Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2017
Review[Anesthetic Management in Thoracic Trauma Patients].
In daily practice, management of patients with blunt thoracic trauma is challenging for the anesthetist. Injuries of airways, lungs, diaphragm, heart and large vessels are the main difficulties. Respiratory and circulatory physiology in general is affected by general anesthesia, which may result in an increased number of perioperative complications. ⋯ Therefore, a high degree of (patho-)physiological understanding and manual skills are required in this scenario. Interdisciplinary cooperation during diagnostic, treatment and in the perioperative course is a prerequisite for a successful management. The present work describes the main characteristics of thoracic trauma and discusses important precautions and typical problems the anesthetist has to face in the clinical setting.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2017
Review[The Patient with Chest Trauma: Surgical Management].
Even though isolated cases of penetrating chest wounds are exceptionally rare in Germany, chest trauma accounts for major morbidity and mortality in over 18 0000 multitrauma patients encountered every year. Injuries range from immediately fatal cardiac wounds and major vessel lacerations to intercostal bleeding, parenchymal damage, chronic haematothorax and secondary empyema. Placement of large-bore chest tubes constitutes a sufficient treatment for most of these pathologies. In select cases further treatment either by minimally invasive techniques (VATS) or conventional thoracotomy is warranted.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2017
Review[Thoracic Trauma - Prehospital Treatment].
Penetrating thoracic injuries are rare in Germany and common in urban regions. 10 percent of the patients in Emergency Departments suffer from blunt thoracic trauma. Mechanism of trauma can predict the severity of the injuries. ⋯ The application of an algorithm in exploration of a thoracic trauma seems to be useful. The selection of trauma center depends on the severity of the trauma, if necessary with the availability of extracorporeal circulation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2017
Review[Preoperative Optimization of Pulmonary Diseases - an Approach].
Preoperative identification of patients with an increased risk for perioperative pulmonary complications is crucial for the anesthesiological management. These complications were underestimated in the past, but are associated with an increased morbidity and mortality when occuring. ⋯ The knowledge of pathophysiology and pharmacological treatment options in this special subset of patients is essential. It has been shown that preventive programs in the preoperative setting were able to reduce pulmonary complications.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2017
Review[Preoperative Evaluation and Arrangements: The Elderly Patient].
With a constantly growing portion of elderly within our population and the advances of modern medicine, surgery on aged and very aged patients has become a daily hospital routine. Due to the physical and mental features of ageing these patients face special perioperative risks. ⋯ Even in the healthy elderly, most organ functions are "physiologically" instable or deficient and the homeostasis of health and disease is fragile. The preoperative evaluation of the aged patient has to be extended towards risk factors and pathologic pre-conditions which derive especially from high age and are so far not determined by a mere "fit-for-anaesthesia?"