Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS最新文献

{"title":"[Catecholamine levels in plasma and cerebrospinal fluid of neurosurgical patients with normal and elevated intracranial pressure].","authors":"C Rudolph,&nbsp;L Schaffranietz,&nbsp;M Jaeger,&nbsp;B Vetter,&nbsp;J Meixensberger,&nbsp;D Olthoff","doi":"10.1055/s-2004-825875","DOIUrl":"https://doi.org/10.1055/s-2004-825875","url":null,"abstract":"<p><strong>Objective: </strong>Catecholamine levels in the plasma and cerebrospinal fluid of 21 neurosurgical patients with hydrocephalus and with normal and elevated intracranial pressure were determined prospectively in a clinical study.</p><p><strong>Methods: </strong>The study comprised 11 patients with normal intracranial pressure (8 female, 3 male, group 1) and 10 patients with elevated intracranial pressure (6 female, 4 male, group 2). The patients underwent a ventriculo-peritoneal shunt operation, external ventricular drainage or ventriculocisternostomy. The measuring times were set as follows: time 1: pre-operative; time 2: intra-operative; time 3: post-operative. The anaesthetic for the operations was administered as a total intravenous anaesthesia with propofol and alfentanil, muscle relaxation being achieved with rocuronium bromide or cis-atracurium.</p><p><strong>Results: </strong>Measurements of the catecholamine levels (adrenaline, noradrenaline and dopamine) at the three set times revealed an intra-operative fall compared to the initial pre-operative value and a rise in the catecholamine level again after the operation. It is likely that this largely reflects the course of the anaesthetic. The fall in the plasma catecholamine level was much slighter in group with elevated intracranial pressure. But in the group of patients with elevated intracranial pressure the catecholamine levels found in the plasma were much higher than those of the patients without elevated pressure. In the case of adrenaline, it was possible to demonstrate a statistically significant difference at the three measuring times. This suggests that especially the analyzed adrenaline level in the plasma could take on the role of a marker in cases of elevated intracranial pressure. In group 2, with elevated intracranial pressure, the catecholamine levels in the cerebrospinal fluid (CSF) were considerably higher than those in group 1, but the difference did not reach the significance level. The lack of correlation between the catecholamine values in the plasma and CSF described in the literature (comparison of the corresponding values at time 2) was confirmed for noradrenaline and dopamine in patients with elevated intracranial pressure (group 2). In both groups of patients there was a CSF plasma gradient for dopamine at time 2, i. e. the dopamine level was higher in cerebrospinal fluid than in the plasma.</p><p><strong>Conclusion: </strong>The study shows that even a slight rise in intracranial pressure without clinically detectable ischaemia may result in elevated plasma and CSF catecholamine levels. Although catecholamine values are not routine parameters, they can be used in developing procedures to protect the brain in neurosurgical patients.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":" ","pages":"603-9"},"PeriodicalIF":0.4,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2004-825875","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40922414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The unexpectedly difficult airway -- a plea for the oxford-non-kinking-tube].","authors":"J A Baum,&nbsp;G Sachs,&nbsp;H-G Stanke","doi":"10.1055/s-2004-825952","DOIUrl":"https://doi.org/10.1055/s-2004-825952","url":null,"abstract":"<p><p>The skill to safely manage the unexpectedly difficult airway is expected from every anaesthetist. The strategies to safely overcome this severe problem have to be adapted to the given equipment and the individual aptitude and skills of the respective colleague. The algorithms for management of the difficult airway should be as simple as possible, and one cannot assume that devices for fibre-optic intubation are available at every site. Indispensable, however, is the availability of face masks, naso- and oropharyngeal airways and laryngeal mask airways in different sizes at each induction site. This paper is especially devoted to recalling the Oxford non-kinking tube and its specific way of handling, as a lot of cases of unexpectedly difficult airway can be safely managed with this tool. Alternatives to safeguarding the difficult airway are the intubation laryngeal mask airway or the esophago-tracheal combitube. For managing the worst case, the \"cannot ventilate - cannot intubate\" disaster, instruments for percutaneous punction of the trachea and devices for oxygen insufflation must be readily available in every theatre.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":" ","pages":"610-5"},"PeriodicalIF":0.4,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2004-825952","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40922415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Tumorectomy in conscious patient with suspected pregnancy associated breast cancer under cervical epidural anesthesia].","authors":"B Rainer,&nbsp;J Berger,&nbsp;M Widschwendter,&nbsp;G Mitterschiffthaler,&nbsp;G Putz","doi":"10.1055/s-2004-814576","DOIUrl":"https://doi.org/10.1055/s-2004-814576","url":null,"abstract":"<p><p>In this report we present a 35 year old pregnant woman (no significant disease in patient history, non smoker, primipara, gestational week 15) who had to undergo elective tumorectomy due to suspected pregnancy associated breast cancer. General anesthesia during pregnancy can potentially be harmful for the fetus (hypoxia, acidosis, premature delivery, teratogenicity). We decided to anesthetize the patient with a cervical segmental epidural block.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":" ","pages":"412-4"},"PeriodicalIF":0.4,"publicationDate":"2004-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2004-814576","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40868240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[How to establish an preoperative anaesthetic clinic].","authors":"T Laux,&nbsp;H Kawach,&nbsp;C Madler","doi":"10.1055/s-2004-825696","DOIUrl":"https://doi.org/10.1055/s-2004-825696","url":null,"abstract":"<p><p>The preoperative anaesthetic clinic has established at large german hospital since 1980 because of shorter ways, waiting times and best preoperative risk-management. Now there is an increasing need for the preoperative anaesthetic clinic in all german hospitals because of the introduction of DRGs for hospital billing since 2003. Organization, leadership, equipment and aspects of the personnel are discussed. Tasks of a \"anaesthetic management center\" can be fulfilled by the preoperative anaesthetic clinic like OP-organization, distribution of intensive care units, implementation of clinical pathways and quality management. Thus requires an adequate equipment and personnel. An model of rotation for the physician personnel is introduced. Cooperation of the OP departments is necessary. At least our preoperative anaesthetic day clinic has become an logistic centre and an speaking point for patients and the OP-department.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":" ","pages":"391-9"},"PeriodicalIF":0.4,"publicationDate":"2004-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2004-825696","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40868237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cross-validation of simple questioning methods to determine patient satisfaction with anaesthesia care].","authors":"L H Eberhart,&nbsp;U Bothner,&nbsp;W Bündgen,&nbsp;I Celik,&nbsp;G Geldner,&nbsp;P Kranke,&nbsp;D Sauer,&nbsp;M Simon,&nbsp;K Werthwein,&nbsp;H Wulf","doi":"10.1055/s-2004-814550","DOIUrl":"https://doi.org/10.1055/s-2004-814550","url":null,"abstract":"<p><strong>Introduction: </strong>Evaluation of patient satisfaction with the perioperative care is an integral part of modern quality management. For this purpose simple questioning techniques are often used in clinical practise or reports of clinical trials. However, little research has been performed to investigate whether these tools and methods are useful and provide valid information.</p><p><strong>Methods: </strong>Two-hundred patients undergoing elective surgical procedures were interviewed. Five different simple techniques or questions that have been used in the international and in the German literature throughout the last years were applied in random sequence together with the validated German translation of the QoR-9 questionnaire to measure quality of recovery. All analyses were performed descriptively.</p><p><strong>Results: </strong>All investigated techniques could be answered without help by another person in 95 % up to 100 %. All simple dichotomous questions regarding satisfaction were insufficient to discriminate satisfied from less satisfied patients. A rating using grades known from the German school system (1 - 6) and a visual analogue scale (VAS; 0 - 100 mm) obtained ratings lower than the maximum possible values in 10 % and 11 % of the patients respectively. Furthermore, the flexibility that was provided by these tools was not utilized by the patients. The results of the QoR-9 questionnaire as a marker of postoperative recovery showed only a moderate correlation with ratings of patient satisfaction.</p><p><strong>Conclusion: </strong>Until now, there is no method or questioning technique in the German language that can be recommended for a quality assurance program. Thus, further research is needed to develop tools that provide valid information with adequate resolution to allow discrimination of patient satisfaction with perioperative care.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":" ","pages":"406-11"},"PeriodicalIF":0.4,"publicationDate":"2004-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2004-814550","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40868239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Perioperative coagulation disorders].","authors":"R U Scherer,&nbsp;R M Giebler","doi":"10.1055/s-2004-825697","DOIUrl":"https://doi.org/10.1055/s-2004-825697","url":null,"abstract":"","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":" ","pages":"415-43; quiz 444-6"},"PeriodicalIF":0.4,"publicationDate":"2004-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2004-825697","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40868241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Breast cancer during pregnancy -- a challenge for the anaesthesiologist?].","authors":"D Balogh","doi":"10.1055/s-2004-814577","DOIUrl":"https://doi.org/10.1055/s-2004-814577","url":null,"abstract":"","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":" ","pages":"389-90"},"PeriodicalIF":0.4,"publicationDate":"2004-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2004-814577","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40868236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Relationship between nutrition and ASA-classification in the elderly].","authors":"M Sakarya,&nbsp;F Karadağ,&nbsp;N Lüleci,&nbsp;G Tezcan Keleş,&nbsp;I Topçu,&nbsp;T Erinçler","doi":"10.1055/s-2004-814440","DOIUrl":"https://doi.org/10.1055/s-2004-814440","url":null,"abstract":"<p><strong>Objective: </strong>Old age and bad nourishment are risk factors for the postoperative period. In this study, the \"mini nutritional assessment\" (MNA) of elderly patients was evaluated before the operation and compared with their ASA-classification.</p><p><strong>Methods: </strong>215 outpatients (age > 60 years) were included. MNA-score was fixed as follows: MNA 24 - 30 = normal (MNA I); MNA 17 - 23.5 = risk of malnutrition (MNA II; MNA < 17 = undernourished (MNA III). In addition, the ASA-score of all patients was registered. chi (2)-, Mann-Whitney-U- and correlation analysis were used for statistical analysis. A cut off-value of 24 was fixed for MNA and correlated with the ASA-score.</p><p><strong>Results: </strong>34.9 % of all patients were allocated to MNA II or III, but only 19.9 % to ASA III or IV. The sensitivity of the ASA-classification for evaluation of the nutritional status was 0.33, selectivity was 0.87, positive predictive value was 0.58 and negative predictive value was 0.70.</p><p><strong>Conclusion: </strong>ASA evaluation is not suitable for assessment of the nutritional status. With regard to typical postoperative complications, the nutritional status of patients should be assessed separately.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":" ","pages":"400-5"},"PeriodicalIF":0.4,"publicationDate":"2004-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2004-814440","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40868238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[ProSeal-laryngeal mask versus endotracheal intubation in patients undergoing gynaecologic laparoscopy].","authors":"S N Piper,&nbsp;J G Triem,&nbsp;K D Röhm,&nbsp;W H Maleck,&nbsp;T A H Schöllhorn,&nbsp;J Boldt","doi":"10.1055/s-2004-814331","DOIUrl":"https://doi.org/10.1055/s-2004-814331","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to assess the practicality of the ProSeal laryngeal mask (PS-LMA) airway during laparoscopic surgery with capnoperitoneum compared to endotracheal intubation (ET).</p><p><strong>Methods: </strong>Prospective, randomized study. 104 patients undergoing gynaecologic, laparoscopic surgery were allocated randomly to two groups: 1. ET-group (n = 50). 2. PS-LMA-group (n = 54). Total intravenous anaesthesia was performed by the same anaesthesiologist.</p><p><strong>Measurements: </strong>Mean arterial pressure, heart rate, at 4 and circuit pressure at 2 measurement points, and the incidences of coughing and sore throat. Insertion of the ET and the PS-LMA was scored by using a four-point scale. Ease of placing the gastric tube was judged by measuring the number of attempts at insertion and the insertion times. A p-value of < 0.05 was considered as significant.</p><p><strong>Results: </strong>There were no differences between PS-LMA and ET concerning circuit pressure at any measurement point. At the end of anaesthesia, mean arterial pressure (92 +/- 13 vs. 100 +/- 14 mmHg; p < 0.01) and heart rate (66 +/- 13 vs. 76 +/- 14 beats/min; p < 0.01) were lower in the PS-LMA-group compared to the ET-group. At the end of anaesthesia 25 patients of the ET-group coughed but nobody in the PS-LMA-group (p < 0.00001). There was no difference with regard to postoperative sore throat. The insertion of the PS-LMA was easier compared to ET (p < 0.05), but we found no significant difference concerning insertion times. Fewer attempts at insertion of the gastric tube were necessary in the PS-LMA-group than in the ET-group (p < 0.01), whereas insertion times did not differ.</p><p><strong>Conclusion: </strong>The PS-LMA is a convenient and practicable approach for anaesthesia in patients undergoing laparoscopic surgery.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":" ","pages":"132-7"},"PeriodicalIF":0.4,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2004-814331","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40861411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[New insights in postoperative pain therapy].","authors":"A Brack,&nbsp;B W Böttiger,&nbsp;M Schäfer","doi":"10.1055/s-2004-814314","DOIUrl":"https://doi.org/10.1055/s-2004-814314","url":null,"abstract":"<p><p>In this review, novel clinical studies on postoperative pain therapy are summarized. Based on these studies, several conclusions can be drawn: i) following tonsillectomy, postoperative therapy with NSAIDs leads to a significant increase in the number of reoperations; thus NSAIDs should be used with caution; ii) COX-2 inhibitors in combination with intravenous opioids improve recovery and functional outcome after knee replacement surgery; iii) the combination therapy of different non-opioid analgesics has no proven clinical efficacy and should not be used routinely; iv) patients' age is not a determinant in postoperative opioid titration after surgery; in contrast, it does predict opioid consumption during the first postoperative day; v) morphine and piritramide have identical analgesic efficacy and induce nausea and vomiting with the incidence; opioid selection can, thus, be based on economic considerations and vi) if tramadol is ineffective in postoperative pain therapy, this might be caused by an allelic variant of one of the cytochrome P450 enzymes (CYP2D6); these patients should be treated with a different opioid.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":" ","pages":"157-64"},"PeriodicalIF":0.4,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2004-814314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40861415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}