Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · May 2008
[Stress ulcer prophylaxis in septic patients. Evidence-based overview].
In spite of decreasing incidence stress-related gastrointestinal bleeding is still an important problem in intensive care medicine. Especially patients with severe sepsis or septic shock are prone to develop lesions of the upper gastrointestinal tract with consecutive bleeding. ⋯ The following article presents an update on important aspects of stress-related mucosal disease. It further reviews current literature to provide evidence-based recommendations for stress ulcer prophylaxis in septic patients.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · May 2008
[EEG-Monitoring to avoid awareness during anaesthesia - benefit or luxury?].
The intraoperative perception of pain, anxiety and helplessness is a serious complication of anaesthesia, the frequency is now 0,1-0,2 %. Post-operative memories can cause posttraumatic stress disorder (PTSD), but this will require a consolidation of conscious awareness in the long-term memory. ⋯ In patients with high risk of awareness EEG monitoring can decrease the incidence. Because of lack of evidence, its use in every anaesthesia cases is an option but not a must.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · May 2008
[Introduction Course HEMS-Physician - from idea to course concept].
Physicians who take a role as flight physicians in a Helicopter Emergency Medical System (HEMS) will encounter more frequently certain emergencies - such as multiple trauma, mass casualties etc. - compared to physicians in a ground based Emergency Medical System (EMS). Furthermore EMS teams already present on scene have a variance of expectations towards HEMS-Physicians. ⋯ Not least HEMS-Physicians need to have knowledge of safety and technical aspects of rescue helicopters and of operation tactics as well. Since there has been no uniform or standardised training for physicians, who will take a role in a HEMS, a course concept has been developed to improve and standardise the preparation for this challenging task.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · May 2008
[Neuromuscular monitoring: methods and machines].
Muscle relaxing agents are clinically in use for general anaesthesia to optimize the conditions to the endotracheal intubation as well as the surgical conditions. Therefore different musclerelaxants with specific pharmacological characteristics are available. Many factors that depend on the condition of the patient and the used musclerelaxant agent influence the duration of the neuromuscular blockade. ⋯ A sufficient recovery of the neuromuscular transmission is reached to a TOF-ratio of 0,9 and should be aimed before the extubation at the end of surgery. No subjective evaluation of the neuromuscular recovery is able to identify residual paralysis above a TOF-ratio of 0,5. Recent studies suggest that objective methods should be used to monitor neuromuscular function to avoid postoperative residual blockades.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · May 2008
[Dural puncture - post dural punkture headache].
Post dural puncture headache is one of the most common complications of neuraxial blockade. Its incidence is reported to be as high as 70 %. ⋯ In addition to symptomatic treatments such as bed rest, hydration and administration of analgesics, the application of an epidural blood patch is the treatment of choice, with a success rate over 90 %. However, side effects and rare complications of the epidural blood patch must be carefully considered.