Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2021
[Perioperative Management: from the OR to the ICU].
Patients who undergo high-risk surgical procedures represent a large proportion of admissions to intensive care units. Postoperative outcomes are a result of the complex interplay between the exact surgical procedure performed, the previous health of the patient, and specific intra- and postoperative events. Appropriate triage of patients to intensive care postoperatively may have a relevant impact on patient outcomes after high-risk surgery. ⋯ Intrahospital transports are prone to adverse events and need careful preparation to be executed safely. In addition, exchange of clinical information during the transfer of responsibility between anesthesiologist and the intensive care physician has been recognized as a high-risk area for medical errors to occur. Structured handover protocols can reduce communication breakdowns during postoperative transfer of patients from the OR to the ICU.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2021
[Perioperative Management: From the Operating Room to Postanesthesia Care Unit/to the Normal Ward].
The early postoperative period is of increasing importance in modern operative medicine with a continuously increasing surgical spectrum and patients with increasingly complex comorbidities. Even with optimal preoperative evaluation and intraoperative care, postoperative complications are not uncommon. ⋯ The qualification of the medical staff and spatial structure must meet the recommended minimum and must be in line with the existing operational structures. Good interdisciplinary and interprofessional communication reduces the loss of information and a good error reporting culture helps to reduce critical incidents.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2021
[Spinal Analgesia - Cleverly Used for Vaginal Delivery].
Neuroaxial procedures are among the most effective ways of relieving pain during childbirth. Especially in the late phase of vaginal delivery, surprising moments, instrumental methods or special maneuvers require quick and sufficient analgesia. This refers to situations with a sudden, often unexpected and particularly pronounced intensity of pain. ⋯ There is no possibility of repetition without re-puncture, so that limited duration of action is a significant disadvantage. Applied drugs correspond to those described for combined spinal and epidural analgesia, such as a mixture of low-dose bupivacaine and sufentanil, and can be adapted to local conditions. In the future, longer acting substances could overcome the main limitation (temporary effect) of spinal analgesia and suitable adjuvants could further increase the attractiveness of the procedure.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2021
Review[Extracorporeal Strategies in Sepsis Treatment: Role of Therapeutic Plasma Exchange].
Mortality in sepsis remains high. Various techniques for extracorporeal cytokine removal have been investigated as additional therapeutic measures in sepsis and septic shock. ⋯ The use of extracorporeal blood purification methods cannot be recommended for sepsis patients outside of clinical trials given the current lack of evidence of their efficacy. Future investigations should aim to homogenize the studied patient collective in respect to clinical sepsis severity, time point of intervention and different inflammatory (sub-)phenotypes.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2021
Review[Diabetes mellitus in Anaesthesia - Optimal Blood Sugar Control in the Perioperative Phase].
Uncontrolled high blood sugar can be dangerous for diabetics throughout the perioperative period - in particular, when blood glucose levels exceed a threshold of 250 mg/dl or HbA1c levels are higher than 8.5 - 9%. In such cases, all elective surgery should be withheld to minimize the risk of severe complications. ⋯ Current literature suggests that non-critically ill diabetics should be treated with rapid-acting insulin analogues subcutaneously in operating theatres, whereas critically ill patients should receive continuous intravenous insulin infusions using a standardized protocol. In summary, this review can give a hand in dealing with diabetics during the perioperative period and offers guidance in controlling blood sugar levels with the help of oral antidiabetic drugs and insulin.