Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2014
[Children with respiratory infections - How and when to perform anesthesia].
Infections of the upper respiratory tract ( URI) are the most common preoperative encountered comorbidity in childhood. Whether anesthesia for a child with respiratory infection should be performed or better be canceled, is still a dilemma for many anesthetists. The reasons for this are understandable: respiratory infections are associated with an increased incidence of perioperative respiratory adverse events, and there have been no evidence-based recommendations for the procedure in the individual case. ⋯ Although most of them remain without serious sequelae they have potential for serious morbidity and mortality when not immediately diagnosed and treated. Risk factors for respiratory complications include age <1 year , pulmonary comorbidity, invasive airway and airway surgery. Hence the individual decision is dependant on the risk but also the benefit factors and the expertise of the medical team.
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For stroke prevention in patients with atrial fibrillation and other indications new oral anticoagulants have been developed. These drugs are direct anticoagulants in contrast to the indirectly acting vitamin-K antagonists, which are used for decades as the only available drugs. ⋯ However, to transfer the benefit from the large scale studies to the real world conditions, physicians have to get clinical experience in using the new drugs. Especially drug interactions, impaired renal function and periinterventional bridging need special attention to ensure transfer of the new drugs benefits to daily life treatment.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2014
Review[Advanced indications of the laryngeal mask - Limitations of use].
The use of extraglottic airway devices (EGA) is well accepted for airway management for certain classic indications such as general anaesthesia during limb surgery in the supine position. Furthermore, EGA have been deemed a useful tool during the management of an unrecognized difficult airway. ⋯ This article provides an evidence based review of the role of EGA during a variety of indications and is designed to assist with the decision making process of whether an EGA may or may not be appropriate for a particular indication. Moreover, recommendations are given for advanced indications.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2014
[New oral anticoagulantsRegional anaesthesia and new oral anticoagulants].
New oral anticoagulants (NOAC) are increasingly applied after hip and knee replacement and in patients with non-vavular atrial fibrillation. Patients with cardiac disease benefit from regional anaesthesia, especially catheter-provided postoperative pain relief, but are at higher risk for puncture-related haematoma when NOAC are applied simultaneously. ⋯ The respective time intervals are prolonged in patients with renal insufficiency, especially when Dabigatran is applied, until 36 to 72 h. In general, high risk patients with NOAC undergoing surgery benefit from an interdicsciplinary approach and from less traumatic techniques such as spinal anaesthesia or superficial peripheral nerve blocks.