Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2008
Review[Pain relief with cannabinoids-- the importance of endocannabinoids and cannabinoids for pain therapy].
The endocannabinoid system reduces sensitization processes. Low doses of cannabinoids may enhance the potency of opioid-drugs and reduce the risk of tolerance to opioids. So far no cannabinoid has been approved for the treatment of acute pain due to lack of consistent data. ⋯ The adjunct of cannabidiol and the oromucosal formulation increase the therapeutic index of delta9-tetrahydrocannabinol. The differentiation of analgetic effects and cannabimimetic effects may be increased while compounds--such as ajulemic acid--are used which preferentially act on peripheral cannabinoid receptors and exert receptor independent effects. A further approach in this direction is the use of enzymes which metabolize endocannabinoids.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2008
Case Reports[Emergency care management of patients with cancer at the final stage of disease--seven cases].
The care of patients with cancer disease in the final stage amounts to 2.5% of all emergency-medical applications. This corresponded to the number of pediatric emergency cases. For this every emergency physician can be involved in the care of those patients. ⋯ Nevertheless, the emergency physicians were alarmed by the patients' relatives because of needing professional help at the moment. The differences of the cases appeared in the regulatory framework. The seven cases have shown that different legal meanings could be important in emergency therapy of palliative patients.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2008
Review[Simulation training for German anesthesiologists--case scenarios and training results].
Training of medical personnel using simulation techniques is an acknowledged measure of process optimization and quality assurance in a clinical setting. In 2006, a simulator-based training of anaesthesiologists was introduced in the University Medical Centre of Schleswig-Holstein, Campus Kiel, Germany. The training was performed on a human patient simulator (Meti, Sarasota, USA) and the course was conducted by instructors and engineers from the Simulation Centre Mainz in an operation room equipped with common anaesthesia devices. ⋯ The training was offered to the anaesthesia personnel of whole Schleswig-Holstein, Germany. A higher and more balanced overall performance of the participants was determined by the instructor teams in comparison to the training results in their own simulation centre. This improved performance was ascribed to the special circumstances of this training namely the familiar surroundings and team members.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2008
Review[Lung protective ventilation - protective effect of adequate supported spontaneous breathing].
Based on available data, it can be suggested that spontaneous breathing during ventilator support has not to be suppressed even in patients with severe pulmonary dysfunction if no contraindications are present. Experimental data do not support the contention that spontaneous breathing aggravates ventilator-induced lung injury. ⋯ This should result in a lung protective effect of adequate supported spontaneous breathing. Clinical data supported this belief demonstrating improvement in pulmonary gas exchange, systemic blood flow, and oxygen supply to the tissue and a decrease in days on ventilator support and duration of stay in the intensive care unit.