Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1996
Review Case Reports[Resuscitation in multiple trauma].
We report on a case of successful outpatient cardiopulmonary resuscitation of cardiac arrest after blunt multisystem injury. The literature is discussed and prognostic indicators are described.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1996
[The Ulm emergency medicine training course. 1: Concept].
The course in emergency medicine was introduced by the German Federal Government to meet the requirements of the curriculum of the 4th year of medical education in 1992. The Department of Anaesthesiology of the University Hospital Ulm drew up a course consisting of one week of practical instructions (Table 3) for groups of 24 students, case presentation and accompanying lectures that cover the topics of emergency medicine (Table 2). ⋯ The aim of the course is training competence (psychomotoric skills and clinical competence) for the primary care of life-threatening emergencies. The following educational methods were included in the concept: problem oriented learning, situation-oriented learning, learning by doing (cognitive apprenticeship).
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Differential administration of non-opioids in postoperative analgesia, I. Quantification of the analgesic effect of metamizole using patient-controlled analgesia].
The aim of this study was to investigate: 1. Whether the perioperative administration of metamizol causes a significant reduction in postoperative opioid requirements within the first 24 h after surgery. 2. The opioid-sparing effect after different types of operations. 3. Whether preoperative application of metamizol causes a significant reduction of the pain-score immediately after operation. ⋯ Perioperative administration of metamizol results in better pain relief and significantly lower buprenorphine requirements particularly after laparoscopic operations. To achieve a significant pain reduction immediately after the operation, the first dose should be applied before induction.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1996
Review[Is infection and septic shock caused by a global oxygen deficiency? An overview in 2 parts. 1: Infection and correlation between DO2 and VO2].
A global hypoxia resulting in an oxygen debt is assumed to be present in patients who suffer from the different stages and degrees of sepsis including septic shock and ARDS. As a consequence, the therapeutic concept of optimal values for cardiac output and oxygen delivery for these patients was proposed. This article reviews the literature with the objective of determining whether investigations dealing with oxygen delivery and consumption and with the plasma lactate concentration support the idea of the global hypoxia in septic patients. ⋯ The dogmatic proposal to increase cardiac output and oxygen delivery to certain levels cannot be sustained. However, regional hypoperfusion (e.g., of the splanchnic vascular bed) cannot be excluded. New approaches like gastric mucosal tonometry, measurement of splanchnic blood flow, and determination of regional metabolism are currently under investigation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1996
[Attempt at a definition of the individual anesthesia level by repetitive pain stimulation: correlation with EEG findings].
Previous studies using EEG for assessment of depth of anaesthesia correlate anaesthetic concentration with the anaesthetic stage. This procedure neglects the well known effect of individual different susceptibility to anaesthetics. Thus, patients receiving similar concentrations of anaesthetics may not necessarily be at the same level of "anaesthetic depth". The aim of this study was to define an interindividual comparable level of anaesthesia by recording the autonomic cardiovascular reaction to a standardised painful stimulus (tetanic stimulus, 80 mA, 100 Hz). ⋯ This method to define individual depth of anaesthesia as described, results in more consistent EEG patterns and may be useful in relating EEG to depth of anaesthesia.