obtain the patient's informed consent. But how much information do patients want about risks, and how should this topic be approached during the preoperative consultation? In this article we will discuss risk perception in general and options to describe potential medical risks.