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

{"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}

{"title":"[Legionella prevention in intensive care units].","authors":"I F Chaberny,&nbsp;S Ziesing,&nbsp;P Gastmeier","doi":"10.1055/s-2004-814282","DOIUrl":"https://doi.org/10.1055/s-2004-814282","url":null,"abstract":"<p><p>From time to time hospitals are in the focus of the local and national media because of cases of nosocomial Legionnaires' disease. In particular intensive care patients are a risk group because of their high amount of immunocompromised patients with an increased risk of developing a Legionellosis. Therefore it is an important aim to maintain an effective prevention system. Nevertheless in some hospitals legionella can be identified. Particularly in these hospitals a high level of attention is required to recognize cases of legionellosis and to take adequately steps to avoid outbreaks of legionellosis. The following article explains the recently published recommendations of the American hospital hygiene experts.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":" ","pages":"127-31"},"PeriodicalIF":0.4,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2004-814282","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40861410","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":"[Theophylline induces contractures in porcine skeletal muscle preparations with the disposition to malignant hyperthermia].","authors":"M U Gerbershagen,&nbsp;M Fiege,&nbsp;R Weisshorn,&nbsp;K Kolodzie,&nbsp;F Wappler","doi":"10.1055/s-2004-814328","DOIUrl":"https://doi.org/10.1055/s-2004-814328","url":null,"abstract":"<p><strong>Objective: </strong>Theophylline, a methylxanthine, leads to an increase of the cytoplasmic Ca(2+)-concentration in the muscle cell. Since the in-vitro contracture test (IVCT) with halothane and caffeine does not distinguish a 100% between malignant hyperthermia susceptible (MHS) and non-susceptible (MHN), we examined the in-vitro effects of theophylline in porcine skeletal muscle preparations.</p><p><strong>Methods: </strong>After approval by the local animal care committee ten MHS- and nine MHN-swine were anaesthetized and muscle biopsies taken. For IVCT, muscle specimens were exposed to bolus administrations of theophylline in concentrations of 3.0 respectively 5.0 mmol/l. Muscle contracture development and twitch amplitudes were recorded over a period of 30 minutes. Data are expressed as medians and ranges.</p><p><strong>Results: </strong>After both theophylline bolus administrations MHS-muscles developed significantly higher contractures compared to the MHN-specimens. The MHS-muscles reached a maximum contracture of 17.0 mN (7.2-59.6 mN) after administration of 3.0 mmol/l theophylline. In comparison, two MHN-specimens showed weak contractures with a maximum of 1.4 mN. The 5.0 mmol/l theophylline IVCT resulted in maximum contractures of 19.1 mN (2.1-39.2 mN) for the MHS-preparations. Just in three MHN-muscles weak contractures of 0.0 mN (0.0-0.8 mN) were recorded. Thus, a significant difference without overlap was revealed for the maximum contracture.</p><p><strong>Conclusion: </strong>Theophylline in concentrations of 3.0 and 5.0 mmol/l revealed a clear difference between MHS- and MHN-porcine muscle preparations. Further examinations on human skeletal muscles are needed to demonstrate the value of theophylline in the IVCT MH-diagnosis.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":" ","pages":"147-52"},"PeriodicalIF":0.4,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2004-814328","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40861413","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":"[Delayed onset of malignant hyperthermia crisis during a living donor liver transplantation caused by sevoflurane].","authors":"I Gillmeister,&nbsp;C Schummer,&nbsp;M Hommann,&nbsp;W Schummer","doi":"10.1055/s-2004-814333","DOIUrl":"https://doi.org/10.1055/s-2004-814333","url":null,"abstract":"<p><p>We report on a 25-year old ASA physical status I patient, who developed within 20 minutes a full-blown malignant hyperthermia (MH) in the context of a living donor liver transplantation after 180 minutes of uneventful anaesthesia. The only trigger substance applied was Sevoflurane. The patient had already received a short, uneventful anaesthesia with Isoflurane a couple of years ago. In the context of the special constellation an initial dose of Dantrolene of 10 mg/kg body weight was administered. The patient was stabilised within 30 minutes, and the enzyme levels remained low compared with other case reports. The post-operative in vitro caffeine halothane contracture testing confirmed that son and mother were susceptible to MH, contracture testing in the father was negative. All known triggers may cause life-threatening MH crisis - even after hours and after inconspicuous multiple exposures to known trigger substances. Therefore all trigger substances must be avoided in all patients susceptible to MH.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":" ","pages":"153-6"},"PeriodicalIF":0.4,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2004-814333","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40861414","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":"[Accidents with dangerous goods--how can the risks be recognized and assessed?].","authors":"R Spörri,&nbsp;R Walther,&nbsp;A Reichert,&nbsp;R Braun","doi":"10.1055/s-2004-814309","DOIUrl":"https://doi.org/10.1055/s-2004-814309","url":null,"abstract":"","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":" ","pages":"165-76; quiz 177-8"},"PeriodicalIF":0.4,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2004-814309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40861416","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}