Therapeutische Umschau. Revue thérapeutique
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The aim of the postoperative pain therapy is besides the amelioration of the patients well-being, also lessening of unwanted vegetative reactions and avoidance of the need for excessive care situations. There are numerous ways of therapy and medication at our disposal for this purpose. The first line of drugs are the analgesically most active opiates; they can be combined with antiphlogistics and antipyretics, in order to decrease the specific opiate-induced side effects. ⋯ In comparison to the conventional way, its therapeutic success was described as convincing, even overwhelming. Difficulties or deficiencies in the postoperative pain therapy are mostly caused by lack of time and insufficient knowledge and experience of the personnel, on the other hand also by limited technical possibilities of monitoring the patient. A possible solution may be the setting-up of a special service for the treatment of postoperative pain.
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Surveillance of the patient in the particularly critical phase immediately following operation and anaesthetic must be considered a purely anaesthesiological task. Today, it is no longer considered sufficient merely to keep the patient under observation until his protective reflexes have returnded; rather, appropriate postoperative therapeutic measures must be initiated already during the recovery phase to enable the patient to be returned to the nursing ward with his or her vital functions optimal and stabilised. The tasks of the anaesthetist in the recovery phase are as follows: safeguarding of the transportation phase of the patient from the operating room to the recovery unit; hand-over of the patient to the recovery staff; monitoring for possible complications in the recovery phase, collection of suitable diagnostic parameters to determine the current state of the patient; initiation of optimised treatment as dictated by the state of the patient; documentation of all findings as well as all therapeutic measures instituted, and deciding on the further transfer of the patient.
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Ambulatory surgery and anesthesia continued to grow and develop over the last few years: Longer lasting and more complex diagnostic and therapeutic procedures are being performed on an outpatient basis. In addition, outpatient procedures, being less disruptive to the patient's everyday life, are of potential benefit especially for children and elderly patients. The proper selection and evaluation of these patients from the anesthesiological and surgical points of view are very important with regard to successful ambulatory interventions. ⋯ The choice of the anesthetic procedure itself is made individually. An adequate intra- and postoperative monitoring is essential. A checklist with exact discharge criteria is helpful in practice.
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Biography Historical Article
[The development of anesthesia in german-speaking regions in the 19th century].
Following the first public demonstration of ether anaesthesia by W. T. G. ⋯ Schleich in 1892/1894 and of spinal anaesthesia by A. Bier in 1899. The ultimate success of local and regional anaesthesia was made possible by using adrenaline with the local anaesthetic (1901) and by the introduction of novocaine in 1905.(ABSTRACT TRUNCATED AT 250 WORDS)
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Monitoring during and after anaesthesia is aimed at recording changes in physiological functions including the patient's response to the anaesthetic and surgery, and identifying avoidable critical incidents caused by human error or equipment failure. Assessment and control of the depth of anaesthesia would be desirable but cannot yet be accomplished in clinical practice. For every anaesthetic, some degree of primary, basic or minimal monitoring is essential and is, in a number of countries, prescribed or recommended by regulations or guidelines. ⋯ ECG, blood pressure, and pulse oximetry also have to be employed during regional anaesthesia and in the post-anaesthesia care unit. The question as to whether further monitoring techniques need to be added (extended or secondary monitoring) will depend upon the medical problems of the individual patient and on the nature and duration of the surgical and anaesthetic procedures. For this purpose, invasive methods are preferentially used, in particular central venous and arterial pressure recording, and a pulmonary artery catheter for measuring pulmonary artery and pulmonary capillary wedge pressures and cardiac output, all in combination with blood gas analysis.