Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 2003
Case Reports[Time costs cardiac muscle tissue--prehospital therapy of acute myocardial infarct--a case report].
Symptoms of an acute myocardial infarction are a common reason for calling the emergency physician. Pre-hospital mortality caused by cardiac infarction is constantly high. The main potential for decreasing infarction mortality lies in the pre-hospital period. ⋯ A particular focus is the management of pre-hospital thrombolysis, the preconditions, realization and risks of which are described. In this context, the experience and competence of the emergency physician is prerequisite for the exact diagnosis and therapy. Furthermore, the importance of a smooth transition from pre-hospital therapy to intensive care is emphasized.
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Anaesthesiol Reanim · Jan 2003
Comparative Study[Regional anesthesia in newborn infants, infants and children--what prerequisites must be met?].
In general, every anaesthetic technique should only be used with a given indication after a careful risk-benefit evaluation, when there are no contraindications and when the physician has sufficient knowledge and skill to safely perform the technique. ⋯ the great advantage of regional blocks is that they can be administered without the risks of opioids, e.g. respiratory depression, nausea, vomiting and delayed gastric emptying. Regional anaesthesia is rarely indicated instead of general anaesthesia: even ex-premature babies can safely undergo general anaesthesia supplemented with a regional block. Special risks occur when regional blocks are performed in anaesthetised children, and special care is needed. However, in contrast to adult practice, this is a generally accepted modality of paediatric anaesthesia worldwide. In addition, perfect analgesia may obscure the signs of compartment syndrome and beginning pressure sores. Preoperative evaluation: the preoperative evaluation relies mainly on the patient's history. Coagulation tests are not performed as routine screening. However, even with a careful history, bleeding disorders can be overlooked, especially in neonates and infants. Mastering the technique: caudal anaesthesia can be used for a large variety of interventions below the umbilicus; therefore, a sufficient caseload can be achieved by most anaesthetists, and the technique can be easily learned. It should belong, together with wound infiltration, ilioinguinal and penile block, to the armamentarium of all anaesthetists caring for children. However, regional blocks are of limited duration and are therefore only part of a concept of balanced analgesia, which also involves nonsteroidals, paracetamol and opioids.
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Delirium is mental dysfunctions occurring as impaired attentional and memory systems with disturbances of consciousness, affectivity, psychomotor activity and sleep patterns. Numerous factors and underlying diseases may be responsible for these non-specific symptoms. Therefore, a thorough evaluation of preadmission history and current clinical status, supplemented by laboratory and extended technical diagnostic procedures, are always required. ⋯ Personal care should be intensified and include help from family members. Most problems arise from agitated, non-cooperative patients. Treatment with clonidine, gamma-hydroxybutyric acid or neuroleptic drugs like perazin and haloperidol may be required to reduce agitation and the activation of sympathetic influence.
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Anaesthesiol Reanim · Jan 2003
Randomized Controlled Trial Clinical Trial[Mesenteric traction syndrome during the operation of aneurysms of the abdominal aorta--histamine release and prophylaxis with antihistaminics].
Mesenteric traction syndrome occurs during abdominal surgery and is described as sudden tachycardia, hypotension and flush. Among other etiological factors, eventeration or mesenteric traction of the small intestine may cause histamine release from mesenteric mast cells. Therefore, our hypothesis was that mesenteric traction syndrome could be positively influenced by prophylactic administration of H1- and and H2-antihistamines. ⋯ In the placebo group, however, the haemodynamics only stabilised 5 min after mesenteric traction when anaesthetic gas concentration was repeatedly reduced and vasopressor/volume administration was increased (placebo group = 20 times vs. antihistamine group = 8 times (p = 0.001, Chi2-test). From these results we conclude that prophylactic administration of antihistamines reduces in particular the incidence of arrhythmias and the number of stabilising measures during mesenteric traction. Prophylaxis with H1- and H2-antihistamines may therefore be of perioperative benefit and should be considered in AAA surgery.