Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2015
Review[Robot-assisted surgery in visceral and thoracic surgery gynaecology, urology - importantanaesthetic considerations].
Robot-assisted surgery, as a development of laparoscopic surgery, has an increasing field of application. Beside urology, this technique has also been implemented in visceral and thoracic surgery and gynaecology. For the surgeon an enhanced view of the surgical field and a better mobility of the instruments are the most important advantages. ⋯ Therefore, a standardised order and protection of all i. v.-lines, cables and the ventilation-hose of the (double-lumen) tube is essential. After the roboter is connected to the patient, it is nearly impossible to change or extend patient monitoring. Especially in case of emergency, e. g. respiratory complications or heart failure, a close communication with the surgeon and a team approach are indispensable.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2015
Review[Sepsis and multiple organfailure - Potential therapeutic interventions].
Sepsis therapy is aiming to eliminate the focus of infection and to obtain or to restore microcirculation. Severe sepsis and septic shock have to be treated as fast and aggressively as hemorrhagic shock, because the time between onset of disease and initiating the therapy is crucial for the probability of survival. ⋯ The compliance with the bundle measures and consequent training of medical staff to predefined goal measures and therapy protocols is determining the success of sepsis therapy. The bundle measures of the first six hours (resuscitation bundle) deserve special attention.
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Our understanding of the causes and pathophysiological basis of sepsis has been subject to constant change over the last decades. In today's understanding, sepsis is primarily a pathology of the immune system, triggered by an underlying infection but perpetuated by the host's response itself. ⋯ While a overshooting immune reaction predominates in early sepsis, this reaction is rapidly compensated, often leading to a immune dysfunction, rendering the host susceptible for secondary infections. This review aims to provide the reader with an overview of the broad molecular mechanisms contributing to the clinical picture of sepsis.