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1.
Anaesthesist ; 69(1): 11-19, 2020 01.
Artigo em Alemão | MEDLINE | ID: mdl-31912197

RESUMO

In 2019 the annual conference of the scientific working group on obstetric anesthesiology of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) took place in the usual manner. Emergency situations, such as the challenge of a preclinical birth or the recognition and treatment of an amniotic fluid embolism were discussed. In addition, topics on the correct treatment of a female patient with a known addictive disorder were of great interest as well as the discussion on the question when a transfusion should be performed in postpartum anemia and which risks accompany the increasing prevalence of obesity, especially during pregnancy. A further hot topic was the deliberation on the prevalence and differential diagnostic clarification of neurological complications after epidural anesthesia. In connection with the topic of birth, exciting and practice relevant topics for all anesthetists confronted with this field were presented and discussed. The essential aspects are summarized in this article.


Assuntos
Anestesia Obstétrica/tendências , Adulto , Anestesia por Condução , Anestesia Epidural , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/métodos , Cesárea , Feminino , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Gravidez , Complicações na Gravidez
2.
Anaesthesist ; 67(10): 773-779, 2018 10.
Artigo em Alemão | MEDLINE | ID: mdl-30259054

RESUMO

This article reports the fulminant course of a pneumogenic sepsis with severe ARDS (acute respiratory failure) in a 36-year-old female Indian patient, who died within 14 h after admission to the intensive care unit due to a multiorgan failure. During treatment the diagnosis of a miliary tuberculosis was suspected but was only confirmed by the autopsy. Due to high hygiene standards, miliary tuberculosis as the cause of septic shock is rare in Europe. Only 1-2% of the patients with pulmonary miliary tuberculosis develop an ARDS with a mortality of 60-90%. Based on this case the diagnostics as well as treatment of the patient are described. Furthermore, the management of an open tuberculosis on an intensive care unit is explained.


Assuntos
Choque Séptico/microbiologia , Tuberculose Miliar/complicações , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/microbiologia , Insuficiência de Múltiplos Órgãos/terapia , Choque Séptico/diagnóstico , Choque Séptico/terapia , Tuberculose Miliar/diagnóstico , Tuberculose Miliar/terapia
3.
Anaesthesist ; 65(4): 281-94, 2016 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-27048845

RESUMO

Every day, more than 800 women die from causes related to pregnancy or childbirth. Since 1952 the Confidential Enquiry of Maternal Deaths Reports (CEMD) have collected and analysed data on maternal mortality in the United Kingdom and Northern Ireland. This publication analyses the CEMD from 1985-2013 regarding anaesthesia- and analgesia related maternal deaths during pregnancy or peripartum. During this period, there has been a reduction in directly anaesthesia-related maternal deaths to 4.3%. Yet, an increase in anaesthesia-associated maternal deaths has been recorded. The rate of fatal complications during obstetric regional anaesthesia doubled in recent years, while the fatality risk for obstetric general anaesthesia has decreased. Many of the reported maternal deaths could presumably have been avoided. The anaesthesiologist has to be familiar with state-of-the-art, guideline-based concepts for anaesthesia during pregnancy, childbirth or post partum, especially using tools like simulation. Vital sign monitoring after obstetric anaesthesia has to be identical to other postoperative monitoring, and Modified Early Warning Scores should be used for this purpose. In regional anaesthesia, current standards for hygiene have to be adhered to and patients have to be visited after spinal/epidural anaesthesia. Interdisciplinary communication and collaboration still have to be improved; careful interdisciplinary planning of childbirth in high-risk obstetric patients is strongly advised.


Assuntos
Anestesia Obstétrica/mortalidade , Mortalidade Materna , Mães , Adulto , Anestesia por Condução/mortalidade , Anestesia Geral/mortalidade , Causas de Morte , Parto Obstétrico , Feminino , Guias como Assunto , Humanos , Monitorização Intraoperatória , Hemorragia Pós-Parto/mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Sepse/mortalidade , Sinais Vitais
4.
Anaesthesist ; 65(1): 3-21, 2016 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-26745995

RESUMO

Obstetric analgesia and anesthesia have some specific aspects, which in particular are directly related to pathophysiological alterations during pregnancy and also to the circumstance that two or even more individuals are always affected by complications or therapeutic measures. This review article deals with some evergreens and hot topics of obstetric anesthesia and essential new knowledge on these aspects is described. The article summarizes the talks given at the 16th symposium on obstetric anesthesia organized by the Scientific Committee for Regional Anaesthesia and Obstetric Anaesthesia within the German Society of Anaesthesiology. The topics are in particular, special features and pitfalls of informed consent in the delivery room, challenges in education and training in obstetric anesthesia, expedient inclusion of simulation-assisted training and further education on risk minimization, knowledge and recommendations on fasting for the delivery room and cesarean sections, monitoring in obstetric anesthesia by neuraxial and alternative procedures, the possibilities and limitations of using ultrasound for lumbal epidural catheter positioning in the delivery room, recommended approaches in preparing peridural catheters for cesarean section, basic principles of cardiotocography, postoperative analgesia after cesarean section, the practice of early bonding in the delivery room during cesarean section births and the management of postpartum hemorrhage.


Assuntos
Anestesia Obstétrica/normas , Anestesia Obstétrica/tendências , Obstetrícia/normas , Obstetrícia/tendências , Adulto , Cesárea , Parto Obstétrico , Feminino , Humanos , Recém-Nascido , Segurança do Paciente , Gravidez
5.
Anaesthesist ; 58(2): 163-70, 2009 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-19082988

RESUMO

After formal reorganization of the emergency department of the St. Vincenz Krankenhauses, Limburg, a change in the patient admission process was accomplished. The aim was to improve patient satisfaction and treatment quality by optimizing personnel, diagnostic and spatial resources. In particular the focus was on shifting the initial assessment of treatment priority to the nursing staff. A structured primary assessment triage system (Manchester triage system, MTS) was implemented by which a symptom-based prioritization of patients into five categories can be achieved. In parallel with the development and installation of a software program linking computer-based MTS classifications to defined clinical pathways and diagnostic procedures, a standardized, documented assessment of treatment priority could be achieved in 95% of emergency patients. On average the time between patients' first contact with the nursing staff and treatment by a physician was shortened from 15 to 10 min. Using this standardized, documented and user-independent triage system, medical as well as forensic safety of the admission process in an emergency department was improved.


Assuntos
Serviços Médicos de Emergência/organização & administração , Triagem/organização & administração , Algoritmos , Sistemas Computacionais , Humanos , Enfermeiras e Enfermeiros , Satisfação do Paciente , Segurança , Software
6.
Arterioscler Thromb Vasc Biol ; 21(9): 1550-5, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11557687

RESUMO

Vascular endothelial growth factor (VEGF) has been implicated in the reendothelialization of the vascular wall after balloon injury. This study investigated whether thrombin, which is formed during activation of the coagulation cascade at sites of vascular injury, upregulates VEGF expression in vascular smooth muscle cells (VSMCs). VEGF expression was assessed in native and cultured VSMCs by Northern blot analysis and reverse transcription-polymerase chain reaction and the release of VEGF protein by immunoassay. alpha-Thrombin time- and concentration-dependently increased VEGF mRNA levels, mainly that mRNA coding for the soluble splice variant VEGF(164/165), and stimulated the release of VEGF protein. These effects required the proteolytic activity of thrombin and were mimicked by a thrombin receptor activating-peptide. Upregulation of VEGF expression was also induced by conditioned medium from alpha-thrombin-stimulated VSMCs. Both the early and the delayed alpha-thrombin-induced VEGF expressions were attenuated by antioxidants and by diphenyleneiodonium. alpha-Thrombin-induced VEGF release was significantly reduced by a platelet-derived growth factor (PDGF)-, a transforming growth factor (TGF)-beta-, and a basic fibroblast growth factor (bFGF)-neutralizing antibody. Thrombin caused a redox-sensitive upregulation of expression of VEGF in VSMCs through a direct and an indirect effect, which was dependent on the endogenous formation of PDGF, TGF-beta, and bFGF. Upregulation of VEGF expression may represent an important mechanism by which the coagulation cascade contributes to the regeneration of the endothelial lining at sites of balloon injury.


Assuntos
Fatores de Crescimento Endotelial/biossíntese , Linfocinas/biossíntese , Músculo Liso Vascular/metabolismo , Espécies Reativas de Oxigênio/fisiologia , Trombina/farmacologia , Acetilcisteína/farmacologia , Angioplastia com Balão/efeitos adversos , Animais , Antioxidantes/farmacologia , Arteriopatias Oclusivas/etiologia , Ácido Ascórbico/farmacologia , Células Cultivadas , Fatores de Crescimento Endotelial/genética , Fator 2 de Crescimento de Fibroblastos/biossíntese , Humanos , Cinética , Linfocinas/genética , Masculino , Músculo Liso Vascular/efeitos dos fármacos , Fator de Crescimento Derivado de Plaquetas/biossíntese , RNA Mensageiro/biossíntese , Ratos , Ratos Wistar , Ativação Transcricional , Fator de Crescimento Transformador beta/biossíntese , Fator A de Crescimento do Endotélio Vascular , Fatores de Crescimento do Endotélio Vascular
7.
Int J Obstet Anesth ; 14(2): 114-20, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15795146

RESUMO

BACKGROUND: Using ropivacaine combined with sufentanil, we determined the analgesic efficacy of parturient-controlled epidural analgesia (PCEA) with or without (demand-only PCEA) continuous background infusion in reducing labor pain in 66 parturients. METHODS: After placement of the epidural catheter and administration of an initial bolus containing ropivacaine 16 mg and sufentanil 10 microg, parturients were prospectively randomized into two groups. The PCEA solution consisted of ropivacaine 0.16% plus sufentanil 0.5 microg/mL. Parturients with PCEA plus continuous background infusion received 4 mL/h plus an hourly maximum of three 4-mL boluses on demand (lock-out time 20 min); parturients with demand-only PCEA received an hourly maximum of four 4-mL boluses (lock-out time 15 min) of anesthetic solution. Pain scores (VAS 0-100 mm), drug doses administered, duration of labor, sensory and motor epidural block characteristics, maternal satisfaction, neonatal outcome and adverse events were determined. RESULTS: Both regimens provided excellent parturients' satisfaction and pain relief. However, periods of VAS scores>40 mm during all stages of labor were significantly more frequent in parturients receiving demand-only PCEA (22.4%) compared to parturients receiving PCEA plus continuous background infusion (7.5%, P=0.0011). Drug doses administered, duration of PCEA, labor and delivery, epidural block characteristics, neonatal outcome and adverse events did not differ between groups. CONCLUSION: Under the conditions of the study, PCEA plus continuous background infusion was more effective than demand-only PCEA in treating labor pain without increasing consumption of anesthetic solution.


Assuntos
Amidas/administração & dosagem , Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Analgesia Controlada pelo Paciente/métodos , Dor do Parto/tratamento farmacológico , Sufentanil/administração & dosagem , Adulto , Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Feminino , Humanos , Recém-Nascido , Satisfação do Paciente , Gravidez , Estudos Prospectivos , Ropivacaina
8.
Geburtshilfe Frauenheilkd ; 75(8): 792-807, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26365999

RESUMO

Purpose: Official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). Positioning injuries after lengthy gynecological procedures are rare, but the associated complications can be potentially serious for patients. Moreover, such injuries often lead to claims of malpractice and negligence requiring detailed medical investigation. To date, there are no binding evidence-based recommendations for the prevention of such injuries. Methods: This S1-guideline is the work of an interdisciplinary group of experts from a range of different professions who were commissioned by DGGG to carry out a systematic literature search of positioning injuries. Members of the participating scientific societies develop a consensus in an informal procedure. Afterwards the directorate of the scientific society approves the consensus. The recommendations cover.

9.
Int J Clin Pharmacol Ther ; 38(8): 408-14, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10984015

RESUMO

OBJECTIVE: Acetyl starch (ACS) is a new synthetic colloid solution for plasma volume expansion and is now undergoing phase II clinical trials. We compared the pharmacodynamics and tolerability of ACS with those ofhydroxyethyl starch (HES) in 32 patients (American Society of Anesthesiologists physical status I and II) undergoing elective surgery. SUBJECTS, MATERIAL AND METHODS: In this prospective, randomized, double-blind trial patients received either 15 ml/kg ACS 6% (average molecular weight (Mw) 200,000/molar substitution (MS) 0.5) or HES 6% (Mw 200,000/MS 0.5) i.v. up to a maximum dose of 1000 ml. Hemodynamic parameters, rheologic parameters, volume effect, acid-base status as well as effects on hemostasis were studied. RESULTS: After infusion of ACS and HES there was a similar increase in central venous pressure and mean arterial pressure in both groups. Acid-base status was not significantly altered after the end of the colloid infusions. After ACS infusion, plasma acetate concentration increased from 0.13+/-0.16 mg/dl to 2.87+/-1.13 mg/dl, however, after 24 h there was no significant difference in plasma acetate concentration compared to HES. The volume effect ranged from 104-116%(ACS) and from 88-118% (HES) of the colloid dose administered. These differences were not statistically significant. Partial thromboplastin time (aPTT) was only slightly increased after ACS infusion (from 38.6+/-5.7 sec to 41.4+/-5.1 sec), but was significantly increased after HES infusion (from 38.7+/-5.7 sec to 46.1+/-7.0 sec). CONCLUSION: ACS and HES are equally effective plasma volume expanders; ACS might be a new, alternative colloid solution with fewer coagulation side-effects than HES.


Assuntos
Substitutos do Plasma/farmacocinética , Amido/farmacocinética , Adolescente , Adulto , Idoso , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos , Feminino , Hemodinâmica , Humanos , Derivados de Hidroxietil Amido/administração & dosagem , Derivados de Hidroxietil Amido/efeitos adversos , Derivados de Hidroxietil Amido/farmacocinética , Masculino , Pessoa de Meia-Idade , Substitutos do Plasma/administração & dosagem , Substitutos do Plasma/efeitos adversos , Amido/administração & dosagem , Amido/efeitos adversos
11.
Anaesthesist ; 57(1): 87-102, 2008 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-18209976

RESUMO

Preeclampsia is a pregnancy-associated illness affecting multiple organ systems. Symptoms typically occur after the 20th week of gestation and consist of hypertension (>140/90 mmHg) and proteinuria (>300 mg/day). It is one of the leading causes of premature birth worldwide and early diagnosis and treatment are essential for both fetal and maternal health. Therapy is aimed at lowering blood pressure sufficiently to prevent the most severe complications such as intracranial hemorrhages. At the same time attention must be paid to the possible untoward effects of blood pressure medications on uteroplacental perfusion and fetal well being. Magnesium is the cornerstone for both prevention and control of eclamptic cerebrovascular events. In cases of severe preeclampsia and eclampsia prompt delivery is indicated, often carried out by Cesarean section (>34 weeks of gestation). Compared to general anesthesia, regional anesthesia techniques offer certain advantages to both mother and fetus and in the absence of contraindications are the methods of choice.


Assuntos
Anestesia Obstétrica , Eclampsia/fisiopatologia , Pré-Eclâmpsia/fisiopatologia , Adulto , Aspirina/uso terapêutico , Volume Sanguíneo/fisiologia , Cesárea , Eclampsia/diagnóstico , Eclampsia/prevenção & controle , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Inibidores da Agregação Plaquetária/uso terapêutico , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/prevenção & controle , Gravidez
12.
Anaesthesist ; 57(4): 374-81, 2008 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-18270672

RESUMO

After cardiac surgery with extracorporeal circulation, approximately 20% of patients show significant bleeding tendencies and 5% require re-intervention. In 50% of patients undergoing re-operation, no surgical cause can be determined, suggesting coagulopathy after cardiopulmonary bypass (CPB). For perioperative management of transfusion of blood products and coagulation factor concentrates, a clinical algorithm for the perioperative hemostatic therapy in patients undergoing cardiac surgery with CPB has been developed. The currently available evidence and the point of care methods routinely accessible in our institution (blood gas analysis, ACT, point of care Quick value, aPTT and platelet count) were used. The intervention with plasma products, coagulation factor concentrates and hemostatic drugs after extracorporeal circulation are described. Extensive bleeding history as well as the efficacy and side effects of antifibrinolytic treatment are discussed.


Assuntos
Algoritmos , Antifibrinolíticos/uso terapêutico , Transtornos da Coagulação Sanguínea/terapia , Circulação Extracorpórea , Complicações Pós-Operatórias/terapia , Fatores de Coagulação Sanguínea/uso terapêutico , Gasometria , Transfusão de Sangue , Desamino Arginina Vasopressina/uso terapêutico , Fibrinogênio/uso terapêutico , Heparina/uso terapêutico , Antagonistas de Heparina/uso terapêutico , Humanos , Tempo de Tromboplastina Parcial , Plasma , Contagem de Plaquetas , Sistemas Automatizados de Assistência Junto ao Leito
13.
Anaesthesist ; 57(2): 147-50, 2008 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-17928974

RESUMO

For more than 20 years percutaneous vertebroplasty has been used in the minimally invasive treatment of vertebral fractures. We report on a patient with embolisation of bone cement into the pulmonary artery and the right ventricle, which was perforated. The final diagnosis was delayed due to a combination of complications, previous disorders as well as a second embolisation.


Assuntos
Traumatismos Cardíacos/etiologia , Complicações Pós-Operatórias/etiologia , Embolia Pulmonar/etiologia , Disfunção Ventricular Direita/etiologia , Vertebroplastia/efeitos adversos , Anestesia , Cimentos Ósseos/efeitos adversos , Diagnóstico Diferencial , Eletrocardiografia , Traumatismos Cardíacos/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Testes de Função Respiratória , Fraturas da Coluna Vertebral/cirurgia , Espirometria , Tomografia Computadorizada por Raios X , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/terapia
14.
Anaesthesist ; 56(8): 772-9, 2007 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-17508190

RESUMO

BACKGROUND: The optimum intrathecal dose of hyperbaric levobupivacaine for spinal anaesthesia during elective caesarean section has not yet been investigated. METHODS: A total of 30 parturients undergoing elective caesarean section were included in this prospective, randomised, double-blind study. Parturients received either 7.5, 10 or 12.5 mg hyperbaric 0.5% levobupivacaine intrathecally. Analgesic, sensory and motor block characteristics as well as maternal and fetal levobupivacaine plasma concentrations were determined. RESULTS: Of the parturients receiving 7.5 mg levobupivacaine 40% required supplementary intravenous opioid analgesics intraoperatively and none achieved complete motor block. Compared to 7.5 mg levobupivacaine, 10 and 12.5 mg significantly prolonged duration of effective analgesia postoperatively (median: 45 vs. 81 and 96 min, respectively). Both maternal and fetal levobupivacaine plasma concentrations were low, with dose-dependent, statistically significant differences in maternal plasma concentrations. CONCLUSIONS: Levobupivacaine 7.5 mg did not provide satisfactory intraoperative analgesia in all parturients. There were no statistically significant differences between 10 and 12.5 mg levobupivacaine with respect to analgesic, sensory and motor block characteristics. Therefore, based on these data, 10 mg levobupivacaine is recommended for parturients undergoing elective caesarean section with spinal anaesthesia.


Assuntos
Anestesia Obstétrica , Raquianestesia , Anestésicos Locais , Cesárea , Adulto , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Anestésicos Locais/sangue , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Bupivacaína/administração & dosagem , Bupivacaína/efeitos adversos , Bupivacaína/análogos & derivados , Bupivacaína/sangue , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Feto/metabolismo , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Humanos , Recém-Nascido , Injeções Espinhais , Levobupivacaína , Bloqueio Nervoso , Medição da Dor/efeitos dos fármacos , Dor Pós-Operatória/epidemiologia , Gravidez
15.
Anaesthesist ; 55(9): 989-92, 994-6, 2006 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-16874472

RESUMO

Antifibrinolytic therapy with the serine protease inhibitor Aprotinin or the lysine analogues epsilon-aminocapronic acid or tranexamic acid is a therapeutic measure to reduce perioperative blood loss during cardiac surgery. In an international, prospective, non-randomised phase 4 observation study, Mangano et al. investigated the effectiveness and side-effects of Aprotinin, epsilon-aminocapronic acid and tranexamic acid in comparison to no antifibrinolytic therapy in a total of 4,374 patients who underwent cardiac surgery with extracorporeal circulation. In the opinion of Mangano et al. the results of this study question the safety and effectiveness of Aprotinin for reduction of perioperative blood loss by cardiac surgery patients. Despite a critical review of the study and results reported by Mangano et al., the authors of the present paper come to the conclusion that, in view of the availability of more reasonably priced alternatives in Germany, it appears to be sensible to give preference to tranexamic acid instead of aprotinin.


Assuntos
Aprotinina/efeitos adversos , Aprotinina/uso terapêutico , Procedimentos Cirúrgicos Cardíacos , Hemostáticos/efeitos adversos , Hemostáticos/uso terapêutico , Aminocaproatos/efeitos adversos , Aminocaproatos/uso terapêutico , Antifibrinolíticos/uso terapêutico , Feminino , Humanos , Nefropatias/complicações , Masculino , Complicações Pós-Operatórias/tratamento farmacológico , Estudos Prospectivos , Diálise Renal , Insuficiência Renal/induzido quimicamente , Insuficiência Renal/tratamento farmacológico , Ácido Tranexâmico/efeitos adversos , Ácido Tranexâmico/uso terapêutico
16.
Anaesthesist ; 54(7): 655-66, 2005 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-15868177

RESUMO

OBJECTIVE: The Anaesthesiological Questionnaire (ANP) is a self-rating method for the assessment of postoperative complaints and patient satisfaction. The questionnaire was adapted for use in cardiac anaesthesia (ANP-KA). The study was conducted to show the value of ANP-KA as a practicable means of assessing the patient's state after cardiac anaesthesia and for its use in quality assurance. METHODS: A total of 1,688 patients from 19 clinics were included who had exclusively received heart valve surgery, CABG surgery or both operations. They completed the ANP-KA between days 1 and 8 postoperatively. RESULTS: The ANP-KA was completed by 79.1% of the patients without any assistance. The highest incidence rates were reported for a dry mouth/thirst (85.1%) and for pain in the area of surgery (60.2%). Plausible and significant differences in patients' symptoms between the grading for the immediate postoperative period and the current state at filling in the questionnaire were found. Women reported more postoperative complaints than men but no differences were found between male and female patients with regard to satisfaction with anaesthesiological care and convalescence. More complaints were reported after heart valve surgery than after CABG and satisfaction with convalescence was significantly lower after heart valve surgery. The clinics differed with respect to the reported somatic complaints and satisfaction scales. CONCLUSION: The results demonstrate the practicability and validity of the ANP-KA for the assessment of postoperative complaints and patient satisfaction after cardiac surgery.


Assuntos
Anestesia , Anestesiologia/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos , Inquéritos e Questionários , Adulto , Idoso , Anestesia/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte Cardiopulmonar , Coleta de Dados , Feminino , Alemanha , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Reprodutibilidade dos Testes
17.
Zentralbl Gynakol ; 127(4): 242-7, 2005 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-16037906

RESUMO

OBJECTIVE: The management of HIV-positive pregnancies was investigated in conjunction to pre-, peri and postpartal complications and the HIV transmission rate. PATIENTS AND METHODS: Retrospective study of 88 HIV-positive patients who were delivered at the Dept. of Obstetrics and Gynaecology during 1.1.1997-31.12.2001. RESULTS: HIV-positive patients showed significantly more prepartal complications, compared to control group. Low CD4-cell count (< or = 200/microl) or high viral load (> 10 000 HIV-copies/ml) was not associated with increased risk for transmission relevant complications. The overall HIV-transmission rate was 3.4 % (3/89 newborns; with ART 2.5 % [2/85], without ART 33.3 % [1/3]). The transmission rate increased with complications during pregnancy (7.7 % [2/26] vs. 1.6 % [1/61]). Newborns delivered < or = 35 (th) week of gestation showed a transmission rate of 5.3 % compared to 2.9 % of newborns delivered after the 35 (th) week of gestation. 98 % of the patients were delivered by cesarean section (primary: n = 71, prior: n = 15), spontaneously: n = 2). 97 % of patients (85/88) were treated with antiretroviral therapy (ART). No differences were found in the postpartal complication rate of HIV-positive to -negative patients. None of the newborns was breast fed. CONCLUSIONS: Treatment of this risk-pregnancies in HIV experienced centers significantly reduces the risk of HIV transmission.


Assuntos
Soropositividade para HIV/transmissão , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez/virologia , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , Estudos Retrospectivos
18.
Artigo em Alemão | MEDLINE | ID: mdl-11050961

RESUMO

Asthma is defined as a chronic inflammatory airway disease in response to a wide variety of provoking stimuli. Characteristic clinical symptoms of asthma are bronchial hyperreactivity, reversible airway obstruction, wheezing and dyspnea. Asthma presents a major public health problem with increasing prevalence rates and severity worldwide. Despite major advances in our understanding of the clinical management of asthmatic patients, it remains a challenging population for anesthesiologists in clinical practice. The anesthesiologist's responsibility starts with the preoperative assessment and evaluation of the pulmonary function. For patients with asthma who currently have no symptoms, the risk of perioperative respiratory complications is extremely low. Therefore, pulmonary function should be optimized preoperatively and airway obstruction should be controlled by using steroids and bronchodilators. Preoperative spirometry is a simple means of assessing presence and severity of airway obstruction as well as the degree of reversibility in response to bronchodilator therapy. An increase of 15% in FEV1 is considered clinically significant. Most asymptomatic persons with asthma can safely undergo general anesthesia with and without endotracheal intubation. Volatile anesthetics are still recommended for general anesthetic techniques. As compared to barbiturates and even ketamine, propofol is considered to be the agent of choice for induction of anesthesia in asthmatics. The use of regional anesthesia does not reduce perioperative respiratory complications in asymptomatic asthmatics, whereas it is advantageous in symptomatic patients. Pregnant asthmatic and parturients undergoing anesthesia are at increased risk, especially if regional anesthetic techniques are not suitable and prostaglandin and its derivates are administered for abortion or operative delivery. Bronchial hyperreactivity associated with asthma is an important risk factor of perioperative bronchospasm. The occurrence of this potentially life-threatening condition in anesthesia practice varies from 0.17 to 4.2%. The anesthesiologists' goal should be to minimize the risk of inciting bronchospasm and to avoid triggering stimuli. As increases in airway resistance are noticed, therapy should be directed towards optimizing oxygenation and proper diagnosis needs to be established. With deepening anesthesia level and aggressive pharmacological management utilizing both, beta-agonists and steroids, respiratory failure may be properly controlled.


Assuntos
Anestesia/métodos , Asma/fisiopatologia , Anestesia/efeitos adversos , Espasmo Brônquico/prevenção & controle , Feminino , Humanos , Complicações Intraoperatórias/prevenção & controle , Monitorização Fisiológica , Gravidez , Complicações na Gravidez , Cuidados Pré-Operatórios , Testes de Função Respiratória , Fatores de Risco
19.
Anaesthesist ; 53(7): 637-44, 2004 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-15221118

RESUMO

Levobupivacaine, the S-enantiomer of racemic bupivacaine, will be available in Germany in mid-2004. Pharmacological studies demonstrated that, compared to bupivacaine, levobupivacaine has equal local anaesthetic potency with reduced potential for cardiac and CNS toxicity. This review introduces the new long-acting amide local anaesthetic levobupivacaine to the reader and evaluates its place in obstetric analgesia and anaesthesia compared to bupivacaine and ropivacaine.


Assuntos
Analgesia Obstétrica , Anestesia Obstétrica , Anestésicos Locais , Bupivacaína , Adulto , Amidas , Analgesia Epidural , Animais , Bupivacaína/efeitos adversos , Bupivacaína/química , Bupivacaína/toxicidade , Cesárea , Feminino , Humanos , Troca Materno-Fetal , Gravidez , Ropivacaina , Estereoisomerismo
20.
Anasth Intensivther Notfallmed ; 24(6): 355-61, 1989 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-2694857

RESUMO

Midazolam (M) has been successfully used in oral and rectal premedication of children of one to six years of age. The following study was designed to investigate the efficacy of both methods when used as premedication "on demand". 60 children (1-6 years) were randomly assigned to 0.3 mg/kg bw M orally and 0.5 mg/kg bw M rectally. Psychological, behavioural and physiological parameters were measured at special time intervals and special stressful events (separation from the mother or father, induction of anaesthesia). Rectally premedicated children were found to be better prepared concerning psychological and behavioural parameters. This can be due to the dosage as well as the faster absorption of M. In the postoperative period orally premedicated children experienced significantly more nausea and vomiting. This might be due to the preparation with saccharin, peppermint oil and ethanol. - In "premedication on demand" rectal Midazolam must be preferred to orally administered Midazolam in the preparation mentioned above.


Assuntos
Midazolam/administração & dosagem , Medicação Pré-Anestésica , Administração Oral , Administração Retal , Criança , Pré-Escolar , Humanos , Lactente , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego
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