Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2022
Review[Perioperative Role of Echocardiography and its Influence on Surgical Management].
Perioperative echocardiography is an important puzzle piece for surgical management especially in the area of cardiovascular surgery. This imaging technique is not only used to confirm preoperatively made diagnoses but also for morphological and functional assessment of cardiac structures and verification of surgical or interventional results. ⋯ Indications and contraindications are discussed as well as the use of echocardiography during the different phases of surgery and intensive care. The possible influence of the echocardiographic finding on modification of the surgical approach is presented based on a case example and underlined by clinical tips and tricks.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2022
Review[Employment of the Pregnant Anaesthesiologist According to Maternity Protection Act].
With the onset of pregnancy, female physicians face a conflict of interest between the protection of the unborn child and the loss of self-determination in their professional lives. The Maternity Protection Act provides guidelines for the continued employment of pregnant and breastfeeding women. This review focusses on legal basics, employment ban, individual risk assessment, implementation in clinical practice, and pitfalls. We suggest that each hospital should define safe workplaces for the pregnant anesthesiologist.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2022
[Targeted hemodynamic monitoring in the operating theatre: what for and by what means?]
Goal directed hemodynamic monitoring and the balance in goal directed therapy between adequate fluid/volume therapy and the application of vasoactive or inotropic drugs are the basic elements of modern perioperative therapy. Surgical procedures should be accompanied by as few side effects and complications as possible. Nevertheless, the number of postoperative complications remains surprisingly high, despite of the modern surgical procedures. ⋯ Thus, it is clear that anesthesia plays a central role in this balancing act. This article aims to provide an overview of the application of the currently available perioperative goal directed hemodynamic monitoring. The current possibilities are discussed by using a case example and an outlook on the future of hemodynamic monitoring is given.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2022
Review[Hemodynamic Monitoring in the ICU: the More Invasive, the Better?]
Less invasive or even completely non-invasive haemodynamic monitoring technologies have evolved during the last decades. However, the invasive devices such as the pulmonary artery catheter and transpulmonary thermodilution technologies are still the clinical gold standard in terms of advanced haemodynamic monitoring, especially in the treatment of critically ill patients. The current data situation regarding the early use of continuous haemodynamic monitoring in this patient population, specifically flow-based variables such as stroke volume to prevent occult hypoperfusion, is overwhelming. ⋯ Given the fact that perioperative morbidity and mortality are higher than anticipated, anaesthesiologists and intensivists are in charge to deal with this problem. The recent advances in minimally invasive and non-invasive haemodynamic monitoring technologies may facilitate a more widespread use in the operating theatre and in critical care patients. This review evaluates the significance of invasive, minimally- and non-invasive monitoring devices and their specific haemodynamic variables in this particular field of perioperative medicine.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2022
[Measurement of Anti-SARS CoV-2 Antibodies following Vaccination: Valuable Monitoring or Irrelevant Tool?]
Vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) provides effective protection against infection or severe coronavirus disease 2019 (COVID-19). Moreover, it is regarded as the single most important measure to end the pandemic. ⋯ However, considering the complexity of the humoral and cellular immune response the question arises whether the relation of anti-SARS-CoV-2 antibody titers and COVID-19 vaccine effectiveness is a myth or a fact? The current article aims to answer this question and provide a short review of the immunological mechanisms of SARS-CoV-2 vaccination. Recommendations for clinical practice are given based on the current evidence and known problems of anti-SARS-CoV-2 antibody measurements after vaccination.