Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 1998
Case Reports[Emphysematous pyelonephritis--a rare cause of sepsis].
A 66-year old female was admitted to our ICU in septic shock with accompanying signs of gastroenteritis and diabetic-related hyperglycemia. Computer tomography of the abdomen revealed the rare diagnosis of emphysematous pyelonephritis. Immediate nephrectomy led to a favourable outcome in this dramatic case. Although abscess drainage and broad-based antibiotic therapy are generally the first-line therapy today, emergency surgery would seem to be indicated in selected cases.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 1998
[Incidence and predisposing factors of persistent backache after lumbar catheter epidural anesthesia in a non-obstetrical settingø].
To determine the incidence of long term backache after lumbar epidural anesthesia with catheter (EPA) in the non-obstetrical setting. ⋯ The incidence of long term backache after EPA in the non-obstetrical setting is 11.5% and almost exclusively associated with pre-existing back pain. Biometrical factors seem to play no role. In patients with pre-existing back pain satisfaction with the anesthetic procedure might be improved by improving informed consent.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Remifentanil in gynecologic laparoscopy. A comparison of consciousness and circulatory effects of a combination with desflurane and propofol].
Rapid post-anaesthetic awakening and low hypnotic potency are two characteristic properties of the new opioid remifentanil. For clinical use remifentanil must be combined with another anaesthetic agent. Propofol is well-established for ambulatory anaesthesia, however, the properties of desflurane (low blood-gas solubility, rapid elimination) suggest this volatile anaesthetic to be a comparable alternative, particularly if rapid awakening is desired. The present study was designed to compare emergence times and haemodynamics for a combination of remifentanil wich hypnotic concentrations of either propofol or desflurane. ⋯ Remifentanil in combination with either desflurane or propofol, used for general anaesthesia during gynaecological laparoscopy, will facilitate a smooth haemodynamic course as well as a rapid emergence thereafter. Recovery times after remifentanil-based anaesthesia are significantly shorter with 3.0 vol% of desflurane than with 6 mg/kg/h propofol. Thus, desflurane appears to be a well-suited adjunct to remifentanil and an ideal alternative to propofol, if rapid recovery is required. Differences are best explained by the pharmacological properties of both coanaesthetics and their applied dosages.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 1998
Review[Postoperative nausea and emesis: mechanisms and treatment].
The incidence of postoperative emetic symptoms in patients varies between 3 and 91%. Nausea and emesis remain the most common as well as unpleasant side-effects experienced by patients following general anaesthesia, both in the ambulatory and non-ambulatory care setting. Furthermore, emesis carries the risk of severe postoperative complications and is associated with additional costs. ⋯ If symptoms do develop in the recovery room, tight fitting oxygen masks should be avoided and adequate hydration and analgesia ensured. To avoid side effects, antiemetics should be administered in minimally effective dosages. If emesis persists, combination of antiemetic drugs with different profiles of receptor action may be particularly useful.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 1998
Clinical Trial[Diagnosis of susceptibility to malignant hyperthermia with an in vitro contracture test with the phosphodiesterase iii inhibitor enoximone].
Inhibition of phosphodiesterase III (PDE-III) by enoximone elevates cyclic AMP (cAMP) content and intracellular calcium in human cardiac muscle. An involvement of cAMP in the pathogenesis of malignant hyperthermia (MH) has been suggested, because a higher basal content of cAMP was found in skeletal muscles from MH susceptible (MHS) than in normal (MHN) individuals and swine. In this study the in vitro effects of enoximone on skeletal muscles and the possibility to distinguish MHS from MHN patients were investigated. ⋯ The PDE-III-inhibitor enoximone induces contracture development in skeletal muscles. These contractures were attained at lower concentrations and were larger in MHS compared to MHN muscles. In vitro diagnosis of MH by a contracture test with enoximone appears to be possible. Furthermore, regarding these results a trigger potency for MH by enoximone could not be proved, but the use of enoximone in MHS patients might be dangerous.