Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Remifentanil is a short-acting opioid of high analgetic potency and superior controllability. It is widely used in day-case surgery, procedural sedation, for reduction of recovery-times and obstetrics and whenever excellent controllability of opioid effects is needed. Especially in combination with Propofol it is used for target-controlled infusion (TCI). The first part of the article provides readers with information about historical aspects, pharmacological characteristics, effects and side effects of remifentanil.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2017
[Prevention of Perioperative Hypothermia - Guidelines for Daily Clinical Practice].
Inadvertent perioperative hypothermia (body core temperature < 36 °C) is a serious complication leading to increased rates of wound infection, higher blood loss associated with increased transfusion requirements as well as patient dissatisfaction among others. Body core temperature is a vital parameter and needs constant monitoring just like heart rate, blood pressure and arterial oxygen saturation. Patient-, anesthesia-, surgery- and environment-related risk factors were identified for occurring perioperative hypothermia. ⋯ A bundle of procedures has to be arranged in order to improve patient outcome. Steps include general (e.g. staff instruction), pre- (e.g. prewarming), intra- (e.g. active warming) and postoperative (e.g. drug therapy) actions. An effective concept for prevention of perioperative hypothermia has to be adjusted to departments' specific constructional, organizational, process-related and staff characteristics with clearly visible and assigned responsibilities.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2017
[How Much Alarm Can the Human Being Tolerate?]
Due to growing technisation of intensive care the number of devices with integrated alarm systems is steadily increasing. However, most of the sounding alarms are false alarms causing high levels of frustration, aggression and inappropriate behaviour amongst the medical personnel. ⋯ In the interest of the medical staff and our patients, we should reduce the high frequency of false alarms by using modern alarm algorithms techniques, lower both noise exposure and stress load with the help of modern individualized alarm systems and by increasing awareness on the dangers of alarm fatigue through training and by using individualized patient-related alarm limits. Despite economic challenges hospitals and intensive care units should optimize staffing, thereby lowering the risk to patients and improving employee satisfaction.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2017
Review[Thoracic Trauma - Prehospital Treatment].
Penetrating thoracic injuries are rare in Germany and common in urban regions. 10 percent of the patients in Emergency Departments suffer from blunt thoracic trauma. Mechanism of trauma can predict the severity of the injuries. ⋯ The application of an algorithm in exploration of a thoracic trauma seems to be useful. The selection of trauma center depends on the severity of the trauma, if necessary with the availability of extracorporeal circulation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2017
Review[Preoperative Evaluation of Adult Patients Before Elective, Non-Cardiothoracic Surgery].
Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e.g. blood chemistry, ECG, spirometry, chest x-ray) can contribute to a reduction of perioperative risk is often not very well known or controversial. Similarly, there is considerable uncertainty among anaesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. ⋯ These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and updating when new validated evidence becomes available.