Der Anaesthesist
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The wide variability of clinical symptoms and the ongoing difficulties concerning the rapid and specific laboratory diagnosis of sepsis, contribute to the fact that sepsis primarily remains a clinical diagnosis. To contribute to a more tailored antibiotic coverage of the patient early on in the course of the disease, modern diagnostic concepts favour the qualitative and quantitative molecular biological detection of blood stream pathogens directly from whole blood. ⋯ In the short term, such tests will not substitute conventional blood culture despite their superior rapidity and sensitivity, mainly because of higher cost. The amazing speed of ongoing scientific developments means, however, that techniques that might appear complicated, labour intensive, and costly today, will develop to become the future standards in the microbiological diagnosis of patients with sepsis and septic shock.
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Randomized Controlled Trial
[Sympathomimetic effects of low-dose S(+)-ketamine. Effect of propofol dosage].
In analgetic dosages ketamine has stimulatory effects on the cardiovascular system, which limits its use in patients with heart disease. The aim of this study was to clarify whether low-dose S(+)-ketamine used to prevent chronic pain similarly stimulates the cardiovascular system and to determine the impact of propofol dosage on this effect. ⋯ Even low-dose S(+)-ketamine has a stimulatory effect on the cardiovascular system. This stimulatory effect is nullified in the presence of a continuous propofol infusion at a dosage of more than 3 mg/kg BW/h.
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Acute confusional states (delirium) occur in up to 80% of patients in the intensive care unit. Delirium is an important independent prognostic determinant of hospital outcome, including duration of mechanical ventilation, nursing home placement, functional decline and death. ⋯ Recently, a number of new screening instruments have been validated for the monitoring of delirium in non-communicative patients receiving mechanical ventilation. Critical care patients should be routinely assessed for delirium and treated immediately using available preventive and therapeutic measures, both pharmacological and non-pharmacological, to improve the clinical course.
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Review
[Management of hemostasis disorders after extracorporeal circulation. A clinical therapy algorithm].
After cardiac surgery with extracorporeal circulation, approximately 20% of patients show significant bleeding tendencies and 5% require re-intervention. In 50% of patients undergoing re-operation, no surgical cause can be determined, suggesting coagulopathy after cardiopulmonary bypass (CPB). ⋯ The intervention with plasma products, coagulation factor concentrates and hemostatic drugs after extracorporeal circulation are described. Extensive bleeding history as well as the efficacy and side effects of antifibrinolytic treatment are discussed.
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Randomized Controlled Trial
[Intrathecal morphine in orthopaedic surgery patients. Optimised dose in patients receiving dipyrone].
The influence of different postoperative doses of intrathecal morphine on the time of first opioid request by orthopaedic patients was investigated. The first choice analgesic was dipyrone and a maximum dose of 6 mg/day was allowed. ⋯ In orthopaedic patients with dipyrone as the primary analgesic, the addition of 0.1 mg or 0.2 mg morphine to spinal anaesthesia provided a simple long-lasting postoperative analgesia and the use of additional opioids could be avoided during the 24h postoperative period.