Der Anaesthesist
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Former preterm infants with postconceptual age <50-60 weeks are at risk of postoperative apnea and bradycardia when operated under general anaesthesia. In addition, after general anaesthesia with endotracheal intubation preterm infants, who had suffered from severe respiratory distress syndrome, often require prolonged postoperative mechanical ventilation. Pure regional anaesthetic techniques can avoid most of these postoperative respiratory complications. ⋯ Recently, pure caudal anaesthesia for this indication has become a promising alternative. If a pure regional anaesthesia technique is not indicated or feasable, the combination of light inhalational anaesthesia with a caudal block seems appropriate. Overnight cardiorespiratory monitoring is mandatory in these patients regardless of the anaesthetic technique used.
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When tissue is destroyed, pain arises. Tissue destruction as well as wound healing are associated with an inflammatory reaction. This leads to activation of nociceptors ("pain receptors") which can cross-communicate with the inflammatory infiltrate. ⋯ In parallel, antiinflammatory cytokines such as IL-4, IL-10, IL-13 and IL-1ra are produced and reduce hyperalgesic effects of the proinflammatory cytokines initially produced. Inflammatory pain, therefore, is the result of an interplay between hyperalgesic and analgesic mediators. Drugs such as immunosuppressants influencing this interplay may also impair endogenous hyperalgesic and analgesic mechanisms.
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In obstetric anaesthesia almost all anaesthetic agents are capable of traversing the fetomaternal blood barrier. They all carry potential side-effects putting the unborn or newborn child at risk. ⋯ Furthermore compromisation of uterine blood flow or contractility of the mature uterus plays an important role for the incidence of intrauterine asphyxia and premature labour or birth. Considering the physiological and pathophysiological alterations during pregnancy regarding all organ systems, the overall goal is to find an ideal choice of anaesthetic drugs and techniques in order to minimise an increased anaesthetic risk during pregnancy.
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Recombinant activated coagulation factor VII (rFVIIa, NovoSeven) was originally developed for the treatment of bleeding complications in haemophilia patients with allo-antibodies (inhibitors) against exogenous factor VIII or IX. In 1988, rFVIIa was used successfully in such patients for the first time. ⋯ A large number of case reports and results from initial clinical trials suggest that rFVIIa may also be effective in the prevention and treatment of bleeding in patients under oral anticoagulation, with liver diseases, and in patients without any pre-existing haemorrhagic diathesis. However, further clinical studies will be necessary to specify the future potential of rFVIIa.