Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2005
[Carotid-surgery in ultrasound-guided anesthesia of the regio colli lateralis].
Carotid endarterectomy significantly reduces the risk of stroke in patients with symptomatic and asymptomatic carotid artery stenosis. An increasing number of interventions in carotid surgery are performed under regional anesthesia in conscious patients. Carotid endarterectomy in local anesthesia requires block of the cervical nerves C2-C4, which may be accomplished in different ways. The most frequent method of regional anesthesia in carotid surgery is a combined block of profunda and superficial cervical plexus (by using a nerve stimulator). Ultrasound is frequently used in anesthesia for venous access and peripheral nerve block. By ultrasound, it is possible to visualize puncture needle and spread of local anesthetics at the correct position for block of cervical plexus in carotid surgery. The aim of the case reports was to demonstrate the effectiveness of using ultrasound for regional anesthesia in carotid surgery. ⋯ Ultrasound presents an alternative to cervical block using nerve stimulation, especially in patients with anatomical abnormalities. The method proves to be effective and may improve the approach to profundeal cervical plexus.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2005
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of clonidine and tramadol added to prilocaine brachial plexus block - analgesia, sensory and motor block].
In a randomized, double-blind study we investigated the effect of clonidine and tramadol added to prilocaine on duration of analgesia, sensory and motor brachial plexus block. 60 patients were randomized in three groups. Group A received 40 ml prilocaine 1,5 % with tramadol 1,5 mg/kg KG, group B 40 ml prilocaine 1,5 % plus clonidine 1,5 microg/kg KG and group C 40 ml prilocaine 1,5 % without any additional medication. We recorded heart rate, blood pressure, oxygen saturation and sedation score at regular intervals. ⋯ There was no difference between the three groups concerning onset of brachial plexus block and duration of analgesia. But there was a significant prolongation of the duration of sensory and motor block in group B. Haemodynamic parameters remained stable in all patients, there were no significant changes in blood pressure and sedation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2005
Review[Sepsis and multiple organ failure - update of current therapeutic concepts].
Severe sepsis with multiple organ dysfunctions is still the leading cause of death in non-cardiac intensive care units. The incidence is expected to rise in the future due to the growing number of older and immuno-compromized patients, the use of invasive procedures, and an increase in the percentage of aggressive or resistant microorganisms. ⋯ The new therapeutic approaches take account of this more sophisticated view of pathophysiologic changes, resulting in the modulation of the coagulation in combination with an improvement of the ICU-management of organ dysfunctions. This review discusses the therapeutic concepts, reported es exciting new interventions in the ICU setting to decrease the inacceptable high mortality in patients with severe sepsis.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2005
Randomized Controlled Trial Clinical Trial[Effectiveness of clonidine and fentanyl addition to bupivacaine in postoperative patient controlled epidural analgesia].
The aim of this prospective randomized double-blinded study was to compare the analgesic and side-effects of bupivacaine in combination with clonidine or fentanyl during patient-controlled-epidural analgesia (PCEA) in the postoperative period after abdominal hysterectomy. ⋯ Addition of clonidine or fentanyl to local anesthetics for PCEA can reduce the analgetic demand. Epidural clonidine can reduce postoperative nausea and is connected with higher patients' satisfaction.