Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2017
Review[Anesthetic Management in Thoracic Trauma Patients].
In daily practice, management of patients with blunt thoracic trauma is challenging for the anesthetist. Injuries of airways, lungs, diaphragm, heart and large vessels are the main difficulties. Respiratory and circulatory physiology in general is affected by general anesthesia, which may result in an increased number of perioperative complications. ⋯ Therefore, a high degree of (patho-)physiological understanding and manual skills are required in this scenario. Interdisciplinary cooperation during diagnostic, treatment and in the perioperative course is a prerequisite for a successful management. The present work describes the main characteristics of thoracic trauma and discusses important precautions and typical problems the anesthetist has to face in the clinical setting.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2017
Review[The Patient with Chest Trauma: Surgical Management].
Even though isolated cases of penetrating chest wounds are exceptionally rare in Germany, chest trauma accounts for major morbidity and mortality in over 18 0000 multitrauma patients encountered every year. Injuries range from immediately fatal cardiac wounds and major vessel lacerations to intercostal bleeding, parenchymal damage, chronic haematothorax and secondary empyema. Placement of large-bore chest tubes constitutes a sufficient treatment for most of these pathologies. In select cases further treatment either by minimally invasive techniques (VATS) or conventional thoracotomy is warranted.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2017
Case Reports[Cerebellar Infarction After Carbon Monoxide Poisoning and Hyperbaric Oxygen Therapy].
We report on a patient who developed a space-occupying cerebellar infarction with occlusive hydrocephalus after a poisoning with carbon monoxide with the intention to commit suicide. A neurosurgical and intensive care therapy were needed. The patient's survival without severe neurological deficits could be secured due to the early detection of the intracerebral lesions.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2017
Review[Preoperative Evaluation and Arrangements: The Elderly Patient].
With a constantly growing portion of elderly within our population and the advances of modern medicine, surgery on aged and very aged patients has become a daily hospital routine. Due to the physical and mental features of ageing these patients face special perioperative risks. ⋯ Even in the healthy elderly, most organ functions are "physiologically" instable or deficient and the homeostasis of health and disease is fragile. The preoperative evaluation of the aged patient has to be extended towards risk factors and pathologic pre-conditions which derive especially from high age and are so far not determined by a mere "fit-for-anaesthesia?"
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2017
Review[Preoperative Preparation: Patient Blood Management - What is Optimal?]
Patient Blood Management (PBM) focusses on anemia management, the minimization of (unnecessary) iatrogenic blood loss and the exhaustion of natural tolerance to anemia with rational use of red blood cell transfusion. The focus of the current review article is now the preoperative phase with the following PBM components: management of anemia, pre-transfusion analytics and management of anticoagulants. Preoperative anemia is an independent risk factor for increased perioperative morbidity and mortality. ⋯ Preoperative pre-transfusion analytics should be performed by a step-wise approach depending on the transfusion probability (and the baseline hemoglobin) and current in-house data. Management of (oral) anticoagulants needs to consider an individual risk stratification for bleeding and thromboembolic events, should be initiated in the preoperative phase, and should specify whether the anticoagulant needs to be continued, stopped or bridged. Long-term success of the preoperative PBM program can only be guaranteed with clearly defined responsibilities in the preoperative PBM team, communication and training of all those involved in the process of care.