Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2018
Review[Pain Therapy Aspects in Tumour Surgery].
Due to preexisting pain or surgically induced sensitization patients undergoing oncological surgery are predisposed for a postoperative high pain intensity with the risk of developing persistent pain. In oncological surgery, pain therapy should be adapted to the underlying pain mechanism. Different treatment principles should be applied in a graded concept of acute pain therapy. ⋯ Before using such treatment, pain mechanisms should be verified by an adequate pain diagnostic. The impact of perioperative regional analgesia on the oncological outcome is subject to controversy. Opioids reveal both: tumor promoting and tumor inhibiting properties.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2018
Review[Traumatic Injuries of the Central Nervous System].
The term "traumatic injuries of the central nervous system" (CNS) refers to both traumatic brain injury (TBI) as well as traumatic spinal cord injury (SCI). Both types of injuries substantially contribute to morbidity and mortality in developed as well as developing countries. The underlying pathophysiological processes are very complex and despite extensive research efforts they are still not completely understood. ⋯ Thus, in order to treat these conditions effectively an interdisciplinary treatment approach consisting of intensive conservative as well as operative treatment options in specialized centers experienced in the treatment of patients with traumatic injuries of the CNS is necessary. This review summarizes the epidemiology, pathophysiology, diagnostic approaches as well as current preclinical and clinical treatment options based on current guidelines and literature. Finally, the prognosis for both conditions is outlined.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2018
Review[Neurointensive Care: Aneurysmal Subarachnoid Hemorrhage - State of the Art].
The aneurysmal subarachnoid hemorrhage is a life threatening disorder associated with high morbidity and mortality. Identification and treatment of the bleeding source is mandatory within the first 24 hours to prevent rebleeding. ⋯ Consequent monitoring of the patients including transcranial doppler sonography and undelayed treatment of complications can improve the outcome of the patient substantially. Longterm neuropsychological sequelae may hamper the patient and thwart his reconstitution, thus requiring psychological intervention.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2018
Practice Guideline[A Process-Oriented Approach at Current Recommendations for Obstetric Anesthesia and Postoperative Monitoring After C-Section].
The known guidelines before a planned operation on aspiration, fasting and preoperative risk evaluation also apply in obstetrics. Extended measures are only justified under concrete anamnestic or specific symptoms. Neuraxial anesthesia techniques should be offered to the mother as early as possible, as waiting for a certain opening of the cervix is not justified. ⋯ Low-dose local anesthetic concentrations in combination with an opioid are still recommended. The benefit of pencil-point spinal needles in minimizing the risk of post-puncture headache has been demonstrated. Predictable emergencies are airway emergencies, hemorrhagic emergencies and cardiopulmonary resuscitation with emergency cesarean if appropriate (> 20 SSW).
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2018
Case Reports[Metabolic Acidosis under Acetaminophen Intake - an Unordinary Side Effect].
Metabolic acidosis is common among hospitalized patients. However, in a few cases a long-term administration of acetaminophen can lead to transient 5-oxoproline accumulation and causes metabolic acidosis with high anion gap in adults. A 73-year-old man was hospitalized with Staph. aureus sepsis after right knee prosthesis infection and received analgesic treatment with acetaminophen 2 g/d and antibiotic therapy with flucloxacillin over several weeks. ⋯ A change in antibiotic treatment, interruption of acetaminophen and administration of acetylcysteine lead to a normalization of the acid-base balance. In a patient with metabolic acidosis under acetaminophen administration, particularly in the context of sepsis, malnutrition, liver and kidney diseases as well as antibiotic treatment with flucloxacillin an accumulation of 5-oxoproline must be considered. The treatment with acetaminophen must be interrupted and acetylcysteine should be administered.