Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2000
Review[Target controlled infusion (TCI)--status and clinical perspectives].
The technique of target controlled infusion (TCI) has influenced the development of intravenous anaesthesia substantially and opens the possibility of many new and exciting applications in peri-operative anaesthetic care. The launch of "Diprifusor" as the first commercially available TCI system for propofol was the cornerstone of a successful research period within the last decade, which evaluated the pharmacokinetic foundations of computer assisted intravenous drug delivery. ⋯ This review gives an update on the rational pharmacokinetic basis of TCI development, the preliminary clinical experience with the new technique, the performance and accuracy of TCI devices and potential technical pitfalls in clinical routine. Besides clinical application in anaesthesia with "Diprifusor" TCI, target controlled systems are expected to play a significant role as research tools in the evaluation of drug interactions in anaesthesia and in the development of novel control techniques for the administration of sedative and analgesic drugs in the peri-operative period.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 1999
Multicenter Study[Respiratory and circulatory parameters as indicators of the postoperative analgesic demand in newborns and infants].
Due to immature cognitive functions, infants are unable to communicate their pain perception verbally. To assess postoperative analgesic demand, the anaesthetist has to rely on observational techniques. Generally, pain expression is considered to be a multidimensional phenomenon consisting of physiological, motor-reflex and behavioural patterns. The majority of observational approaches to pain assessment in infants use the behavioural dimension only, regardless of the fact that pain perception might contribute substantially to the stress response. The aim of this study is to evaluate, whether sensitivity and specificity of a behavioural pain scale (CHIPPS [1]) can be improved by adding physiological measures, especially those representing the stress response. ⋯ Despite the multidimensional approach and the corresponding multivariate analyses, a unidimensional scale consisting of behavioural items was found to be a valid indicator of an postoperative analgesic demand. Due to the lack of diagnostic properties and difficulties to obtain sound values even under research conditions, physiological measurements like blood pressure, respiratory rate and heart rate are not suitable for the assessment of a postoperative analgesic demand in infants, neither for clinical nor for research purposes.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 1999
[Anesthesia monitoring: degree of compliance with guidelines in Austria].
For the first time an evaluation of standard anesthetic monitoring was performed according to the guidelines of the Austrian Society for Anesthesiology, Resuscitation und Intensive Care Medicine (OGARI). ⋯ For the first time an Austrian-wide evaluation of anesthetic monitoring investigated the compliance with the 1992 recommendations of the Austrian Society of Anesthesiology, Resuscitation and Intensive Care Medicine. The data demonstrate that these recommendations including the anesthetic monitoring equipment have already been implemented to a high degree.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 1999
Case Reports[Splenic rupture as a complication of ventilation in the prone position and pneumococcal sepsis as a late complication].
We are reporting the case of a female patient who had to undergo splenectomy after she suffered splenic rupture as a result from "kinetic therapy" during the treatment for pulmonary failure secondary to sepsis. Four years later the patient was again admitted with a clinical picture consistent with sepsis. Two blood cultures were positive for pneumococci confirming the diagnosis of pneumococcal sepsis. ⋯ A polyvalent vaccine is available for prophylaxis. Although penicillin G is still commonly used as an antibiotic therapy for pneumococcal infection, increased resistance of pathogens to penicillin must be anticipated. Alternative antibiotic regimens are demonstrated.