Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2003
Randomized Controlled Trial Comparative Study Clinical Trial[The time-course of action of rapacuronium and mivacurium after early reversal following equally lasting relaxation].
This study was designed to compare the time course of action and the safety profile of Rapacuronium and Mivacurium in day case dental surgery. After Ethics Committee approval 61 healthy adult patients, scheduled for dental day case surgery, were randomised in an assessor-blinded manner to receive either 1.5 mg/kg Rapacuronium with and without 0.05 neostigmine 5 min later (19 patients each) or a total of 0.25 mg/kg Mivacurium (n = 16). Anaesthesia was induced using Propofol 2 - 5.1 mg/kg and Remifentanil 24 - 73 mcg/kg/h and maintained with Desflurane in N2O/O2 (2/1). ⋯ Also clinical duration was significantly shorter following Rapacuronium without reversal (12 +/- 4 min) as well as with reversal (9 +/- 1 min) compared with Mivacurium (21 +/- 5 min)). Patients treated with Rapacuronium and reversal recovered faster (14 +/- 8 min)) compared to the other two groups (Mivacurium: 20 +/- 6 min, Rapacuronium without reversal: 31 +/- 9 min). The fraction of clinical duration of the total duration was highest following Mivacurium (51 %) when compared with Rapacuronium/Neostigmine (43 %) and Rapacuronium (28 %).
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2003
Review[Rationale and management of perioperative atrial fibrillation].
Atrial fibrillation is the most common clinically relevant arrhythmia. Anesthesiologists will be faced with atrial fibrillation of new or undetermined onset at their preoperative evaluation of patients as well as during intra- and post operative care. Because of fast electrophysical and structural remodeling, atrial fibrillation tends to persist and reoccur after successful conversion with increasing time of duration. ⋯ In contrast, for treatment of chronic atrial fibrillation rate control therapy and thromboembolic prophylaxes seems to be more advisable with a lower risk of drug side effects and stroke. Anticoagulation should be initiated not later than 48 hours after the onset of atrial fibrillation. Finally, the development of implantable devices for the treatment of atrial fibrillation seem to be a promising therapeutic option for patients in end-stage heart diseases.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2003
Review["Pre-warming" - how can perioperative hypothermia be avoided?].
Perioperative hypothermia is a well known problem in general and neuroaxial anaesthesia. Some years ago effective therapeutic means as e. g. forced air systems and infusion heaters were introduced into clinical routine. If these systems are used intraoperatively only, hypothermia is solely treated symptomatically. ⋯ Pre-warming is a simple, effective and cheap way to reduce perioperative hypothermia. This article gives a short overview on pathophysiology of perioperative hypothermia. Published clinical experiences are discussed and practical guidelines for everyday-use given.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2003
Case Reports[Is levosimendan an inoprotective drug in patients with acute coronary syndrome undergoing surgical revascularization?].
Levosimendan, is a new calcium sensitiser with 2 major effects. First, levosimendan acts as a positive inotropic agent by binding calcium dependently to cardiac troponin C. ⋯ These unique properties of levosimendan might be of great advantage in patients with myocardial ischemia simultaneously requiring inotropic support. The concept of perioperative inoprotection is presented in 6 patients with acute ischemia undergoing emergent cardiac surgery.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 2003
Review[Extracorporeal membrane oxygenation (ECMO) as cardiac assist device in pediatrics].
Extracorporeal membrane oxygenation (ECMO) is a common treatment for severe respiratory failure. However, ECMO can also be used as cardiac support. ECMO is the most common mechanical circulatory assist device in pediatrics, followed by pulsatile ventricular assist devices. ⋯ The transthoracic connection of ECMO after cardiac failure in cardiothoracic surgery in childhood allows a controlled weaning on the intensive care unit. Weaning from ECMO is successful in about 45 to 80 % in cases of circulatory support; survival rates depend on patient selection, treatment protocol and indication. Bleeding problems, thromboembolic complications, hemolysis, infections, renal and neurologic complications are major problems.