Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2019
[Anaesthesia in Adult Patients with Obesity].
The prevalence of obesity has substantially increased worldwide during the last ten years. Hence, more anaesthetic procedures will be performed in obese patients in the future and more hospitals have to be prepared for the perioperative treatment of extremely obese patients including medical, technical and organisational issues. These include not only the management of the perioperative problems of adiposity, but also of its numerous concomitant diseases. ⋯ Preoxygenation is improved by continuous positive airway pressure (CPAP). In this educational review, a summary of the currently known facts regarding anaesthesia in obese patients is outlined together with future perspectives. Regional anaesthesia is also recommended for postoperative pain therapy.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2019
[The Critically Ill Obese Patient: Too Big to Fail?]
Worldwide, currently more than 1.9 billion adults are overweight, 650 million of them are obese. Hereby they pose a significant burden on the budget of the health system and on the workload of intensive care units. Mechanical ventilation of critically ill obese patients needs to take into account the characteristic pathologic alterations of their respiratory system. ⋯ Failure to do so may result in obesity supine death syndrome. Finally, latest research documented lower mortality rates in obese individuals who require intensive care. This represents another hard to explain obesity paradox.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2019
[Ultrasound-Guided Regional Anaesthesia in Obesity].
Obesity is associated with a number of anaesthesia-relevant risks. Regional anaesthesia procedures offer a number of advantages, but they also pose an anaesthetic challenge. ⋯ The use of ultrasound (US) technology with the ability to visualize the target structures may be helpful in performing neuraxial and peripheral blockades. However, a lot of experience and training is required because the ultrasound imaging of very low-lying nerves in obese patients is limited due to the physical limitations of US technology.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2019
[Staphylococcus aureus Bacteraemia - an Interdisciplinary Challenge].
Staphylococcus aureus is the second-most-common pathogen among bloodstream infections. Due to a high hospital mortality rate (15 - 40%), frequent complications and recurrences the clinical management of Staphylococcus aureus bacteremia (SAB) is distinct from bacteremia from other pathogens. ⋯ SAB is associated with high morbidity and mortality. Clinical management is complex. By adhering to diagnostic and therapeutic measures, the prognosis can be improved.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2019
[Blood Transfusion: a Guide to Clinical Decision Making].
Nowadays, management of hemotherapy is regulated in Germany by the transfusion act and several guidelines while the transfusing physician is responsible for correct implementation at the bedside. Indications for blood products have to be carefully adapted to the patient's current clinical situation and pre-existing diseases have to be considered as well. Today, for most perioperative elective surgeries, evidence-based transfusion thresholds for packed red blood cell concentrates (RBC) have been defined and should be considered. ⋯ For severe hemolytic transfusion reactions, in almost all cases, wrong blood in tube (WBIT) at the diagnostic bedside blood withdrawal or a mix-up of blood components before transfusion is causative. Massive transfusion situations require a proactive management, which includes RBC, FFP and potentially also PC and coagulation factor concentrates. Prior to elective surgery, anemic patients should be diagnosed and treated for the cause of their anemia, if possible.