Praxis
-
Review
[Burning Vulva: Significance of Surgery in Inflammatory and Precancerous Vulvar Pathologies].
Vuval pathologies manifested by allodynia and burning sensations can be due to infection, inflammatory dermatoses or other causes. Infective as well as certain inflammatory diseases, e.g. drug eruptions, allergic eczemas, irritative dermatitis/vulvitis, Behcet's Syndrome and pemphigus/pemphigoid usually respond well to conservative treatment. The category of inflammatory diseases also contains pathologies that in certain circumstances do require a surgical intervention, e.g. ⋯ Paget) and cancer. Vulodynia also can cause some stinging to the vulvar skin. The surgical aspects relating to the treatment of the benign and premalignant pathologies indicated above are mentioned in this mini-review.
-
Review
[Anxieties of patients before anesthesia - what information can the family physician provide?].
Patients' fears of anesthesia mostly focus on a possibly inadequate anesthetic effect, on postoperative wound pain and/or nausea and vomiting (PONV). Concerning the possibility of an inadequate anesthetic effect, patients usually express two different kinds of fears: first, that they might stay conscious during surgery («Awareness») without it being noticed, and second that they might not wake up again after the operation or that they might sustain neurological damages or deficits after the anesthesia. Last but not least patients are afraid they might suffer from substantial pain after waking up from the anesthesia. In this article we take a closer look at these aspects and discuss ways and possibilities of handling them, suggesting useful approaches for the general practitioner when talking these issues through with his patients prior to an operation.
-
Preoperative fasting is essential to reduce the risk of a perioperative pulmonary aspiration in patients undergoing anaesthesia for elective surgery. Evidence and expert opinion-based guidelines suggest two, four and six hours of fasting for clear fluids, breast milk and light meals/non-clear fluids respectively to improve anaesthesia safety, patient's comfort and homeostasis. ⋯ Abnormal gastric emptying has an impact on preoperative fasting times and the choice of the anaesthesia technique. A safe anaesthesia technique is most important since gastric emptying differs in patients and there is no guarantee that the stomach is empty after fasting according to guidelines.