Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2007
[Spinal and epidural anaesthesia for caesarean section in patients with pre-eclampsia].
Neuraxial regional anaesthesia is now widely used in obstetric anaesthesia. Specifically, the rate of spinal anaesthesia increased considerably and is favoured for scheduled caesarean section. Former concerns to use regional anaesthetic techniques in non scheduled cases, e.g. spinal anaesthesia for pre-eclampsia are not supported by recent study data. Spinal and epidural anaesthesia are both safe in patients presenting with pre-eclampsia, if contraindications for neuraxial anaesthesia are taken into account.
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Numerous scientific case reports and observational studies, including that of Curtis Mendelson with its great historical relevance, have reported the problem of aspiration pneumonitis during labour. Because of this, strict fasting prior to delivery to reduce pulmonary aspiration has been doctrine since the 1940s. However, maternal mortality from anaesthesia, particularly from aspiration, has dropped dramatically over recent decades. ⋯ However, the available data with patients receiving clear fluids run contrary to this assumption, or at least dispute its clinical relevance. Recent studies report positive influence of reduced fasting time on both maternal comfort and maternal/fetal metabolism without increased risk. This has already led to meaningful discussion regarding a corresponding change in official recommendations.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2007
Review[Epidural anesthesia: step by step to success].
Besides pain management in obstetric patients epidural anaesthesia plays a major role in the perioperative setting. Especially the technique of thoracic epidural anaesthesia (TEA) provides better postoperative analgesia when compared with systemic pain therapy. ⋯ An acute pain management service is required to guarantee high effectiveness and a low complication rate. TEA is an important part of a multimodal perioperative concept, especially in fast-track surgery, which means advantages for patients outcome and hospitals economics.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2007
Review[Ventilator-associated pneumonia and multiresistant bacteria].
Ventilator-associated pneumonia remains the most serious nosocomial infection in critically ill patients. Providing appropriate antibiotic therapy promptly is crucial for successful treatment; whereas the diagnostic approach seems to play a minor role. ⋯ For patients at risk a combination therapy, considering local resistance data and formerly applied antibiotic substances, is recommended. Reevaluation and deescalation of antibiotic therapy based on microbiological culture results and discontinuation of antimicrobial treatment after one week is essential for the control of broadspectrum antibiotic use and antibiotic resistance.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2007
Comparative Study[The use of the flexible laryngeal mask in children with adenoidectomy--a retrospective comparison with endotracheal intubation].
While adenoidectomy in childhood is a standard procedure, different alternatives of airway and anaesthesiologic management are discussed. Therefore we investigated retrospectively paediatric anaesthesias with laryngeal mask (LMA) or endotracheal intubation (ITN) during adenoidectomies in our department of otorhinolaryngology. ⋯ Our study shows the LMA being a safe and effective alternative to ITN in airway treatment of children undergoing adenoidectomy.