Der Anaesthesist
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In part 1 of this review, perioperative aspects of the use of non-opioids (acetaminophene, dipyrone, traditional NSAR, coxibs) were discussed. In part 2 the perioperative aspects of opioids (weak opioids: tramadol, tilidine with naloxone, strong opioids: morphine, piritramide, oxycodone, hydromorphone, fentanyl, methadone, buprenorphine) and coanalgesics (gabapentinoids; ketamine) will now be presented. The main aim of the review is to describe the use, risks and cost of some substances to facilitate the differential indication. New aspects concerning the use of gabapentinoids and ketamine are discussed.
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The aim of this study was to determine the actual cost per intensive care unit (ICU) day in Germany based on routine data from an electronic patient data management system as well as analysis of cost-driving factors. A differentiation between days with and without mechanical ventilation was performed. ⋯ For the first time, a cost analysis of intensive care in Germany was performed with routine data based on the matrix of the institute for reimbursement in hospitals (InEK). The results revealed a higher resource use on the ICU than previously expected. The large share of personnel costs on the ICU was evident but is comparable to other medical departments in the hospital. The need for mechanical ventilation increases the daily costs of resources by approximately 25%.
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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.