Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 1998
[Results of a survey of anesthetists on postoperative nausea and vomiting].
Although an increasing number of studies concerning postoperative nausea and vomiting (PONV) have been performed, we do not know, what anaesthesiologists think about this problem and how they handle it in their daily routine. ⋯ A great majority (93%) stated, that PONV is a relevant problem, that still remains unsolved. This proofs the need for further controlled studies.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1998
Review[NMDA-receptor antagonist in pain therapy].
The treatment of patients suffering from chronic neuropathic pain remains a clinical challenge, particularly in cases where opioid therapy fails to provide sufficient pain relief. Spinal sensitization might be one cause for induction and maintenance of such states of pain, frequently accompainied by symptoms like allodynia, hyperalgesia and temporal summation of second pain. Experimental data concerning the role of NMDA-mediated processes in central sensitization and the effects of NMDA receptor antagonists in different models of neuropathic pain are reviewed. ⋯ Further clinical studies may reveal whether these substances will play a role as adjuncts in future pain treatment. Improving the efficacy of opioids by blocking NMDA receptor-mediated activity constitutes another clinically relevant concept for pain management. Numerous experiments have shown synergistic effects of NMDA antagonists and opioids in analgesia, while the development of opioid tolerance was prevented.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1998
Clinical Trial[Use of the laryngeal mask in oral and dental surgery].
The suitability of the laryngeal mask (LM) for anesthesia in oral and dental surgery of the face was investigated considering in particular the risks of aspiration and dislocation. We also examined acceptability to the surgeon. ⋯ Leakage due to dislocation of the LM and airway obstruction only leads to a relevant risk of SaO2 to drop if both components occur simultaneously. With increasing experience and close cooperation between surgeon and anesthesiologist, they may be almost completely avoided so that even exposure of the lower, wisdorri teeth will seldom iiecessiiate the LM to be replaced by ETA. In relation to the tongue depressor, cuff pressure should be kept at low levels in order to obtain better flexibility of the LM. The LM provides sufficient protection against aspiration of intraoperative fluid in the pharynx. Acceptability to the surgeon is high because of good operative conditions and shortened periods in between two operations when compared to ETA. Improved protective reflex responses after the operation and its advantages when used in patients with tightness of the jaw make the LM a suitable instrument for anesthesia in oral and dental surgery.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 1998
Randomized Controlled Trial Clinical Trial[Concentration-dependent changes in the latency and amplitude of somatosensory-evoked potentials by desflurane, isoflurane and sevoflurane].
Comparison of the influence of desflurane, isoflurane, and sevoflurane on the parameters of cortical somatosensory evoked potentials (SEP). ⋯ 1) Sevoflurane and desflurane are better suited for anaesthetic management during intraoperative electrophysiological monitoring than isoflurane, because SEP amplitudes are better preserved. 2) SEP amplitude is less altered by changing anaesthetic concentrations in the concentration range from 0.7 to 1.3 MAC than SEP latency.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 1998
Case Reports[Insulin as an anabolic: hypoglycemia in the bodybuilding world].
Excessive body building may be dangerous. To promote athletic performance and to improve physical appearance many of the body builders abuse anabolic-androgenic steroids and other drugs. The abuse of insulin as an anabolic medication in this athletic community was followed by a case of severe hypoglycaemia in a body builder. ⋯ After orotracheal intubation by an emergency physician, despite of ongoing infusion of glucose the blood glucose concentration remained low as measured in the out-of-hospital setting. Finally administration of additional glucose and glucagon in the intensive care unit was able to stabilize the metabolic system. In any case of severe hypoglycaemia, repetitive measurements of blood glucose even in the prehospital setting should be performed to detect the hypoglycaemia especially if athletes are concerned.