Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2018
Review[Echocardiography in Acute Right Heart Insufficiency].
The anesthetist is increasingly faced with more complex operations in combination with an aging patient population characterized by pre-existing conditions. Acute right heart failure is often not recognized as the cause of cardiopulmonary insufficiency. Echocardiography has emerged as an important diagnostic tool. ⋯ If indicated, a peri-/intraoperative echocardiographic examination also has a direct influence on therapy control. With a focused cardiac examination crucial information can be gained and the outcome of the patient can be positively influenced by adapted therapy control. By using standard ultrasound views, right heart failure can be detected as the cause of hemodynamic instability.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2018
Review[Management of Pediatric Airway in Anesthesia].
Airway management is a major competence of clinical anesthesia. Knowledge of available materials and skills in the use of specific methods and techniques are essential and should be trained routinely. ⋯ For the airway management in pediatric patients, special materials, techniques, individual and institutional expertise must be present. This article presents a selection of materials, methods and techniques of the treatment recommendations for the management of a difficult airway.
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The therapy of patients suffering from sepsis and septic shock is one of the greatest challenges in critical care medicine. In the initial phase of septic shock patients often present with hyperdynamic circulatory conditions with elevated cardiac index, tachycardia and progressive hemodynamic instability. The type of tachycardia differs from atrial fibrillation or flatter to sinus tachycardia. ⋯ Despite predominantly β2-mediated immunomodulatory effects the administration of a selective β1-adrenergic blocker may be beneficial in some cases. On the other hand, incautious administration of beta-blockers especially in case of insufficient volume replacement may result in direct negative inotropic effects rapidly aggravating hypotension and shock. This review focused on pharmacology of the β-adrenergic system, the pathophysiological rationale and current literature on clinical practice of the use of beta-blockers in sepsis and septic shock.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2018
Review[Safe Paediatric Anaesthesia: Update on Drug Safety].
Drug errors occur in all areas of care. Due to age-group-specific characteristics and the need for dose calculation, the probability of errors in children increases compared to adults. The recognition of the fallibility of every supplier and the acceptance of security structures are essential. The article describes a catalogue of measures for drug safety suitable for everyday use.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2018
Review[Multimodal Neuromonitoring and its Impact on Therapeutic and Diagnostic Decisions in Critical Ill Patients].
Patients with acute cerebral injuries for various reasons (traumatic, ischemic, hemorrhagic) are at risc for developing secondary brain damage and further neurological deterioration. The aim of neuromonitoring is to recognize subtile changes in intracranial physiology as early as possible to initiate adequate diagnostic and therapeutic measures to prevent secondary brain damage. ⋯ Electrophysiological monitoring by electrocorticography or evoked potentials and measurement of cerebral blood flow provide additional information. The indications and clinical impact of these various monitoring techniques are discussed to ensure optimal medical care in patients with acute brain injury.