Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2022
Review[Anesthetic and Perioperative Management in Carotid Endarterectomy (CEA), Part 1: Anesthetic Procedures].
Carotid endarterectomy is a standard procedure in therapy and prevention of ischemic stroke in particular patients. To ensure an optimal anesthetic management, fundamental knowledge of anatomy, pathophysiology and surgical technique is essential. General anesthesia may be considered as well as regional anesthesia in affected patients. This article reviews the cause of extracranial carotid artery stenosis, its surgical and anesthetic treatment as well as perioperative characteristics.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2022
Case Reports[Lethal Heatstroke with Disseminated Intravascular Coagulopathy].
We report on a case of severe heat stroke due to extended exposure to the sun in an enclosed glass cabin of an agricultural vehicle. Patient treatment, lab results and complications are reported and we examine the current literature on heat stroke. Heat stroke is a very rare and highly severe condition mostly suffered by vulnerable individuals or individuals exposed to extreme physical strain. ⋯ Haemostasis is also directly affected by the elevated temperature. Besides physical cooling, there is no known specific treatment to prevent secondary damage from heat stroke. Additionally, supportive care and ICU monitoring should be applied.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2022
[Light Therapy for Prevention of Delirium in Critically Ill Patients: What's the Evidence?]
Circadian dysrhythmia affects the majority of ICU patients and has far-reaching effects on organ functioning. At the level of the central nervous system, circadian misalignment facilitates executive cognitive dysfunction and the development of ICU delirium. ⋯ Results from preliminary research indicate that multidimensional, patient-specific chronotherapeutic concepts developed specifically for the ICU setting may help improve the healing process of patients. Circadian lighting therapy might be a promising intervention in this context.
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Noise pollution in the intensive care unit is not only an omnipresent but also a considerable problem, both for patients and healthcare staff. There are a number of significant sources of noise that are at least partially responsible for the frequent and serious sleep disorders of intensive care unit patients. This has a negative impact on the recovery of intensive care patients and favours the occurrence of delirium, which can be associated with increased overall mortality. This article provides a summary of the current evidence on the occurrence of noise-associated consequences and possible options for reducing noise exposure in the intensive care unit and offers perspectives for improving treatment of intensive care patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2021
[Intraoperative Neuromonitoring: Electroencephalography].
Intraoperative neuromonitoring using electroencephalography (EEG) enables anaesthesiologists to monitor the depth of anaesthesia. It is intended to reduce the occurrence of intraoperative wakefulness, postoperative delirium and postoperative cognitive deficits and to shorten process times in the operating room. This article shows how to interpret the raw EEG, spectrograms and processed indices for different age groups and anaesthetics and summarizes the resulting clinical benefits. ⋯ Clinical benefits of EEG-based neuromonitoring comprise reduced doses of anaesthesia, shorter wake-up times after surgery and a lower incidence of intraoperative awareness during total intravenous anaesthesia. Moreover, anaesthesia guided by processed EEG indices can reduce the incidence of postoperative delirium and postoperative cognitive deficits in older patients. In-depth knowledge about intraoperative EEG changes that go beyond the interpretation of processed indices could lead to a further reduction in intra- and postoperative complications in the future.