Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2020
[Barriers to Conversations About Death and Dying in the Medicine].
Conversations about death, dying and the end of life are usually difficult. They can turn out to be both a burden and a challenge for those engaging in these talks. There is evidence that talking early about end-of-life-topics shows positive effects concerning medical and psychological conditions of patients. ⋯ In daily medical routine end of life topics should be addressed early and actively. Especially the readiness for these conversations should be tested repeatedly and talks should be offered regularly. Critical events such as relapse, modulating therapy concepts and knowledge of unrealistic treatment expectations should be regarded as prompts to offer conversations about dying and end-of-life care actively.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2020
[Drug Interactions in Emergency Medicine].
Unwanted drug interactions are responsible for a high rate of hospitalization. The rate of unwanted interactions increases with the number of drugs taken. ⋯ They can be caused by an emergency treatment and can be the cause of a necessary emergency treatment. To avoid unwanted drug interactions, electronic databases and smartphone apps could be helpful.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2020
[Drug-drug Interactions in Intensive Care].
Drug-drug interactions are common problems in intensive care units. Numerous studies could demonstrate the impact of the total amount of prescribed drugs and the occurrence of potential respectively manifest drug-drug interactions in critically ill patients. The average number of clinically used drugs in this setting is approximately 25 - 35 per patient, thus the profound knowledge of pharmacodynamic and pharmakokinetic mechanisms regarding drug interplay is important for treatment safety. ⋯ The most important drug classes noted in this context are analgesics and sedatives, antibiotics, antimycotics, antiepileptics, immune suppressive drugs, prokinetics and gastric acid regulating drugs. Furthermore, some pharmacodynamic interactions are described like QTc prolongation or serotonin syndrome. Additionally, a clinical case is demonstrated regarding the malignant impact of rifampin co-medication in a patient suffering from severe hypertension with the use of several antihypertensive drugs.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2020
[Perioperative Infusion Therapy in Children].
The composition and type of intravenous fluids during paediatric anaesthesia have been subjects of debates for decades. Errors in perioperative infusion therapy in children may lead to serious complications and a negative outcome. Therefore, in this review historical and recent developments and recommendations for perioperative fluid management in children are presented, based on physiology and focused on safety and efficacy. ⋯ For intraoperative maintenance infusion, addition of 1 - 2% glucose is sufficient to avoid hypoglycaemia, lipolysis or hyperglycaemia. Modified fluid gelatine or hydroxyethyl starch in balanced electrolyte solution can safely be used to quickly normalize blood volume in case of perioperative circulatory instability and blood loss. In conclusion, physiologically composed infusion solutions are beneficial for maintaining homeostasis, shifting the status more towards the normal range in children with pre-existing imbalances and have a wide safety margin in case of accidental hyperinfusion.