Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2002
[The abbreviated mental test in a German version for detection of postoperative delirium].
Delirium is the most common acute organic psychosis postoperatively, and occurs more frequently in the elderly than anticipated. The abbreviated mental test (AMT) is a widely used cognitive test in Great Britain. The present study assessed the AMT in a German version for diagnosis of postoperative delirium. ⋯ As in Great Britain, the AMT in its German version is useful in diagnosing delirium. We recommend the use of the AMT preoperatively in elderly patients at risk for delirium.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2002
Clinical Trial[The visualisation of dura perforation and blood patches with ultrasound].
The postdural puncture headache (PDPH) is a possible complication after spinal or epidural puncture. The therapeutic concept is usually organised step by step, but the epidural blood patch is the most reliable and effective therapy. In earlier studies myelographie, epidurographie and MRT were used, to visualise the localisation of the dural defect and to describe the effects of patching the epidural space. ⋯ Within a short time we could detect the increase of cerebrospinal fluid and the patients headache was treated sucessfully. The clinical use of this diagnostic technique can be found in the simultaneous presentation of the dura leakage and the intervention while performing an epidural bloodpatch. Since these informations are relevant for further clinical practice further investigations are warranted.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2002
Review[Anesthesia in neuromuscular disorders. Part 2: specific disorders].
The neuromuscular disorders described are divided into four groups: motoneuron diseases, peripheral neuropathies, disturbances of neuromuscular transmission and myopathies. In motoneuron diseases problems mainly result from respiratory insufficiency and the predisposition for aspiration caused by progressive muscular weakness. Depolarising muscle relaxants may elicit myotonic reaction and massive hyperkalemia. ⋯ Muscle metabolism should be supported by administration of substrates depending on the underlying disorder. In membrane disorders muscle rigidity (myotonic reactions) or weakness may lead to respiratory insufficiency. In addition to the depolarising muscle relaxants also anticholinesterase drugs, hypothermia and dyskalaemia can evoke myotonic reactions.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2002
Case Reports[Decompressive craniectomy for severe intracranial hypertension due to cerebral infarction or meningoencephalitis].
We describe the clinical course and outcome following decompressive craniectomy in six patients. Five patients suffered from severe intracranial hypertension due to middle cerebral artery infarction. In one patient the cause was bacterial meningoencephalitis. ⋯ Craniectomy in malignant middle artery infarction should be taken into consideration if conventional brain edema therapy does not sufficiently reduce critically raised intracranial pressure. Craniectomy provides development of brain herniation. This treatment may reduce high lethality rate and high frequency of severe neurological disorders.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2002
Comparative Study[Analgosedation, analgesia with remifentanil in incontinence surgery via tension-free vaginal tape].
The tension-free vaginal tape operation (TVT) is a new surgical treatment of stress urinary incontinence in women. The tape has to be placed at the level of midurethra in the left and right paraurethral canal and has to be brought up to the abdominal wall in close contact with the back of the pubic bone with a special needle instrument. The performed anesthesia is decisive for the operative success, because a sufficient analgesia is demanded and, on the other hand, the correct placement and tension of the urethral tape has to be controlled by the patient performing a stress test by coughing and pressing. In this context the opioid remifentanil seems to be specially suitable because of its pharmacologic characteristics. ⋯ Continuous infusion of remifentanil is suitable for the short time profound analgesia needed for the TVT operation because of the pharmacologic characteristics of remifentanil. A antiemetic prophylaxis should be performed with this analgetic regime.