Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2006
Review[Negative-pressure pulmonary edema (NPPE)].
Negative-pressure pulmonary edema (NPPE) is a clinical entity of anaesthesiologic relevance, perioperatively caused by obstruction of the conductive airways (upper airway obstruction, UAO) due to laryngospasm in approx. 50% of the cases, its early recognition and treatment by the anaesthesist is mandatory. NPPE, also addressed as post-obstructive pulmonary edema (POPE) presents in most cases as a complex of symptoms with rapid onset, consisting of acute respiratory failure with dyspnea, tachypnea, and strained respiratory efforts. ⋯ Partially due to largely differing criteria used for diagnosis, opinions about incidence and prevalence of NPPE are unhomogenous in medical literature. It has been shown that generation of NPPE is not only limited to patients being intubated and ventilated, but occurs also in patients requiring higher fractions of oxygen.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2006
Randomized Controlled Trial[No potentiation of fentanyl by use of transdermal buprenorphine in patients undergoing fast-track anesthesia for open-heart surgery].
Simultaneous use of opioids with a different pharmacological profile may lead to unexpected prolongation of effects. In an open label study possible overhang in post-operative respiratory effects and vigilance was determined in a group of patients (n = 22) carrying a transdermal buprenorphine patch for at least 2 months for treatment of chronic pain, undergoing a fentanyl-based fast-track enflurane anesthetic technique for open-heart operation. Data was compared with another randomised group (n = 21) undergoing similar open-heart procedures with no other opioid than fentanyl on board. ⋯ Patients using a buprenorphine patch for the relief of chronic pain cannot be regarded as opioid naïve. Due to adaptive mechanisms and the development of tolerance, there is no prolongation of the respiratory depression induced by intraoperative fentanyl. Long-term use of transdermal buprenorphine does not lead to potentiation or prolongation of opioid effects in cardiac surgery patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2006
Randomized Controlled Trial Comparative Study[Evaluation of CVC-set].
Frequently central venous catheter sets do not contain all necessary materials. To evaluate, if combined measures using a specially arranged central venous catheter (CVC) set result in economical and clinical advantages, we compared both cost and time differences of a CVC complete set with ECG guide wire lead and an adhesive fixation with a standard set requiring additional materials, ECG fluid column lead and surgical suture. Furthermore, quality of different ECG leads, the reliability and tolerability of the adhesive fixation was compared. ⋯ The test CVC complete set allows a significant time saving and cost reduction in performing a central venous catheter line because of completely included disposable materials. CVC position control via guide wire needs less time and shows significantly better quality of ECG compared to fluid column ECG lead. An adhesive revealed to be a reliable CVC fixation comparable to a surgical suture.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2006
Review[The position of the emergency physician in the emergency medical service].
The participation of emergency physicians guarantees the quality of a modern emergency medical service (EMS). Within the scope of cost savings in health-care system, it is questioned whether emergency medical services in the future can be managed without emergency physicians. Deficits of structure and qualitaty of the emergency physician service are raised objections. ⋯ The rate of patients discharged from hospital after cardiopulmonal resuscitation is 3 fold higher than in a rescue service without emergency physicians. However this improvement of quality of care by physicians is linked to higher financial charges. Another aspect supporting the obligatory employment of emergency physicians in Germany is the jurisdiction guaranteeing the right of the patient to receive advanced medical treatment only by (emergency) physicians.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2006
[Retrospective analysis of neurological patients on a medical intensive care unit].
The aim of this study was to evaluate number and kind of neurological patients in comparison with other patients on a medical ICU. ⋯ Our data also demonstrate the relevant amount of neurological patients (19 % measured by bed assignment) in comparison to all patients, and the specific neurological procedures were applicable on a medical/interdisciplinary ICU. A higher interest for neurological patient on a medical ICU would therefore be essential.