Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 1996
Review[Is remifentanil an ideal opioid for anesthesiologic management in the 21st century?].
Current trends toward outpatient surgery and closed loop computer controlled drug administration have created a demand for short acting anaesthetic agents. Such agents not only provide the anaesthetist with rapid patient recovery after completion of the procedure, but also with almost immediate intra-operative control over the anaesthetic state of the patient. Shorter acting anaesthetic agents are being developed in several therapeutic areas including volatile anaesthetics, neuromuscular blockers as well as injectable anaesthetics. ⋯ Reducing the infusion rate of remifentanil to analgesic doses suitable for the postoperative pain management or immediate administration of longer acting opioids at the end of anaesthesia might solve this problem. At present it is difficult to predict precisely the future ranking of remifentanil. However, the unique pharmacokinetic profile of remifentanil should make it useful in the various surgical settings and in all circumstances where precise control over the analgesic state are desirable.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 1996
[Perioperative monitoring of the course of anesthesia, the postanesthesia visit and inquiry of patient satisfaction. A prospective study of parameters in process and outcome quality in anesthesia].
This study is an investigation into the results of reporting on incidents during and after anaesthesia, to reveal any possible associations between intra-procedural and final outcome. The study contributes to the quality assurance project of the German Society of Anaesthesiology and Intensive Care (DGAI). We adjusted and tabulated our data for preoperative risk and for different methods of anaesthesia. This nation-wide DGAI project was launched to compare clinical institutions in accordance with German social legislation. ⋯ Quality parameters assessed by anaesthetists and patients are independent in respect to their frequency. For this purpose, anaesthesiological quality assurance must focus on both the anaesthetist and the patient. As clinical consequence, we suggest establishing an interdisciplinary post-anaesthesia service. Acceptance by, and collaboration between, the surgical disciplines are indispensable especially for a successful application of effective pain and antiemetic therapy.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 1996
Biography Historical Article[Helmut Schmidt--a protagonist of modern anesthesia in Germany].
Helmut Schmidt, an assistant of the reputed surgeon Paul Sudeck, who headed the Surgical Department of the University in Hamburg at that time, habilitated in 1928. The title of his monograph was "Merits of nitrous oxide anaesthesia--a comparative study seeking reintroduction and increase of the use of nitrous oxide in Germany". With this paper, Schmidt qualified himself as the first lecturer for anaesthesiology in Germany. ⋯ Due to the resistance by conservative surgeons, he failed to establish a "German Society of Anaesthesia" during the 90th meeting of the "German Society of Natural Scientists and Physicians" held in Hamburg in 1928. In fact, this was accomplished only as late as 1953. The following text recalls a number of contributions to anaesthesiology made by the honorary member of the "German Society for Anaesthesiology" Helmut Schmidt, who was born a hundred years ago and whose name and merits have fallen into oblivion during the past decades.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Continuous intra- and postoperative peridural analgesia with combined low dose sufentanil, clonidine and bupivacaine].
The purpose of this study was to investigate whether continuous epidural administration of combined low dose local anaesthetic, opioid and clonidine can provide sufficient postoperative analgesia after major abdominal surgery. ⋯ Epidural administration of drug solutions containing a low dose local anaesthetic, opioid and alpha 2-agonist, provides excellent analgesia after major abdominal surgery. Patients at rest can be treated very effectively with both a combination of only two or with all of the tested drugs. On exercise the mixture containing all analgesics was more efficient than the solutions with only two of the tested drugs. Severe side effects such as respiratory depression or cardiovascular instability were not seen.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 1996
[Sepsis score in surgical intensive care medicine].
In a prospective study (400 patients, intensive care stay > 18 h) the following data were documented daily: Clinical sepsis, a modified sepsis score, Apache II-score, number of organ failure, Elastase-concentrations and injury severity score (ISS > or = 20 = polytrauma). On admission day a prognostic assessment for early diagnosis of septic complications during intensive care could be demonstrated by a combination of the modified sepsis score and the number of organ failures and the presence of polytrauma. All other parameters did not have any predictive value.