Articles: critical-care.
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The surgeon uses the scalpel rather than the prescription pad, but this fact is deceptive. Analysis of the development of surgical history yields an impressive insight into the interaction between medication and operative treatment. ⋯ With regard to drugs, intensive care medicine confronts the surgeon with an inconceivable complex of interactions, side effects and dose adaptations. In addition, human suggestibility influences the outcome of operative interventions no less than medical drugs.
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Klinische Wochenschrift · Jan 1991
Review[Disorders of blood coagulation in the intensive care unit: what is important for diagnosis and therapy?].
In the haemostatic system there is normally a stable balance between its components (vessel wall, platelets, coagulation, fibrinolysis), which are in continuously close interaction. Disturbances of this balance may lead to bleeding, thrombosis, or thrombohaemorrhagic consumptive disorders. The task of haemostaseologic diagnostics is to discover eventual preexisting but as yet undiagnosed disturbances in any patient entering an intensive care unit and, in cases of acute bleeding, to provide useful information that facilitates therapeutic decisions. ⋯ Promising attempts to overcome DIC via substitution of antithrombin III and fresh frozen plasma are discussed. Optimal management of complications and monitoring of therapy requires the close teamwork of attending surgeons or physicians and haemostaseologists. The purpose of any therapy is to preserve or regain the balance of haemostasis.
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The patterns of recovery of patients who received seven different analgesic and sedative treatments were investigated with regard to the time at which the subjects awoke. For observations of the neurologic status, we developed a special score. ⋯ Piritramid/promethazine, pethidine/flunitrazepam, pethidine/promethazine and tramadol/methohexital required more time for awakening. On the basis of these results, we prefer to use the combination of fentanyl/midazolam, alfentanil/midazolam and ketamine/flunitrazepam to judge all patients' neurologic scores.
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Klinische Wochenschrift · Jan 1991
Review[How painful is long-term ventilation? Considerations on the importance of analgesia within the scope of analgosedation].
The goal of analgesia and sedation in intensive care units is most often achieved using numerous drug combinations, mostly justified by physicians' and nurses' habits instead of rational pharmacological criteria for the choice of drugs and dosages. The present paper aims at defining the analgesic situation of ventilated intensive care patients and concludes from analogy with other, better understood states of pain that the importance of analgesic drugs is frequently overrated. To achieve effective analgesia and sedation in individual patients, the dosage must be titrated to individual needs. The author suggests that standardized baseline analgesia should be used, which enables sedation to be titrated, whereas the opposite is not practicable in clinical routine.
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Recent therapeutic advances in inotropic drugs and vasipressors uses allow a reappraisal of their indications during the perioperative period. Non-catecholamines vasopressors, ephedrine and phenylephrine, are particularly suitable for treatment of abrupt peroperative arterial hypotensions as observed during induction of general and medullar anesthesias. Cardiac arrest, peroperative anaphylactoid and toxic accidents are treated with epinephrine. ⋯ Inodilators (enoximone, amrinone and milrinone) ans nex dopaminergic compound (dopexamine) are powerful vasodilators agents to be introduced with care when association of amines and current vasodilators have failed. Finally, arterial pressure has to be maintained with norepinephrine after dopamine failure. Epinephrine remains last chance.