Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2013
Review[The Helsinki Declaration for Patient Safety in Anaesthesiology-Post operative care including pain management].
Primary aspects of post operative care should include decisive and adequate treatment of pain. Accordingly, schemes based on international guidelines and in consensus with other departments of the university hospital were developed. Successful therapy includes resolute action on three levels: Instruction of physicians, including supervision. standardized approach based on a readily available algorithm. adherence to fundamental implications of pain therapy such as pain assessment, repeated consultations and observation of complications. Based on this concept, patient safety in anesthesia can be increased.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2013
Review[Hemostasis and antifibrinolytic therapy in major pediatric surgery].
More than 30 years ago the pioneering work of Andrew and co-workers showed that the coagulation system of children is different than from adult. They have introduced the term of "developmental hemostasis" to describe this phenomenon. They were able to show that the concentration of coagulation factors and inhibitors are age-dependent and therefore reference limits from adult practice cannot be transferred to children one to one. ⋯ In a few adult studies so far tranexamic acid was found to be comparably as effective as aprotinin. Although TXA is a long known drug available on the market for more than 50 years, the studies connecting factors of indication, dosage regimen and safety are limited especially in children and infants. This article highlights the differences in the coagulation system in children compared to adult as well as indication, dosage regimens and possible side effects of antifibrinolytic agents in children.
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Propofol is a common hypnotic agent in anaesthesiology and intensive care medicine and for procedural sedation as well. Despite the intensive usage the full potential, pharmacokinetic and -dynamic abilities, interactions and side effects of the substance may not be realized by all providers. ⋯ Propofol is a highly potent hypnotic with a wide range of (un)desired effects. This article is reviewing the diversity of the substance in clinical practice.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2013
Review[Status quo in radical prostate surgery].
Radical prostatectomy (RP) is a treatment option with an excellent cure rate in patients with localized prostate cancer but is accompanied by increased side effects. Particularly laparoscopic techniques developed in the last decade and are widespread. The operation techniques (retropubic(RRP), laparoscopic (LRP) and robot assisted laparoscopic (RALP) radical prostatectomy) and the comparative literature available are presented. ⋯ At present RALP seems not to be usable in an economically reasonable way. RRP, LRP and RALP show similar oncologic outcomes and comparable side effects. RP is the gold standard in the treatment of localized prostate cancer.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2013
Review[Anaesthesia for urological surgery - Anaesthesia for robotic assisted prostatectomies].
Because of excellent results, high patient satisfaction, and extraordinary surgical conditions robotic assisted prostatectomies have found a wide spread acceptance. Trendelenburg positioning, CO2-Insufflation, and installation of the robot system cause moderate hemodynamic and respiratory changes. Respiration can be compromised by significantly reduced pulmonary compliance during surgery and a marked CO2 load. ⋯ Over hours edema of head and neck including the upper airways and an increase of the intraocular pressure can develop. There are no restrictions in the choice of the anesthetics. Careful positioning of the patient and critical intravenous fluid management are important determinants of a successful anesthetic management.