Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2007
Review[Complications of regional anesthesia: diagnostic and management].
Neuroaxial anesthesia has become an integral part of perioperative pain therapy and provides several advantages over systemic opioids. Despite these benefits, rare but serious complications occur with epidural analgesia including epidural haematoma, spinal-epidural infections and local anesthetic cardiac toxicity. ⋯ Based on lipophilic and hydrophilic properties, local anesthetics can interfere with ion channels such as sodium, potassium and calcium channels of the CNS and the heart leading to severe neuronal and cardiac (arrhythmia and contractile depression) adverse effects. In this review we take an in-depth look at severe complications associated with regional anesthesia, describe their symptoms and discuss appropriate diagnostic and therapeutical approaches.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2007
Review[Regional anesthesia for postoperative pain control].
Pain is the most frequent and straining symptom after surgery. Regardless of the severity of the surgical trauma patients may suffer from severe pain and may therefore not tolerate or even refuse important postoperative interventions for fear of pain. This may influence the outcome and worsen the prognosis of surgical patients. ⋯ Regional anesthesia, especially epidural analgesia, is most effective to treat postoperative pain. It is discussed whether the incidence and severity of chronic postoperative pain can be reduced and postoperative complications can be prevented by this technique. Epidural analgesia may reduce the risk of postoperative complications (i.e. myocardial infarction) by reducing the surgical stress response and inhibiting the pathophysiological cascade that may trigger undesirable sequelea.
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Postoperative pain is now a critical focus of perioperative patient care. The current perioperative analgesic strategy is a "balanced-multimodal analgesia". Cornerstones of this treatment approach are patient controlled neuraxial administration of local anesthetics and opioids or patient controlled intravenous administration of opioids. ⋯ Thus, adjuvants like anticonvulsants, NMDA receptor antagonists, alpha-2 adrenergic agonists and other non-Opioid analgesics are considered to reduce pain and opioid requirements in the perioperative period. In the present review we discuss recent findings about the effectiveness of different systemic administered adjuvants including ketamine, lidocaine, gabapentin, pregabalin and corticosteroids for postoperative pain treatment. Furthermore a nurse based oral analgesic concept using controlled released Oxycodon for all postoperative patients without a patient controlled analgesia device will be introduced.
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Psychiatric emergencies are catatonia, stupor, central serotonine syndrome, malignant neuroleptic syndrome, suicide risk and agitation. In this article some clinical features of the aforementioned and its therapy are summarized.