Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2006
Review[Spinal regional anesthetic approaches in children: caudal block and spinal anesthesia].
Caudal anesthesia is a safe, simple and very effective method to provide excellent perioperative analgesia. It is used routineously in pediatric anesthesia and can be applied to nearly all children with surgery below the umbilicus. In contrast, spinal anesthesia is a very special technique for former preterm infants below the 50th postconceptive week who are prone to develop postoperative apnea. It has been suggested that some of the problems associated with general anesthesia in these patients may be avoided by the use of spinal anesthesia.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2006
[Invasive cardiovascular monitoring--four methods compared].
The impact of invasive hemodynamic monitoring on patient safety and outcome in perioperative medicine remains inadequately tested and unproven. The indications for the use of these tools should, therefore, be evaluated according to an individual risk-benefit analysis. The measurement of central venous oxygen saturation (ScvO2) is of little invasiveness as most high-risk patients are instrumented with central venous catheters, and ScvO2 has been shown to improve outcome in patients with septic shock. ⋯ PiCCO-system) delivers information not only on global cardiac function and intravascular volume status but also helps to define the pulmonary consequences of cardiovascular therapy. Transesophageal echocardiography (TEE) is a valuable tool in patients undergoing cardiac surgery and represents the beside-method of choice for rapid assessment of acute life-threatening cardiovascular instability. Apart from special indications, these tools tend to replace the pulmonary artery catheter (PAC) which has been shown to be of little value in various patient populations.
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Invasive airway management techniques are the bottom line of most difficult airway management algorithms when less invasive measures (e.g. endotracheal intubation, bag-valve-mask ventilation, or supraglottic airways) have failed. Various devices for transtracheal jet ventilation in children are available, while cricothyrotomy is the gold standard for establishing an invasive airway in adults. Percutaneous tracheostomy could become an alternative to cricothyrotomy if applied by experienced physicians, however, clear scientific evidence to advocate percutaneous tracheostomy in airway emergencies is still pending.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2006
Review[Clinical management of the difficult airway].
Difficult airway management is among the key requirements in routine anaesthesia. Failures to secure the airways resulting in a "Cannot intubate, Cannot ventilate" situation can drastically increase morbidity and mortality of patients within a very short time. Therefore, an algorithm for management of the expected and unexpected difficult airway describing the sequence of various procedures, adapted to internal standards and to techniques that are available, has to be provided by each anaesthesia department. This not only facilitates the preparation of equipment and the training of personnel, but also ensures efficient decision making under time pressure.