Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2017
[Antibiotic Stewardship - From Bench to Bedside].
The article explains the practical implementation of Antibiotic Stewardship (ABS) in the clinic. With increasing prevalence of resistant bacteria, the medical profession is challenged to critically question and reduce antibiotic prescriptions. ABS programs are designed to support this. ⋯ Microbiological pre-analysis is of crucial importance. In this case, fewer swabs, but more meaningful analytical methods, such as blood cultures or invasive probes, must be attempted. Finally, interactions between clinicians, microbiologists and hospital hygienists are of great importance.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2017
[Antimicrobial Stewardship in Daily Life - "Ask Your Doctor and Your Pharmacist"].
Antimicrobial Stewardship (AMS) cannot be practised as a one-man show. A well-established AMS-team with formal authority and dedicated time given by the hospital management can manage its tasks also in exceptional situations as for example an outbreak due to a multi-drug-resistant pathogen. Know-how of clinical infectious diseases is mandatory for all members of the AMS-team. ⋯ Restrictive usage of antibiotics can decrease the antibiotic selection pressure and counteract with the development of new bacterial resistances. Usage of last-resort antibiotics in an outbreak situation leads to an exceptional increase of therapeutic costs with fewer patients at the same time. Interdisciplinary work of infection control, the AMS-team, the different clinical departments and the hospital management are important for the prevention and the management of outbreak situations due to multi-drug-resistant pathogens.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2017
Review Case Reports[Management of Massive Intraoperative Blood Loss Using a Case Study].
Massive intraoperative bleeding is a major and potentially life-threatening complication during surgical procedures. The lethal triade of hemorrhagic shock with metabolic acidosis, hypothermia and coagulopathy enhances bleeding tendency. ⋯ Primary goals include the maintenance of adequate tissue oxygenation, restauration of proper coagulatory function, normothermia and homeostasis of acid-base and electrolyte balance. In the present article, these therapeutic goals and their pathophysiological background are illustrated with a clinical case example.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2016
Review Meta Analysis[Postoperative acute kidney injury: confounder or causal link for surgical outcome?]
Demographic change and increase of complexity of diagnostic and surgical procedures lead to an increasing relevance of acute kidney injury as postoperative complication. Postoperative acute kidney injury is associated with higher mortality, morbidity and treatment costs. It has not yet been unequivocally proven that postoperative acute kidney injury is in fact causally linked with worse treatment outcome in surgical patients. This article aims to give an overview of the phenomenon postoperative acute kidney injury, to discuss problems of demonstrating causal relations in biomedical research, and to present arguments for and against the hypothesis that postoperative acute kidney injury is causally linked to worse surgical outcome.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2016
Review[Awake video laryngoscopy - an alternative to awake fiberoptic intubation?]
Awake video laryngoscopy is a novel option in airway management that is drawing more and more attention as an alternative to awake endoscopic guided intubation.Main issues: Intubation under preserved spontaneous breathing is the safest method to secure the expected difficult airway. In direct comparisons to awake flexible endoscopic intubation, awake video laryngoscopy achieves satisfactory intubation times and a high acceptance of patients and anesthesiologists. Specific cases, in particular very limited mouth opening or sub-glottic masses, require awake flexible endoscopic intubation. Sufficient topical anesthesia and a sophisticated sedation protocol are prerequisites for successful awake video laryngoscopy. ⋯ Awake video laryngoscopy cannot fully replace flexible endoscopic intubation. It is a useful option, but it must be considered that this technique is not suitable for all types of airways, patients or even anesthesiologists. Expertise and adequate practice is mandatory for both techniques. Careful planning, an appropriate blade design and a high expertise in video laryngoscopy are crucial for a successful intubation.