Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Fluid and volume therapy is of paramount importance in anaesthesia and intensive care medicine. Fluid replacement as well as volume therapy can cause hypervolemia with deleterious consequences. ⋯ However, there are several limitations of the different monitoring techniques that the user should be aware of. An algorithm can be helpful for a structured approach in monitoring volume therapy.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2021
Case Reports[Sectio Caesarea under Gitelman Syndrome].
Gitelman syndrome is a rare inherited renal tubulopathy characterized by hypokalemia, hypomagnesemia and metabolic alcalosis. It is caused by a mutation in the SLC12A3 gene leading to a dysfunction of the thiazide-sensitive sodium chloride cotransporter and the magnesium transporters in the distal convoluted tubules. ⋯ Due to many unsolved questions about the impact on pregnancy and the maternal and fetal outcome, the obstetric and anesthesiological management remains a challenge. We discuss the case of a primary cesarean delivery in a 22-year-old woman with a new diagnosed Gitelman syndrome focusing on the anesthesiological approach.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2021
[Cannabis as Medicine: Safe Use of Special Regulations].
In 2017, the legislator created a special regulation for medical cannabis in Germany. Medical cannabis can also be prescribed without marketing authorization at the expense of the statutory health insurance, if other forms of therapy are not sufficiently effective. Before starting therapy with a cannabis medicine outside of approved indications, an application for reimbursement must be submitted to the health insurance company. ⋯ According to first interim results of this survey, many side effects have an influence on the vigilance of patients. The risk of falling is increased, especially in older patients. In the medium term, the special regulation described above should become dispensable due to the approval of cannabis-based finished medicinal products.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2021
[Perioperative Anesthesiologic Management: Risk Assessment and Preoperative Improvement of Patient Conditions].
With patient safety being anesthesiologists' top priority, the focus of preoperative assessment must be to reduce perioperative morbidity and mortality of each patient entrusted to us. Perioperative risk is multifactorial and depends on the extent of surgery and the preoperative condition of the patient. The three main causes of unexpected perioperative death are cardiac arrest, hypoxemia and acute bleeding. ⋯ Prehabilitation strategies reduce perioperative mortality and morbidity by improving functional capacity. These include preoperative nutrition supplementation, physical exercise, correction of iron deficiency and optimized treatment of hyperglycemia. A combination of thorough risk stratification and prehabilitation strategies can improve preoperative conditions and reduce complications in the postoperative period.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2021
[The Guideline "Sedation for Gastrointestinal Endoscopy"].
The guideline "Sedation for gastrointestinal endoscopy" (AWMF-register-no. 021/014) was published initially in 2008. Because of new and developing evidence, the guideline was updated in 2015. ⋯ Essential aspects are the selection of sedatives/hypnotics, structural requirements, personnel requirements with regard to number, availability and training, management of complications and quality assurance. In this article, the development and evaluation of the evidence and its influence on the practical implementation, in particular for anaesthesia, are highlighted.