Anaesthesiologie und Reanimation
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Pain therapy is an essential component of clinical care. Using the example of a regional hospital, the various possibilities of providing effective pain therapy are discussed. ⋯ Proven methods of organising acute pain service are also discussed. The most decisive factor is the degree of patient satisfaction, which can be ensured by measures of quality control.
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Based on a questionnaire of the General Hospital of Hamburg-Altona, we asked 738 patients about postoperative complaints such as nausea, vomiting, pain in the operating field and feeling of coldness in order to record the quality of the results of operation and anaesthesia in 1997 and 1998. The incidence of nausea and vomiting amounted to only 29% on average. One of our earlier studies of postoperative vomiting from 1995-1997 and the results gained from a control group of non-treated patients in our ondansetron study from 1995, which was conducted using information drawn from the routinely-used anaesthesia protocol and was therefore limited to data from the immediate pre- and postoperative period up to discharge of the patients from the recovery ward, showed much higher frequencies of nausea and vomiting (44 and even 66% on average, respectively). ⋯ This shows that a satisfactory solution to this problem has not yet been found--partly due, unfortunately, to financial restrictions. Nevertheless, for 15% of the patients postoperative nausea and vomiting were of only minor importance for general satisfaction with the treatment given them. This was probably due to good premedication of amnestic after-effects of narcosis.
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Anaesthesiol Reanim · Jan 2001
Comparative Study[The asphyxia-cardiac arrest rat model for developing mechanism of effect oriented therapeutic concepts after cardiopulmonary resuscitation].
In order to expand and combine clinical and basic science research opportunities on cardiac arrest, the Asphyxial Cardiac Arrest Rat Model, originally developed at the International Resuscitation Research Center in Pittsburgh, was introduced and adapted at the University of Magdeburg Medical Center. For better utilization of established morphological and biochemical evaluation techniques, the former Sprague-Dawley rat model was adapted for Wistar rats. ⋯ Furthermore, a trend towards a more pronounced secondary blood pressure depression was observed especially during the later half of the first hour after resuscitation. Post-mortem brain evaluations using conventional Nissl and haematoxylin-eosin staining techniques showed--most distinctly in the hippocampal CA1 region--delayed neuronal damage with a peak at 72 hours after resuscitation and with only a few neurons remaining after seven days of survival.
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Epidural analgesia (EDA) is the most effective method of intrapartum pain relief. Its influence on the course of labor continues to be controversial. Although a cause-and-effect relationship has not been proven, this form of analgesia has been blamed for a host of adverse maternal/fetal events during labor, including prolonged first and second stage of labor, dystocia, malrotation of the fetal head and an increased risk of operative delivery (instrumental delivery, Caesarean section). ⋯ Although the Caesarean section rate for women with an EDA was elevated, the total proportion of secondary Caesarean section remained unchanged despite increased use of EDA. Our findings suggest that women selected for intrapartal EDA already represent a population with an increased risk of an unfavourable course of labor, priming of the cervix, increased need of oxytocin and nulliparity. Pain relief in itself is sufficient indication for the use of intrapartal epidural analgesia.
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Anaesthesiol Reanim · Jan 2001
Comparative Study[Hemodynamic monitoring of splanchnic circulation--does the benefit outweight risk of of regional circulation monitoring?].
Over the last 20 years there has been increasing interest in the pivotal role of the splanchnic region in the development of SIRS, sepsis and multiple organ failure. One key question is how to monitor and detect in good time regional splanchnic perfusion, oxygenation and impaired function of liver and gut, so as to start appropriate therapeutic measures. This review describes the pathophysiological background of impaired splanchnic perfusion. ⋯ Despite all the restrictions and the criticism which can be levelled at this method, it remains the only way of monitoring splanchnic perfusion and oxygenation that is currently applicable in clinical routine. The data gained can be useful if clinicians are aware of the weak points of tonometry and consider the data in the overall clinical picture. When this is done, the patient can profit from gastric tonometry and the benefits outweigh the risks.