Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Jan 2003
Clinical Trial[Effectiveness and safety of rectal analgesic sedation in ambulatory pediatric surgery].
Purpose of the study was to evaluate efficacy and safety of conscious sedation in ambulatory pediatric surgery. During 50 settings 38 patients were administered 0.75 mg/kg Ketamine and 0.4 mg/kg Midazolam rectally prior to the diagnostic or therapeutic procedure. Effects on vital signs, anxiolysis and pain reduction were documented. ⋯ Conscious Sedation can been administered safely by the physician, even in the absence of anesthesiological colleagues, as long as the correct indication is taken account of and only well established analgetics in standardised doses are given. Furthermore the intervention needs to take place in a well-organised setting. Advantages of the procedure are a cooperative patient with stable vital signs with the patients themselves and their parents profiting from stress-reduction through amnesia and effective pain management.
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Wien Med Wochenschr · Jan 2003
Review Comparative StudyPrevention and treatment of bleeding by pro-hemostatic treatment strategies.
Pro-hemostatic therapy may achieve an improvement of hemostasis, by amelioration of primary hemostasis, stimulation of fibrin formation or inhibition of fibrinolysis. Pro-hemostatic interventions appear to be effective in reducing peri-operative blood loss and reducing transfusion requirements in specific situations and may be helpful adjuncts in the management of severe spontaneous and post-operative bleeding. The risk of a higher incidence of thrombotic complications associated with the use of pro-hemostatic therapy is unknown but seems not to be very high in clinical practice. There is a need for more systematic and adequately controlled clinical observations to better establish the efficacy and safety of pro-hemostatic interventions.
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Wien Med Wochenschr · Jan 2003
Comparative Study[Transdermal buprenorphine for treatment of chronic tumor and non-tumor pain].
Patients with moderate to severe pain were treated with buprenorphine patches in one of 3 concentrations: 35 micrograms/h, 52.5 micrograms/h and 70 micrograms/h (= 0.8 mg/d, 1.2 mg/d and 1.6 mg/d respectively). The aim of this review was to assess the efficacy and tolerability of this transdermal system (TDS) in patients with chronic pain. A total of 445 patients were included in 3 double-blinded studies. ⋯ Half the cases of erythema and more than on third of the cases of pruritus were spontaneously reversible. More than half the patients (53.7%) in the double blind studies wished to continued treatment with buprenorphine transdermal system. These results demonstrate that buprenorphine patches achieved a very good analgesic effect in all 3 studies and that in particular with respect to the quality of life of the patient these patches offer an exceptional alternative to other conventional therapies.
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Nowadays, fibromyalgia syndrome (FMS) should be diagnosed according to established criteria in order to differentiate it from other specified or unspecified pain conditions. Various underlying reasons for pain exist and possible correlations with FMS should be thoroughly discussed with the patient. Recent pathophysiological examinations suggest that fibromyalgia syndrome may constitute a disorder of the central nervous system, especially of the hypothalamus-hypophysis-axis, and/or of the autonomous nervous system and of pain regulating nerves. ⋯ Extensive patient information, therapeutic devotion and means of physical therapy seem to be more efficient, providing a multitude of therapeutic options. Both fibromyalgia syndrome and chronic fatigue syndrome have to be accepted as medical entities, treated efficiently and studied scientifically. By these means, patients suffering from fibromyalgia syndrome, will not be lost to non-established forms of therapy.
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On 10 April 2001, the Netherlands was the first country to pass a law on the killing of patients at their request (euthanasia), which took effect on 1 April 2002. Belgium followed and passed a euthanasia law on 16 May 2002, which took effect on 23 September 2002 and is even more liberal than the Dutch one. Physicians will be exempted from criminal liability provided they satisfy the so-called 'due care criteria'. ⋯ The current article provides insights into the Dutch, Belgian and Oregon euthanasia and physician-assisted suicide practices and reflects upon some central medical and legal documents on the regulation of euthanasia and the provision of palliative care. Modern palliative care includes both the delivery of competent palliative skills and a virtuous attitude of compassionate caring about the terminally ill patient as an autonomous person. Here, the author rejects killing as due care and proposes a novel concept of 'RAHME' (Aramaic: compassion, love, mercy), which calls for a holistically oriented concept where physicians act as companions to the terminally ill and dying patients.