Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2019
Case Reports[A Fatal Case of Fulminant Necrotising Fasciitis in a 47-Year-Old Male].
Necrotising fasciitis (NF) is a rare soft tissue infection characterized by rapid progressive necrosis. Initially patients usually present with nonspecific symptoms like fever, severe pain and skin lesions that progress rapidly. It requires prompt recognition and early treatment with extensive surgical debridement and intravenous antibiotics. ⋯ NF has previously been reported in literature. Some assumed premorbid conditions associated with NF are diabetes mellitus, chronic kidney injury, adiposity, peripheral artery occlusive disease, arterial hypertension, intravenous drug abuse and immunocompromised state. Here we present a fatal case of NF in a 47-year-old male patient without any comorbidity after minor trauma with a fulminant septic course.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2019
[Increased Arterial Blood-Pressure Previous to Elective Surgery - How to Proceed?]
Guidelines concerning the widespread disease "essential arterial hypertension" have been available for a long time. Recently, the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and the British Hypertension Society (BHS) presented a guideline that is focused on the handling of patients suffering arterial hypertension previous to elective surgery. Is there any effort and/or benefit in postponing the operation? Within this guideline we find a concrete statement and recommendation how to deal with this question and how to evaluate the cardiovascular risk regarding this parameter.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2019
[Pulmonary Hypertension: Diagnostics, Classification and Therapy].
Pulmonary hypertension is a chronic, incurable disease with poor prognosis. The therapeutic aim is a stabilization of patients showing signs of right heart failure as well as disease progression. A pulmonary hypertension is diagnosed in patients displaying a mean pulmonary arterial pressure of > 25 mmHg in resting state. ⋯ For patients with atypical PAH, an initial monotherapy is to be introduced. In case of chronic thromboembolic pulmonary hypertension, the possibility of an operative pulmonary endarterectomy should be evaluated. To date, the only approved drug is Riociguat, a stimulator of the soluble guanylate cyclase.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2019
[Stroke Thrombectomy: Anaesthesiologic Aspects].
Ischemic Stroke is a focal neurological deficit based on an acute ischemia. rt-PA lysis and thrombectomy are therapeutic options. Thrombectomy can be performed under local anaesthesia, sedation or general anaesthesia. ⋯ The following prospective, randomized trials could not detect harmful effects of general anaesthesia. Nonetheless in anaesthesia care of ischemic stroke patients many (patho-)physiological and pharmacological aspects should be taken into account for the best neurological outcome.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2019
Case Reports[Intrahepatic Hematoma and Pulmonary Embolism in a Young Woman with Oral Contraceptives Complicated by Type II Heparin Induced Thrombocytopenia Requiring ECMO-Therapy: a Case Report].
A 46-year-old woman on oral contraceptives developed an intrahepatic hematoma due to a benign hepatic tumor. As an incidental finding, a computed tomography showed a pulmonary embolism. Unfractionated heparin was given in a prophylactic dosing in an attempt to balance the risk of further intrahepatic bleeding with that of thrombosis. ⋯ After hemodynamic and pulmonary stabilization, six days after ECMO-support the cannula was scheduled to be removed. On removal of the venous cannula the patient developed another massive pulmonary embolism with cardiac arrest which led to immediate reinstallation of va-ECMO. Under therapeutic anticoagulation using argatroban the ECMO support continued until the patient was on day 17 successfully weaned.