Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2017
Case Reports[Acute Monkshood Intoxication Requiring Acute Resuscitation in Suicidal Intent].
We report about an acute monkshood intoxication requiring acute resuscitation in suicidal intent in a 56-year-old patient. The Blue Monkshood (Aconitum napellus) is considered to be the most toxic plant in Europe. All plant parts contain the highly toxic alkonoid aconitin. ⋯ The management of an intoxication consists primarily of the therapy of the rhythm disturbances in the form of magnesium and amiodarone. Strict adherence to protective measures (gloves, masks) must be strictly observed. A direct skin contact with plant parts is to be avoided as well as the potential contact with vomit or aspirate.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2017
Review[Development of Anaesthesia-Related Mortality and Impact On Perioperative Outcome].
Achievements in anaesthesiology form the basis for the tremendous development of surgical therapy. Reliable monitoring technology, which is scrutinized on a regular basis using checklists, is allowing anaesthesia at the borders of physiology. ⋯ Furthermore, postoperative care in specialised units and intensive care wards is a key factor of improved patient outcome after surgery. In the future, unravelling the interactions of anaesthesia, surgical trauma and postoperative complications will further contribute to improved patient safety.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2017
Review[The Influence of Anesthesia On Perioperative Outcome in Children - Institutional and Individual Factors].
The perioperative care of children is challenging for health care providers. Since anesthetists cannot affect the nature of the disease and have hardly an impact on the decision for surgery we summarized in this review individual and institutional factors for improving perioperative outcome by anesthetists. ⋯ A behaviorally oriented preoperative preparation of parents and children also affects the postoperative course of the pediatric patients positively as well as institutional concepts for the reduction of perioperative medication errors and adverse drug events. We believe that perspectively pediatric surgery will be increasingly performed in high volume hospitals which are able to guarantee beneficial institutional structures as well as a high educational level and high professional experience of the employed anesthetists.
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Remifentanil is a short-acting opioid of high analgetic potency and superior controllability. It is widely used in day-case surgery, procedural sedation, for reduction of recovery-times and obstetrics and whenever excellent controllability of opioid effects is needed. Especially in combination with Propofol it is used for target-controlled infusion (TCI). The first part of the article provides readers with information about historical aspects, pharmacological characteristics, effects and side effects of remifentanil.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2017
[Prevention of Perioperative Hypothermia - Guidelines for Daily Clinical Practice].
Inadvertent perioperative hypothermia (body core temperature < 36 °C) is a serious complication leading to increased rates of wound infection, higher blood loss associated with increased transfusion requirements as well as patient dissatisfaction among others. Body core temperature is a vital parameter and needs constant monitoring just like heart rate, blood pressure and arterial oxygen saturation. Patient-, anesthesia-, surgery- and environment-related risk factors were identified for occurring perioperative hypothermia. ⋯ A bundle of procedures has to be arranged in order to improve patient outcome. Steps include general (e.g. staff instruction), pre- (e.g. prewarming), intra- (e.g. active warming) and postoperative (e.g. drug therapy) actions. An effective concept for prevention of perioperative hypothermia has to be adjusted to departments' specific constructional, organizational, process-related and staff characteristics with clearly visible and assigned responsibilities.