Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2015
[Perioperative Management of adult patients with obstructive sleep apnea].
Obstructive sleep apnea (OSA) is a common sleep related breathing disorder with an increasing prevalence. Most surgical patients with OSA have not been diagnosed prior to surgery and are at an increased risk of developing perioperative complications. Preoperative identification of these patients is important in order to take appropriate measures concerning a safe perioperative management. ⋯ The extent and duration of postoperative continuous monitoring has to be determined on an individual basis. A preoperatively existing therapy with continuous positive airway pressure should be continued postoperatively as soon as possible. Patients with OSA may be managed on an outpatient basis if certain requirements are met.
-
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.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2015
Review[Community acquired pneumonia in the emergence department - do standardized care bundles improve quality of care?].
Community acquired pneumonia (CAP) is associated with high in-hospital mortality. The initial correct diagnosis, risk assessment and initiation of treatment are responsibilities of the emergency department (ED). In Germany, emergency medicine is not well established nationwide and organized in a very heterogeneous manner. ⋯ In own investigations we demonstrated that implementation of systematic guideline based care bundles for pneumonia significantly improves quality of care in the ED subsequently leading to decreased mortality during hospitalization. Early standardized care bundles in the ED reduce length-of-stay in the hospital and the intensive care unit. Furthermore, those strategies are accompanied with an improvement of economic characteristics.
-
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.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2015
Review[The premedication visit - suggestions for a patient-friendly design].
The premedication visit is often a difficult situation for the anaesthetist. On the one hand the patient needs to be informed in detail, but on the other he must not be alienated unnecessarily. Furthermore, a hospital stay represents an exceptional situation for the patient in which he behaves differently than in everyday life and shows a limited ability to process information. Following certain communication strategies allows to convey information to the patient in a comprehensible manner and to describe his individual anaesthesiological risk without needlessly creating fear.