Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2004
[Along the anesthetic line: a new approach to the brachial plexus -- the subcoracoidal retrograde access].
Introduced is a new approach to the brachial plexus marked out in opposition to the common methods by some theoretical advantages. The needle is proceeded in an acute angle to the course of the plexus. Thus reduces the possibility of nerve damage. Second the insertion of catheter is simplified. The accidental puncture of the pleura is unlikely except in cases of gross deviations of the puncture instruction. In addition the plexus is hit before the musculocutaneous nerve leaves the brachial plexus. The objective of this investigation was to evaluate the usefulness of the subcoracoidal retrograde access in daily practice. Beside the influence of stimulating different fascicles or the necessity of reaching a defined low stimulation level on the success rate and effectiveness of the plexus blockade was investigated. ⋯ The described subcoracoidal retrograde access to the brachial plexus (SCREP) proved to be a safe and easy method with a low complication and high success rate compared with the known practised accesses. In contrary to other authors our findings do not support the connection either between success rate and stimulating certain fascicles nor achieving a defined lowest stimulation level.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2004
Review[Autologous transfusion -- from euphoria to reason: clinical practice based on scientific knowledge (Part II). Intraoperative blood salvage with blood irradiation -- from an anaesthesiological point of view].
The requirement for intraoperative blood salvage (IBS) in cancer surgery stems from the high transfusion rate, the unfavourable effects of an anaemia, and the impact of transfusion risks like immunomodulation in tumor patients. The advantages of IBS are availability, the low waste rate, and the excellent quality of this autologous, unstored blood. The only effective elimination of the risk of tumor cell dissemination after retransfusion of wound blood is achieved by blood irradiation. ⋯ From an anaesthesiological point of view it is part of the therapy, but any context that puts it compatible to medicolegal regulations is welcome. For him as the one responsible for the therapy of intraoperative blood loss it represents the safest and best blood for an optimal hemotherapy in tumor patients. In addition, first data indicate a better outcome of these patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2004
Review[Innovative treatment of acute migraine pain with CGRP receptor antagonists].
Neurogenic inflammation caused by the release of vasoactive neuropeptides such as calcitonin gene-related peptide (CGRP) from nociceptive perivascular nerve fibres has been implicated in the development of acute migraine pain. It has recently been demonstrated that the CGRP receptor antagonist BIBN 4096 BS significantly reduces acute pain in migraine. This therapeutic efficacy provides further evidence for a critical role of CGRP in the pathophysiology of migraine. Given the apparent absence of vasoconstrictor activity both in meningeal and extracranial vessels, BIBN 4096 BS may provide an alternative for the treatment of migraine in those patients where triptans and ergotamine derivatives are contraindicated due to their side effects.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2004
[Rapid sequence induction in prehospital emergency medicine: is it safe?].
The use of 0,9 mg/kg Rocuronium allows endotracheal intubation within 60 seconds and therefore might be an alternative to succinylcholine for rapid sequence induction. We investigated the use of high-dose Rocuronium for RSI in prehospital emergency medicine. ⋯ The use of muscle relaxants improves the intubation conditions and may help to avoid unnecessary high doses of anesthetics in hemodynamic unstable emergency patients. This study shows that rocuronium might be an alternative to succinylcholine for RSI also in prehospital emergency medicine, if succinylcholine is contraindicated.