Der Anaesthesist
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Approximately 5-8 million people in Germany suffer from chronic pain. Some patients can obtain relief from specific interventional techniques. In detail these are blocks of the sympathetic chain and peripheral nerve blocks, regional anesthetic techniques close to the spinal cord and neuromodulation. ⋯ Peripheral nerve blocks are important for postoperative pain treatment. Only a few methods are used for chronic pain and this applies primarily to the intercostal block which is used for the treatment of pain occurring after thoracotomy, intercostal neuralgia and pain associated with infiltration of cancer. Blocks of the vegetative nervous system are accomplished on the ganglions of the head and the sympathetic chain and are therefore most commonly applied to treat headache, neuropathic and sympathetic pain in the area of abdomen and the extremities.
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Randomized Controlled Trial
Hemodynamics in coronary artery bypass surgery: effects of intraoperative dexmedetomidine administration.
Dexmedetomidine is an α2-receptor agonist which is increasingly being used in coronary artery bypass grafting (CABG) surgery due to its suppressive effect on the stress responses against intubation and surgery. In this study effects of dexmedetomidine administration as an adjuvant agent during induction and maintenance of anesthesia on intraoperative hemodynamic changes were studied in patients undergoing CABG. ⋯ Dexmedetomidine can be safely used in CABG operations delivering a stable hemodynamic status throughout the operative period.
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Case Reports
[Thrombotic microangiopathy after extracorporeal circulation: important differential diagnosis].
Thrombotic microangiopathies are characterized by platelet activation, endothelial damage, hemolysis and microvascular occlusion. This group of diseases is primary represented by thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). Patients present with microangiopathic hemolytic anemia and thrombocytopenia as well as occlusion-related organ ischemia to a variable degree. ⋯ Due to a high mortality, particularly of TTP, immediate diagnosis and therapy are essential. In this article two cases of thombotic microangiopathy after cardiac surgery are reported. After exclusion of TTP and HUS as well as other etiologies of thrombotic microangiopathy a relationship between the use of extracorporeal circulation and the pathogenesis of thrombotic microangiopathy is assumed.
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A 22-year-old patient underwent surgery for a glass wound incision of the hand and anesthesia was carried out using an axillary brachial plexus block with prilocaine. Following surgery the patient developed methemoglobinemia which was treated with tolonium chloride. After administration of the drug the sinus rhythm changed into ventricular fibrillation. The current treatment options of methemoglobinemia will be discussed.
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Due to a variety of reasons (e.g. increase in outpatient surgery and legal restrictions related to working hours) it has become increasingly more difficult to have the pre-anesthesia visit and the anesthesia carried out by the same anesthetist. In the light of these organizational changes as well as increasing economical pressure it has become common practice to implement pre-anesthesia assessment clinics. It is unclear, however, if these changes in anesthetic patient care respect patient needs. ⋯ These results suggest that the integration of a pre-anesthesia assessment clinic in anesthetic patient care is not favorable from the patients' point of view because getting to know the anesthetist who will deliver anesthesia is of paramount importance to most patients. In cases where a pre-anesthetic assessment clinic is indispensable, other measures to build up confidence compensating for the lack of personal patient-physician relationship should be developed. In this respect, the promotion of a corporate identity of the whole anesthesia department may be beneficial. Furthermore, keeping the waiting time as short as possible should be a high priority as this item was rated the second most important factor.