Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2017
[Perioperative Intravenous Fluid Therapy in Children].
The objective of this consensus-based S1 Guideline for perioperative fluid therapy in children is to maintain or re-establish the child's homeostasis. Therefore, the perioperative fasting times should be as short as possible to prevent patient discomfort, dehydration, and ketoacidosis. ⋯ The additional use of colloids is recommended to recover normovolemia and to avoid fluid overload when crystalloids alone are not sufficient and blood products are not indicated. Monitoring should be extended in cases with major surgery.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2017
Review[Why and How Should I Assess Frailty? A Guide for the Preoperative Anesthesia Clinic].
Introduction: Frailty is a condition of decreased physiological reserves seen in approx. one third of elderly anesthesiological patients, and affecting many aspects of treatment as well as outcome. Although there are over 60 measurement instruments, frailty assessment is still poorly implemented. Understanding why and how to assess frailty is key to its implementation in preoperative anesthesia clinics. ⋯ Conclusion: Frailty assessments vary immensely in terms of required time, equipment, and expertise. We recommend at least one test for each domain of frailty, so as to obtain a more holistic view of the patient's physiological reserve. The implementation of an adequate and consistent preoperative frailty assessment has the potential to improve patient safety as well as short and long term outcomes.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2017
Review[Interventions for Assisting Geriatric Patients with Frailty Before Surgery].
Frailty is a complex syndrome leading to a higher vulnerability in elderly patients, especially during and after surgery. It is characterized by the simultaneous presence of at least three of five phenotypical symptoms: unintentional weight loss, exhaustion, muscle weakness, slow walking speed, and low activity levels. The presence of two of these symptoms is often labelled as pre-frailty. ⋯ Examples for these interventions are pre-surgery rehabilitation and Delirium Management Units (DMU). This article describes the frailty syndrome and its associated consequences for complications during and after surgery. Additionally, clinical assessments for identifying frailty symptoms as well as pre- and post-surgical interventions to reduce these risk factors are presented.
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Blockades of the cervical plexus are established anesthesia procedures, not only in the context of operative carotid revascularizations. Recent investigations define inner sonoanatomic landmarks as well as the importance of brain nerves for innervation in the neck region. The present practice-oriented article discusses current study results, alternative techniques (ultrasound- versus landmark-guided) and fields of application (carotid desobliteration, surgery of the shoulder, ear and infraclavicular region).
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2017
[Frailty: Prevalence in the Resident Population of Germany 70 - 79 Years of Age - a Population-Based Approach].
In all countries life expectancy is rising, and many older persons spend a longer period in good health. Nevertheless, frailty is present in older people and can be considered as a risk factor for limitations. The "German Health Interview and Examination Survey for Adults" (DEGS1) 2008 - 2011 comprised interviews, examinations and tests. ⋯ Frail persons significantly show more polypharmacy, recurrent falls, receive more frequently nursing care financial benefits, are officially recognized disabled and have poor social support. This population-based information may help to identify frail people with high risk of adverse health outcomes. Prediction models in operative anaesthesiology for specific health care settings should be developed.