Skip to main content
Erschienen in: Der Anaesthesist 11/2004

01.11.2004 | Weiterbildung · Zertifizierte Fortbildung

Analgesie und Sedierung in der Intensivmedizin

verfasst von: Dr. E. Schaffrath, R. Kuhlen, P. H. Tonner

Erschienen in: Die Anaesthesiologie | Ausgabe 11/2004

Einloggen, um Zugang zu erhalten

Zusammenfassung

Sedierung und Analgesie sind wesentliche Gesichtspunkte bei der Betreuung von Intensivpatienten. Das gegenwärtige Sedierungsmanagement ist durch die Entwicklung neuer Medikamente und Beatmungsstrategien komplexer und differenzierter geworden. Dieser Artikel soll einen Überblick der verschiedenen hierbei zur Anwendung kommenden Substanzgruppen geben, wobei ein Schwerpunkt auf neu entwickelten Medikamenten, wie beispielsweise Dexmedetomidin, liegt. Ein weiterer Gesichtspunkt ist die Überwachung der Sedierungstiefe mit Hilfe von Scoringsystemen oder EEG-basierten Daten. Moderne Analgosedierungskonzepte entwickeln sich aus dem Zusammenspiel verschiedener Parameter, wie sie beispielsweise im adaptierten Sedierungs- und Analgesiemanagement (ASAM) aufgegriffen werden.
Literatur
1.
Zurück zum Zitat Aantaa R, Kallio A, Vitranan R (1993) Dexmedetomidine, a novel α2-adrenic agonist: a review of its pharmacodynamic characteristics. Drugs Future 18:49–56 Aantaa R, Kallio A, Vitranan R (1993) Dexmedetomidine, a novel α2-adrenic agonist: a review of its pharmacodynamic characteristics. Drugs Future 18:49–56
2.
Zurück zum Zitat Adams HA, Brausch M, Schmitz CS et al. (2001) Analgosedierung mit (S)-Ketamin/Propofol vs. (S)-Ketamin/Midazolam: Steuerbarkeit, Stressreaktion und Hämodynamik—Eine kontrollierte Anwendungsbeobachtung bei operativen Intensivpatienten. Anästhesiol Intensivmed Schmerzther 36:417–424 Adams HA, Brausch M, Schmitz CS et al. (2001) Analgosedierung mit (S)-Ketamin/Propofol vs. (S)-Ketamin/Midazolam: Steuerbarkeit, Stressreaktion und Hämodynamik—Eine kontrollierte Anwendungsbeobachtung bei operativen Intensivpatienten. Anästhesiol Intensivmed Schmerzther 36:417–424
3.
4.
Zurück zum Zitat Albanese J, Arnaud S, Rey M et al. (1997) Ketamine decreases intracranial pressure and electroencephalographic activity in traumatic brain injury patients during propofol sedation. Anesthesiology 87:1328–1334CrossRefPubMed Albanese J, Arnaud S, Rey M et al. (1997) Ketamine decreases intracranial pressure and electroencephalographic activity in traumatic brain injury patients during propofol sedation. Anesthesiology 87:1328–1334CrossRefPubMed
5.
Zurück zum Zitat Ariano RE, Kassum DA, Aronson KJ (1994) Comparison of sedative recovery time after midazolam versus diazepam administration. Crit Care Med 22:1492–1496PubMed Ariano RE, Kassum DA, Aronson KJ (1994) Comparison of sedative recovery time after midazolam versus diazepam administration. Crit Care Med 22:1492–1496PubMed
6.
Zurück zum Zitat Barr J, Zomorodi K, Bertaccini EJ et al. (2001) A double-blind, randomized comparison of i.v. lorazepam versus midazolam for sedation of ICU patients via a pharmacologic model. Anesthesiology 95:286–298CrossRefPubMed Barr J, Zomorodi K, Bertaccini EJ et al. (2001) A double-blind, randomized comparison of i.v. lorazepam versus midazolam for sedation of ICU patients via a pharmacologic model. Anesthesiology 95:286–298CrossRefPubMed
7.
Zurück zum Zitat Barrientos-Vega R, Sanchez-Soria MM, Morales-Garcia C et al. (1997) Prolonged sedation of critically ill patients with midazolam or propofol: Impact on weaning and costs. Crit Care Med 25:33–40CrossRefPubMed Barrientos-Vega R, Sanchez-Soria MM, Morales-Garcia C et al. (1997) Prolonged sedation of critically ill patients with midazolam or propofol: Impact on weaning and costs. Crit Care Med 25:33–40CrossRefPubMed
8.
Zurück zum Zitat Bennett SN, McNeil MM, Bland LA et al. (1995) Postoperative infections traced to contamination of an intravenous anesthetic, propofol. N Engl J Med 333:147–154CrossRefPubMed Bennett SN, McNeil MM, Bland LA et al. (1995) Postoperative infections traced to contamination of an intravenous anesthetic, propofol. N Engl J Med 333:147–154CrossRefPubMed
9.
Zurück zum Zitat Bertrand Y (1987) Posttraumatic stress disorder. Acta Anaesthesiol Belg 38:411–416PubMed Bertrand Y (1987) Posttraumatic stress disorder. Acta Anaesthesiol Belg 38:411–416PubMed
10.
Zurück zum Zitat Bhana N, Goa KL, McClellan KJ (2000) Dexmedetomidine. Drugs 59:263–270PubMed Bhana N, Goa KL, McClellan KJ (2000) Dexmedetomidine. Drugs 59:263–270PubMed
11.
Zurück zum Zitat Bion JF (1988) Sedation and analgesia in the intensive care unit. Hospital Update 2:1272–1286 Bion JF (1988) Sedation and analgesia in the intensive care unit. Hospital Update 2:1272–1286
12.
Zurück zum Zitat Boldt J, Thaler E, Lehmann A et al. (1998) Pain management in cardiac surgery patients: comparison between standard therapy and patient-controlled analgesia regimen. J Cardiothorac Vasc Anesth 12:654–658CrossRefPubMed Boldt J, Thaler E, Lehmann A et al. (1998) Pain management in cardiac surgery patients: comparison between standard therapy and patient-controlled analgesia regimen. J Cardiothorac Vasc Anesth 12:654–658CrossRefPubMed
13.
Zurück zum Zitat Bosscha K, Nieuwenhuijs VB, Vos A et al. (1998) Gastrointestinal motility and gastric tube feeding in mechanically ventilated patients. Crit Care Med 26:1510–1517CrossRefPubMed Bosscha K, Nieuwenhuijs VB, Vos A et al. (1998) Gastrointestinal motility and gastric tube feeding in mechanically ventilated patients. Crit Care Med 26:1510–1517CrossRefPubMed
14.
Zurück zum Zitat Bourgoin A, Albanese J, Wereszczynski N et al. (2003) Safety of sedation with ketamine in severe head injury patients: comparison with sufentanil. Crit Care Med 31 (3):711–717CrossRefPubMed Bourgoin A, Albanese J, Wereszczynski N et al. (2003) Safety of sedation with ketamine in severe head injury patients: comparison with sufentanil. Crit Care Med 31 (3):711–717CrossRefPubMed
15.
16.
Zurück zum Zitat Brook AD, Ahrens TS, Schaiff R et al. (1999) Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 27:2609–2615CrossRefPubMed Brook AD, Ahrens TS, Schaiff R et al. (1999) Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 27:2609–2615CrossRefPubMed
17.
Zurück zum Zitat Burns AM, Shelly MP, Park GR (1992) The use of sedative agents in critically ill patients. Drugs 43:507–515PubMed Burns AM, Shelly MP, Park GR (1992) The use of sedative agents in critically ill patients. Drugs 43:507–515PubMed
18.
Zurück zum Zitat Cremer Ol, Moons KMG, Boumann EAC et al. (2001) Long-term propofol infusion and cardiac failure in head injured patients. Lancet 357:117–118CrossRefPubMed Cremer Ol, Moons KMG, Boumann EAC et al. (2001) Long-term propofol infusion and cardiac failure in head injured patients. Lancet 357:117–118CrossRefPubMed
19.
Zurück zum Zitat Daunderer M, Schwender D, Spahn DR, Gilliard N (2001) Messung der Narkosetiefe, Awareness und EEG. Anaesthesist 50:231–241CrossRefPubMed Daunderer M, Schwender D, Spahn DR, Gilliard N (2001) Messung der Narkosetiefe, Awareness und EEG. Anaesthesist 50:231–241CrossRefPubMed
20.
Zurück zum Zitat Dorman BH, Zucker JR, Verrier ED et al. (1993) Clonidine improves perioperative myokardial ischemia, reduces anaesthetic requirement and alters haemodynamic parameters in patients undergoing coronary artery bypass surgery. J Cardiathorac Vasc Anesth 7:386–395CrossRef Dorman BH, Zucker JR, Verrier ED et al. (1993) Clonidine improves perioperative myokardial ischemia, reduces anaesthetic requirement and alters haemodynamic parameters in patients undergoing coronary artery bypass surgery. J Cardiathorac Vasc Anesth 7:386–395CrossRef
21.
Zurück zum Zitat Dorman T, Clarkson K, Rosenfeld BA et al. (1997) Effects of clonidine on prolonged postoperative sympathetic response. Crit Care Med 25:1147–1152CrossRefPubMed Dorman T, Clarkson K, Rosenfeld BA et al. (1997) Effects of clonidine on prolonged postoperative sympathetic response. Crit Care Med 25:1147–1152CrossRefPubMed
22.
Zurück zum Zitat Duke P, Maze M, Morrison P (1998). Dexmedetomedine: a general overview. Redefining Sedation International Congress and Symposium Series No.221. Published by the Royal Society of Medicine Press Limited Duke P, Maze M, Morrison P (1998). Dexmedetomedine: a general overview. Redefining Sedation International Congress and Symposium Series No.221. Published by the Royal Society of Medicine Press Limited
23.
Zurück zum Zitat Durbin CG Jr (1994) Sedation in the critically ill patient. New Horiz 2:64–74PubMed Durbin CG Jr (1994) Sedation in the critically ill patient. New Horiz 2:64–74PubMed
24.
Zurück zum Zitat Elliott MW, Confalonieri M, Nava S (2002) Where to perform noninvasive ventilation? Eur Respir J 19:1159–1166CrossRefPubMed Elliott MW, Confalonieri M, Nava S (2002) Where to perform noninvasive ventilation? Eur Respir J 19:1159–1166CrossRefPubMed
25.
Zurück zum Zitat Ely WE, Truman B, Shintani A et al. (2003) Monitoring sedation status over time in ICU patients. JAMA 289(22):2983–2991CrossRefPubMed Ely WE, Truman B, Shintani A et al. (2003) Monitoring sedation status over time in ICU patients. JAMA 289(22):2983–2991CrossRefPubMed
26.
Zurück zum Zitat Engelhard K, Werner C, Eberspächer E et al. (2003) The effect of the α2-Agonist Dexmedetomidine and the N-methyl-D-aspartate Antagonist S(+)-Ketamine on the expression of apoptosis-regulating proteins after incomplete cerebral ischemia and reperfusion in rats. Anesth Analg 96:524–531CrossRefPubMed Engelhard K, Werner C, Eberspächer E et al. (2003) The effect of the α2-Agonist Dexmedetomidine and the N-methyl-D-aspartate Antagonist S(+)-Ketamine on the expression of apoptosis-regulating proteins after incomplete cerebral ischemia and reperfusion in rats. Anesth Analg 96:524–531CrossRefPubMed
27.
Zurück zum Zitat Entholzner E, Hargasser S, Mielke L, Weber F (1993) Tritt die im Tierversuch nachgewiesene Steigerung des Krampfpotentials durch GHB auch beim Menschen auf? Anaesthesist 42:187PubMed Entholzner E, Hargasser S, Mielke L, Weber F (1993) Tritt die im Tierversuch nachgewiesene Steigerung des Krampfpotentials durch GHB auch beim Menschen auf? Anaesthesist 42:187PubMed
28.
Zurück zum Zitat Epstein J, Breslow MJ (1999)The stress response of critical illness. Crit Care Clin 15:17–33PubMed Epstein J, Breslow MJ (1999)The stress response of critical illness. Crit Care Clin 15:17–33PubMed
29.
Zurück zum Zitat Flaishon R, Windsor A, Sigl J (1997) Recovery of consciousness after thiopental or propofol. Anesthesiology 86:613–619CrossRefPubMed Flaishon R, Windsor A, Sigl J (1997) Recovery of consciousness after thiopental or propofol. Anesthesiology 86:613–619CrossRefPubMed
30.
Zurück zum Zitat Fraser GL, Prato S, Berthiaume D (2000) Evaluation of agitation in ICU patients: Incidence, severity, and treatment in the young versus the elderly. Pharmacotherapy 20:75–82CrossRefPubMed Fraser GL, Prato S, Berthiaume D (2000) Evaluation of agitation in ICU patients: Incidence, severity, and treatment in the young versus the elderly. Pharmacotherapy 20:75–82CrossRefPubMed
31.
Zurück zum Zitat Gallimberti L, Ferri M, Ferrasa SD et al. (1992) Gamma-hydroxybutyric acid in the treatment of alcohol dependence: a double-blind study. Alcohol Clin Exp Res 16:673–676PubMed Gallimberti L, Ferri M, Ferrasa SD et al. (1992) Gamma-hydroxybutyric acid in the treatment of alcohol dependence: a double-blind study. Alcohol Clin Exp Res 16:673–676PubMed
32.
Zurück zum Zitat Ghignone M, Calvillo O, Quintin L (1987) Anesthesia and hypertension: The effect of clonidine on perioperative hemodynamics and isofluran requirements. Anesthesiology 67:3–10PubMed Ghignone M, Calvillo O, Quintin L (1987) Anesthesia and hypertension: The effect of clonidine on perioperative hemodynamics and isofluran requirements. Anesthesiology 67:3–10PubMed
33.
Zurück zum Zitat Ghignone M, Quintin L, Duke PC et al. (1986) Effects on clonidine on narcotic requirements and haemodynamic response during induction of fentanyl anaesthesia and endotracheal intubation. Anesthesiology 64:36–42PubMed Ghignone M, Quintin L, Duke PC et al. (1986) Effects on clonidine on narcotic requirements and haemodynamic response during induction of fentanyl anaesthesia and endotracheal intubation. Anesthesiology 64:36–42PubMed
34.
Zurück zum Zitat Gilbert TT, Wagner MR, Vishwanath V et al. (2001) Use of bispectral electroencephalogram monitoring to assess neurologic status in unsedated, critically ill patients. Crit Care Med 29:1996–2000CrossRefPubMed Gilbert TT, Wagner MR, Vishwanath V et al. (2001) Use of bispectral electroencephalogram monitoring to assess neurologic status in unsedated, critically ill patients. Crit Care Med 29:1996–2000CrossRefPubMed
35.
Zurück zum Zitat Hall RI, Sandham D, Cardinal P et al. (2001) Propofol vs midazolam for ICU sedation. A Canadian multicenter randomized trial. Chest 119:1151–1159CrossRefPubMed Hall RI, Sandham D, Cardinal P et al. (2001) Propofol vs midazolam for ICU sedation. A Canadian multicenter randomized trial. Chest 119:1151–1159CrossRefPubMed
36.
Zurück zum Zitat Hammerlein A, Derendorf H, Lowenthal DT (1998) Pharmakokinetic and pharmacodynamic changes in the elderly. Clin Pharmacokinet 35:49–64PubMed Hammerlein A, Derendorf H, Lowenthal DT (1998) Pharmakokinetic and pharmacodynamic changes in the elderly. Clin Pharmacokinet 35:49–64PubMed
37.
Zurück zum Zitat Hansen-Flaschen J, Cowen J, Polomano RC (1994) Beyond the Ramsay scale: need for a validated measure of sedating drug efficacy in the intensive care unit. Crit Care Med 22:732–733PubMed Hansen-Flaschen J, Cowen J, Polomano RC (1994) Beyond the Ramsay scale: need for a validated measure of sedating drug efficacy in the intensive care unit. Crit Care Med 22:732–733PubMed
38.
Zurück zum Zitat Hansen-Flaschen JH, Brazinsky S, Basile C, Lanken PN (1991) Use of sedating drugs and neuromuskular blocking agents in patients requiring mechanical ventilation for respiratory failure. JAMA 266:2870–2875CrossRefPubMed Hansen-Flaschen JH, Brazinsky S, Basile C, Lanken PN (1991) Use of sedating drugs and neuromuskular blocking agents in patients requiring mechanical ventilation for respiratory failure. JAMA 266:2870–2875CrossRefPubMed
39.
40.
Zurück zum Zitat Hempelmann G, Kuhn DF (1997) Klinischer Stellenwert des S-(+)-Ketamin. Anaesthesist [Suppl 1] 46: S3–S7 Hempelmann G, Kuhn DF (1997) Klinischer Stellenwert des S-(+)-Ketamin. Anaesthesist [Suppl 1] 46: S3–S7
41.
Zurück zum Zitat Herbert MK, Roth-Goldbrunner S, Holzer P, Roewer N (2002) Clonidine and dexmedetomidine potently inhibit peristalsis in the Guinea pig ileum in vitro. Anesthesiology 97:1491–1499CrossRefPubMed Herbert MK, Roth-Goldbrunner S, Holzer P, Roewer N (2002) Clonidine and dexmedetomidine potently inhibit peristalsis in the Guinea pig ileum in vitro. Anesthesiology 97:1491–1499CrossRefPubMed
42.
Zurück zum Zitat Himmelseher S, Pfenniger E (1998) The clinical use of S-(+)-Ketamine—an determination of its place. Anasthesiol Intensivmed Notfallmed Schmerzther 33:764–770PubMed Himmelseher S, Pfenniger E (1998) The clinical use of S-(+)-Ketamine—an determination of its place. Anasthesiol Intensivmed Notfallmed Schmerzther 33:764–770PubMed
43.
Zurück zum Zitat Hughes MA, Glass PSA, Jacobs JR (1992) Context-sensitive half-time in multicompartment pharmacokinetic models for intravenous anesthetic drugs. Anesthesiology 76:334–341PubMed Hughes MA, Glass PSA, Jacobs JR (1992) Context-sensitive half-time in multicompartment pharmacokinetic models for intravenous anesthetic drugs. Anesthesiology 76:334–341PubMed
44.
Zurück zum Zitat Jacobi J, Fraser GL, Coursin DB et al. (2002) Clinical practice guidelines for the sustained use of sedatives and analgetics in the critically ill adult. Crit Care Med 30:119–130CrossRefPubMed Jacobi J, Fraser GL, Coursin DB et al. (2002) Clinical practice guidelines for the sustained use of sedatives and analgetics in the critically ill adult. Crit Care Med 30:119–130CrossRefPubMed
45.
Zurück zum Zitat Jarrott B, Lewis SJ, Doyle AE, Louis WJ (1988) Effects of continuous infusions (10 days) and cessation of infusions of clonidine and rilmenidine (S3341) on cardiovascular and behavioral parameters of spontaneously hypertensive rats. Am J Cardiol 24; 61 (7):39D–44D Jarrott B, Lewis SJ, Doyle AE, Louis WJ (1988) Effects of continuous infusions (10 days) and cessation of infusions of clonidine and rilmenidine (S3341) on cardiovascular and behavioral parameters of spontaneously hypertensive rats. Am J Cardiol 24; 61 (7):39D–44D
46.
Zurück zum Zitat Khan ZP, Ferguson CN, Jones RM (1999) Alpha-2 and imidazoline receptor agonists: their pharmacology and therapeutic role. Anesthesia 54:146–165CrossRef Khan ZP, Ferguson CN, Jones RM (1999) Alpha-2 and imidazoline receptor agonists: their pharmacology and therapeutic role. Anesthesia 54:146–165CrossRef
47.
Zurück zum Zitat Kleinschmidt S, Mertzlufft F (1995) Gamma-hydroxybutyric acid- significance for anesthesia and intensive care. Anasthesiol Intensivmed Notfallmed Schmerzther 30:393–402PubMed Kleinschmidt S, Mertzlufft F (1995) Gamma-hydroxybutyric acid- significance for anesthesia and intensive care. Anasthesiol Intensivmed Notfallmed Schmerzther 30:393–402PubMed
48.
Zurück zum Zitat Koepke JP (1989) Effect of environmental stress on neural control of renal function. Miner Electrolyte Metab 15:83–87PubMed Koepke JP (1989) Effect of environmental stress on neural control of renal function. Miner Electrolyte Metab 15:83–87PubMed
49.
Zurück zum Zitat Kollef M, Levy N, Ahrens T et al. (1998) The use of continuous iv sedation is associated with prolongation of mechanical ventilation. Chest 114:541–548PubMed Kollef M, Levy N, Ahrens T et al. (1998) The use of continuous iv sedation is associated with prolongation of mechanical ventilation. Chest 114:541–548PubMed
50.
Zurück zum Zitat Kollef MH, Shapiro SD, Silver P et al. (1997) A randomized, controlled trial of prtocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med 25 (4):567–574CrossRefPubMed Kollef MH, Shapiro SD, Silver P et al. (1997) A randomized, controlled trial of prtocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med 25 (4):567–574CrossRefPubMed
51.
Zurück zum Zitat Kowalski SD, Rayfield CA (1999) A post hoc descriptive study of patients receiving propofol. Am J Crit Care 8:507–513PubMed Kowalski SD, Rayfield CA (1999) A post hoc descriptive study of patients receiving propofol. Am J Crit Care 8:507–513PubMed
52.
Zurück zum Zitat Kress HG (1997) Wirkmechnismen von Ketamin. Anaesthesist [Suppl 1] 46:S8–S19 Kress HG (1997) Wirkmechnismen von Ketamin. Anaesthesist [Suppl 1] 46:S8–S19
53.
Zurück zum Zitat Kress JP, O’Connor MF, Pohlmann AS et al. (1996) Sedation of critically ill patients during mechanical ventilation. A comparison of propofol and midazolam. Am J Respir Crit Care Med 153:1012–1018PubMed Kress JP, O’Connor MF, Pohlmann AS et al. (1996) Sedation of critically ill patients during mechanical ventilation. A comparison of propofol and midazolam. Am J Respir Crit Care Med 153:1012–1018PubMed
54.
Zurück zum Zitat Kress JP, Pohlmann AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–1477CrossRefPubMed Kress JP, Pohlmann AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–1477CrossRefPubMed
55.
Zurück zum Zitat Kröll W, List WF (1992) Eignet sich Sufentanil für die Langzeitanalgosedierung kritisch Kranker? Anaesthesist 41:271–275PubMed Kröll W, List WF (1992) Eignet sich Sufentanil für die Langzeitanalgosedierung kritisch Kranker? Anaesthesist 41:271–275PubMed
56.
Zurück zum Zitat Kulka PJ, Tryba M, Zenz M (1996) Preoperative alpha2-adrenergic receptor agonists prevent the deterioration of renal function after cardiac surgery: results of a randomized, controlled trial. Crit Care Med 24:947–952CrossRefPubMed Kulka PJ, Tryba M, Zenz M (1996) Preoperative alpha2-adrenergic receptor agonists prevent the deterioration of renal function after cardiac surgery: results of a randomized, controlled trial. Crit Care Med 24:947–952CrossRefPubMed
57.
Zurück zum Zitat Lenzenhuber E, Müller C, Rommelspacher H, Spies C (1999) Gamma-Hydroxybuttersäure zur Therapie des Alkoholentzugssyndroms bei Intensivpatienten. Anaesthesist 48:89–96CrossRefPubMed Lenzenhuber E, Müller C, Rommelspacher H, Spies C (1999) Gamma-Hydroxybuttersäure zur Therapie des Alkoholentzugssyndroms bei Intensivpatienten. Anaesthesist 48:89–96CrossRefPubMed
58.
Zurück zum Zitat Lewis K, Whipple JK, Michael K, Quebbeman EJ (1994) Effect of analgesic treatment on the physiological consequences of acute pain. Am J Hosp Phar 51:1539–1554 Lewis K, Whipple JK, Michael K, Quebbeman EJ (1994) Effect of analgesic treatment on the physiological consequences of acute pain. Am J Hosp Phar 51:1539–1554
59.
Zurück zum Zitat Mamelak M (1989) Gammahydroxybutyrat: an endogenous regulator of energy metabolism. Neurosci Biobehav R 13:187–198 Mamelak M (1989) Gammahydroxybutyrat: an endogenous regulator of energy metabolism. Neurosci Biobehav R 13:187–198
60.
Zurück zum Zitat Mangano DT, Layug EL, Wallace A et al. (1996) Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. N Engl J Med 335:1713–1720CrossRefPubMed Mangano DT, Layug EL, Wallace A et al. (1996) Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. N Engl J Med 335:1713–1720CrossRefPubMed
61.
Zurück zum Zitat Mangano DT, Siliciano D, Hollenberg M et al. (1992) Postoperative myocardial ischemia. Anesthesiology 76:342–353PubMed Mangano DT, Siliciano D, Hollenberg M et al. (1992) Postoperative myocardial ischemia. Anesthesiology 76:342–353PubMed
62.
Zurück zum Zitat Maze M, Virtanen R, Daunt D et al. (1991) Effects of dexmedetomidine, a novel imidazole sedative-anesthetic agent, on adrenal steroidogenesis: in vivo and in vitro studies. Anesth Analg 73:204–208PubMed Maze M, Virtanen R, Daunt D et al. (1991) Effects of dexmedetomidine, a novel imidazole sedative-anesthetic agent, on adrenal steroidogenesis: in vivo and in vitro studies. Anesth Analg 73:204–208PubMed
63.
Zurück zum Zitat Monk JP, Beresford R, Ward A (1988) Sufentanil: a review of its pharmacological properties and therapeutic use. Drugs 36:286–313PubMed Monk JP, Beresford R, Ward A (1988) Sufentanil: a review of its pharmacological properties and therapeutic use. Drugs 36:286–313PubMed
64.
Zurück zum Zitat Morton J, Hardman HD, Kamiyama Y et al. (1991) Analgesic efficacy of single escalating doses of GI 87084B administered intravenously to healthy adult male volunters. Anesthesiology 75:A378 Morton J, Hardman HD, Kamiyama Y et al. (1991) Analgesic efficacy of single escalating doses of GI 87084B administered intravenously to healthy adult male volunters. Anesthesiology 75:A378
65.
Zurück zum Zitat Murdoch S, Cohen A (2000) Intensive care sedation: a review of current British practice. Intensive Care Med 26:922–928CrossRefPubMed Murdoch S, Cohen A (2000) Intensive care sedation: a review of current British practice. Intensive Care Med 26:922–928CrossRefPubMed
66.
Zurück zum Zitat Murray MJ, Cowen J, DeBlock H et al. (2002) Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. Crit Care Med 30:142–156CrossRefPubMed Murray MJ, Cowen J, DeBlock H et al. (2002) Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. Crit Care Med 30:142–156CrossRefPubMed
67.
Zurück zum Zitat Oliver MF, Goldman L, Julian DG, Holme I (1999) Effect of mivazerol on perioperative complications during non-cardiac surgery in patients with coronary heart disease: the European Mivazerol Trial (EMIT) 91 (4):951–961 Oliver MF, Goldman L, Julian DG, Holme I (1999) Effect of mivazerol on perioperative complications during non-cardiac surgery in patients with coronary heart disease: the European Mivazerol Trial (EMIT) 91 (4):951–961
68.
Zurück zum Zitat Ostermann ME, Keenan SP, Seiferling RA, Sibbald WJ (2000) Sedation in the Intensive care Unit—a systematic review. JAMA 283:1451–1459CrossRefPubMed Ostermann ME, Keenan SP, Seiferling RA, Sibbald WJ (2000) Sedation in the Intensive care Unit—a systematic review. JAMA 283:1451–1459CrossRefPubMed
69.
Zurück zum Zitat Oye I, Paulson O, Maurset A (1992) Effects of ketamine on sensory perception: evidence for a role of N-methyl-D-aspartate receptors. J Pharmacol Exp Ther 260:1209–1213PubMed Oye I, Paulson O, Maurset A (1992) Effects of ketamine on sensory perception: evidence for a role of N-methyl-D-aspartate receptors. J Pharmacol Exp Ther 260:1209–1213PubMed
70.
Zurück zum Zitat Park GR (2001) Sedation and analgesia-which way is best? Br J Anaesthesia 87:183–184CrossRef Park GR (2001) Sedation and analgesia-which way is best? Br J Anaesthesia 87:183–184CrossRef
71.
Zurück zum Zitat Parke TJ, Stevens JE, Rice AS (1992) Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. BMJ 305:613–616PubMed Parke TJ, Stevens JE, Rice AS (1992) Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. BMJ 305:613–616PubMed
72.
Zurück zum Zitat Perrier ND, Baerga VY, Murray MJ (2000) Death related to propofol use in an adult patient. Crit Care Med 28:3071–3074CrossRefPubMed Perrier ND, Baerga VY, Murray MJ (2000) Death related to propofol use in an adult patient. Crit Care Med 28:3071–3074CrossRefPubMed
73.
Zurück zum Zitat Pfenninger E, Himmelseher S (1997) Neuroprotektion durch Ketamin auf zellulärer Ebene. Anaesthesist [Suppl 1] 46:S47–S54 Pfenninger E, Himmelseher S (1997) Neuroprotektion durch Ketamin auf zellulärer Ebene. Anaesthesist [Suppl 1] 46:S47–S54
74.
Zurück zum Zitat Pohlmann AS, Simpson KP, Hall JB (1994) Continuous intravenous infusions of lorazepam versus midazolam for sedation during mechanical ventilatory support: a prospective, randomized study. Crit Care Med 22:1241–1247PubMed Pohlmann AS, Simpson KP, Hall JB (1994) Continuous intravenous infusions of lorazepam versus midazolam for sedation during mechanical ventilatory support: a prospective, randomized study. Crit Care Med 22:1241–1247PubMed
75.
Zurück zum Zitat Poldermans D, Boersma E, Bax JJ et al. (1999) The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 341:1789–1794CrossRefPubMed Poldermans D, Boersma E, Bax JJ et al. (1999) The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 341:1789–1794CrossRefPubMed
76.
Zurück zum Zitat Pospiech R, Schmidt E (1993) Zum Einsatz von Gamma-Hydroxybuttersäure beimlangzeitbeatmeten Intensivpatienten. Intensiv Notfallbeh 18:157–164 Pospiech R, Schmidt E (1993) Zum Einsatz von Gamma-Hydroxybuttersäure beimlangzeitbeatmeten Intensivpatienten. Intensiv Notfallbeh 18:157–164
77.
Zurück zum Zitat Prause A, Wappler F, Scholz J et al. (2000) Respiratory depression under long-term sedation with sufentanil, midazolam and clonidin has no clinical significance. Intensive Care Med 26:1454–1461CrossRefPubMed Prause A, Wappler F, Scholz J et al. (2000) Respiratory depression under long-term sedation with sufentanil, midazolam and clonidin has no clinical significance. Intensive Care Med 26:1454–1461CrossRefPubMed
78.
Zurück zum Zitat Proescholdt M, Heimann A, Kempski O (2001) Neuroprotection of S(+) ketamine isomer in global forebrain ischemia. Brain Res 22:245–251CrossRef Proescholdt M, Heimann A, Kempski O (2001) Neuroprotection of S(+) ketamine isomer in global forebrain ischemia. Brain Res 22:245–251CrossRef
79.
Zurück zum Zitat Putensen C, Rasanen J, Lopez FA (1994) Ventilation-perfusion distributions during mechanical ventilation with superimposed spontaneous breathing in canine lung injury. Am J Respir Crit Care Med 150:101–108PubMed Putensen C, Rasanen J, Lopez FA (1994) Ventilation-perfusion distributions during mechanical ventilation with superimposed spontaneous breathing in canine lung injury. Am J Respir Crit Care Med 150:101–108PubMed
80.
Zurück zum Zitat Putensen C, Zech S, Wrigge H et al. (2001) Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med 164:43–49PubMed Putensen C, Zech S, Wrigge H et al. (2001) Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med 164:43–49PubMed
81.
Zurück zum Zitat Ramsay M, Savege T, Simpson B, Goodwin R (1974) Controlled sedation with alphaxalone-alphadolone. BMJ 2:656–659PubMed Ramsay M, Savege T, Simpson B, Goodwin R (1974) Controlled sedation with alphaxalone-alphadolone. BMJ 2:656–659PubMed
82.
Zurück zum Zitat Ramsay MAE (2000) Intensive care: problems of over- and undersedation. In: Scholz J, Tonner PH (eds) Alpha2-adrenoceptor agonists in anaesthesia and intensive care. Balliere Tindall 14:419–423CrossRef Ramsay MAE (2000) Intensive care: problems of over- and undersedation. In: Scholz J, Tonner PH (eds) Alpha2-adrenoceptor agonists in anaesthesia and intensive care. Balliere Tindall 14:419–423CrossRef
83.
Zurück zum Zitat Rasanen J, Downs JB, Stock MC (1988) Cardiovascular effects of conventional positive pressure ventilation and airway pressure release ventilation. Chest 93:911–915PubMed Rasanen J, Downs JB, Stock MC (1988) Cardiovascular effects of conventional positive pressure ventilation and airway pressure release ventilation. Chest 93:911–915PubMed
84.
Zurück zum Zitat Reves J, Fragen R, Vinik H (1985) Midazolam: Pharmacology and uses. Anesthesiology 62:310–324PubMed Reves J, Fragen R, Vinik H (1985) Midazolam: Pharmacology and uses. Anesthesiology 62:310–324PubMed
85.
Zurück zum Zitat Reves J, Glass P, Lubasky D (1994) Nonbarbiturate intravenous anesthestetic drugs. In: Miller RM (ed) Anesthesia. Churchill Livingston, New York, pp 247–290 Reves J, Glass P, Lubasky D (1994) Nonbarbiturate intravenous anesthestetic drugs. In: Miller RM (ed) Anesthesia. Churchill Livingston, New York, pp 247–290
86.
Zurück zum Zitat Rhoney DH, Murry KR (1998) A national survey of the use of sedating and neuromuscular blocking agents (NMBA) in the intensive care unit (ICU). Crit Care Med 26 [Suppl]:A24 Rhoney DH, Murry KR (1998) A national survey of the use of sedating and neuromuscular blocking agents (NMBA) in the intensive care unit (ICU). Crit Care Med 26 [Suppl]:A24
87.
Zurück zum Zitat Riker RR, Fraser GL, Simmons LE, Wilkins ML (2001) Validating the Sedation-Agitation Scale with the Bispectral Index and Visual Analog Scale in adult ICU patients after cardiac surgery. Intensive Care Med 27:853–858CrossRefPubMed Riker RR, Fraser GL, Simmons LE, Wilkins ML (2001) Validating the Sedation-Agitation Scale with the Bispectral Index and Visual Analog Scale in adult ICU patients after cardiac surgery. Intensive Care Med 27:853–858CrossRefPubMed
88.
Zurück zum Zitat Riker RR, Picard JT, Fraser Gl (1999) Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med 27:1325–1329CrossRefPubMed Riker RR, Picard JT, Fraser Gl (1999) Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med 27:1325–1329CrossRefPubMed
89.
Zurück zum Zitat Roth-Isigkeit A, Brechmann J, Dibbelt L et al. (1987) Persistent endocrine stress response in patients undergoing cardiac surgery. J Endocrinol Invest 21:12–19 Roth-Isigkeit A, Brechmann J, Dibbelt L et al. (1987) Persistent endocrine stress response in patients undergoing cardiac surgery. J Endocrinol Invest 21:12–19
90.
Zurück zum Zitat Rundshagen, Schnabel K, Wegner C, Schulte am Esch S (2002) Incidence of recall, nightmares, and hallucinations during analgosedation in intensive care. Intensive Care Med 28:38–43CrossRefPubMed Rundshagen, Schnabel K, Wegner C, Schulte am Esch S (2002) Incidence of recall, nightmares, and hallucinations during analgosedation in intensive care. Intensive Care Med 28:38–43CrossRefPubMed
91.
Zurück zum Zitat Scheinin B, Lindgren L, Randell T et al. (1992) Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and perioperative fentanyl. Br J Anaesth 68:126–131PubMed Scheinin B, Lindgren L, Randell T et al. (1992) Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and perioperative fentanyl. Br J Anaesth 68:126–131PubMed
92.
Zurück zum Zitat Scholz J, Steinfath M (1996) Ist Remifentanil ein ideales Opioid für das 21ste Jahrhundert? Anästhesiol Intensivmed Notfallmed Schmerzther 31:592–607 Scholz J, Steinfath M (1996) Ist Remifentanil ein ideales Opioid für das 21ste Jahrhundert? Anästhesiol Intensivmed Notfallmed Schmerzther 31:592–607
93.
Zurück zum Zitat Scholz J, Tonner PH (2000) Alpha2-adrenoceptor agonists in anaesthesia: a new paradigm. Curr Opin Anaesthesiol 13:437–442CrossRef Scholz J, Tonner PH (2000) Alpha2-adrenoceptor agonists in anaesthesia: a new paradigm. Curr Opin Anaesthesiol 13:437–442CrossRef
94.
Zurück zum Zitat Schuster SV, Bilotta JM, Lutz MW, James MK (1991) Analgesic activity of the ultrashort acting opioid, GI 87804B. FASEB J 5:2846 Schuster SV, Bilotta JM, Lutz MW, James MK (1991) Analgesic activity of the ultrashort acting opioid, GI 87804B. FASEB J 5:2846
95.
Zurück zum Zitat Sessler CN, Gosnell MS, Grap MJ et al. (2002) The Richmont Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care 15 (166):1338–1344CrossRef Sessler CN, Gosnell MS, Grap MJ et al. (2002) The Richmont Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care 15 (166):1338–1344CrossRef
96.
Zurück zum Zitat Shafer A (1998) Complications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens. Crit Care Med 26:947–956CrossRefPubMed Shafer A (1998) Complications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens. Crit Care Med 26:947–956CrossRefPubMed
97.
Zurück zum Zitat Shapiro B, Warren J, Egol A et al. (1995) Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: An executive summary. Crit Care Med 23:1596–1600CrossRefPubMed Shapiro B, Warren J, Egol A et al. (1995) Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: An executive summary. Crit Care Med 23:1596–1600CrossRefPubMed
99.
Zurück zum Zitat Sjostrom B, Haljamae H, Dahlgren L, Lindström B (1997) Assessment of postoperative pain: impact of clinical experience and professional role. Acta Anaesth Scand 41:339–344PubMed Sjostrom B, Haljamae H, Dahlgren L, Lindström B (1997) Assessment of postoperative pain: impact of clinical experience and professional role. Acta Anaesth Scand 41:339–344PubMed
100.
Zurück zum Zitat Soliman HM, Mélot C, Vincent JL (2001) Sedative and analgetic practice in the intensive care unit: the results of a European survey. B J Anaesthesia 87:186–192CrossRef Soliman HM, Mélot C, Vincent JL (2001) Sedative and analgetic practice in the intensive care unit: the results of a European survey. B J Anaesthesia 87:186–192CrossRef
101.
Zurück zum Zitat Spies CD, Dubisz N, Neumann T et al. (1996) Therapy of alcohol withdrawal syndrom in intensive care unit patients following trauma: results of a prospective, randomized trial. Crit Care Med 24:414–422CrossRefPubMed Spies CD, Dubisz N, Neumann T et al. (1996) Therapy of alcohol withdrawal syndrom in intensive care unit patients following trauma: results of a prospective, randomized trial. Crit Care Med 24:414–422CrossRefPubMed
102.
Zurück zum Zitat Steinhoff H, Falke K, Schwarzhoff W (1982) Enhanced renal function associated with intermittent mandatory ventilation in acute respiratory failure. Intensive Care Med 8:69–74PubMed Steinhoff H, Falke K, Schwarzhoff W (1982) Enhanced renal function associated with intermittent mandatory ventilation in acute respiratory failure. Intensive Care Med 8:69–74PubMed
103.
Zurück zum Zitat Steinhoff H, Kohlhoff R, Falke K (1984) Facilitation of renal function by intermittent mandatory ventilation. Intensive Care Med 10:59–65CrossRefPubMed Steinhoff H, Kohlhoff R, Falke K (1984) Facilitation of renal function by intermittent mandatory ventilation. Intensive Care Med 10:59–65CrossRefPubMed
104.
Zurück zum Zitat Swart EL, van Schijndel RJ, van Loenen AC, Thijs LG (1999) Continuous infusion of lorazepam versus midazolam in patients in the intensive care unit: sedation with lorazepam is easier to manage and is more cost-effective. Crit Care Med 27:1461–1465CrossRefPubMed Swart EL, van Schijndel RJ, van Loenen AC, Thijs LG (1999) Continuous infusion of lorazepam versus midazolam in patients in the intensive care unit: sedation with lorazepam is easier to manage and is more cost-effective. Crit Care Med 27:1461–1465CrossRefPubMed
105.
Zurück zum Zitat Tonner PH, Weiler N, Paris A, Scholz J (2003) Sedation and analgesia in the intensive care unit. Curr Opin Anaesthesiol 16:113–121CrossRef Tonner PH, Weiler N, Paris A, Scholz J (2003) Sedation and analgesia in the intensive care unit. Curr Opin Anaesthesiol 16:113–121CrossRef
106.
Zurück zum Zitat Twycross RG (1988) Opioid analgetics in cancer pain: current practice and controversies. Cancer Surv 7:29–53PubMed Twycross RG (1988) Opioid analgetics in cancer pain: current practice and controversies. Cancer Surv 7:29–53PubMed
107.
Zurück zum Zitat Vayer P, Mandel P, Maitre M (1987) Gamma-hydroxybutyrate, a possible neurotransmitter. Life Sci 41:1547–1557CrossRefPubMed Vayer P, Mandel P, Maitre M (1987) Gamma-hydroxybutyrate, a possible neurotransmitter. Life Sci 41:1547–1557CrossRefPubMed
108.
Zurück zum Zitat Venn R, Bryant A, Hall GM, Grounds RM (2001) Effects of dexmedetomedine on adrenocortical function, and the cardiovascular, endocrine and inflammatory response in post-operative patients needing sedation in the intensive care unit. Br J Anaesthesia 86:650–656CrossRef Venn R, Bryant A, Hall GM, Grounds RM (2001) Effects of dexmedetomedine on adrenocortical function, and the cardiovascular, endocrine and inflammatory response in post-operative patients needing sedation in the intensive care unit. Br J Anaesthesia 86:650–656CrossRef
109.
Zurück zum Zitat Venn RM, Grounds RM (2001) Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions. Br J Anaesth 87:684–673CrossRefPubMed Venn RM, Grounds RM (2001) Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions. Br J Anaesth 87:684–673CrossRefPubMed
110.
Zurück zum Zitat Venn RM, Hell J, Grounds RM (2000) Respiratory effects of dexmedetomedine in the surgical patient requiring intensive care. Crit Care Med 4:302–308CrossRef Venn RM, Hell J, Grounds RM (2000) Respiratory effects of dexmedetomedine in the surgical patient requiring intensive care. Crit Care Med 4:302–308CrossRef
111.
Zurück zum Zitat Venn RM, Newman PJ, Grounds RM (2003) A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit. Intensive Care Med 29:201–207PubMed Venn RM, Newman PJ, Grounds RM (2003) A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit. Intensive Care Med 29:201–207PubMed
112.
Zurück zum Zitat Wappler F, Scholz J, Prause A et al. (1998) Stufenkonzept zur Analgosedierung in der Intensivmedizin mit Sufentanil. Anästhesiol Intensivmed Schmerzther 33:18–26 Wappler F, Scholz J, Prause A et al. (1998) Stufenkonzept zur Analgosedierung in der Intensivmedizin mit Sufentanil. Anästhesiol Intensivmed Schmerzther 33:18–26
113.
Zurück zum Zitat Webb SA, Roberts B, Breheny FX et al. (1998) Contamination of propofol infusions in the intensive care unit: incidence and clinical significance. Anaesth Intensive Care 26:162–164PubMed Webb SA, Roberts B, Breheny FX et al. (1998) Contamination of propofol infusions in the intensive care unit: incidence and clinical significance. Anaesth Intensive Care 26:162–164PubMed
114.
Zurück zum Zitat Wilhelm W, Biedler A, Larsen R (1997) Remifentanil—Erste klinische Erfahrungen bei 3100 Patienten. Anaesthesist 46:992–997CrossRefPubMed Wilhelm W, Biedler A, Larsen R (1997) Remifentanil—Erste klinische Erfahrungen bei 3100 Patienten. Anaesthesist 46:992–997CrossRefPubMed
115.
Zurück zum Zitat Wilhelm W, Dorscheid E, Schlaich N et al. (1999) Remifentanil zur Analgosedierung von Intensivpatienten. Anaesthesist 48:625–629CrossRefPubMed Wilhelm W, Dorscheid E, Schlaich N et al. (1999) Remifentanil zur Analgosedierung von Intensivpatienten. Anaesthesist 48:625–629CrossRefPubMed
116.
Zurück zum Zitat Yaksh TL (1985) Pharmakology of spinal adrenergic systems which modulate spinal nociceptive processing. Pharmacol Biochem Behav 22:845–858CrossRefPubMed Yaksh TL (1985) Pharmakology of spinal adrenergic systems which modulate spinal nociceptive processing. Pharmacol Biochem Behav 22:845–858CrossRefPubMed
117.
Zurück zum Zitat Young C, Knudsen N, Hilton A, Reves JG (2000) Sedation in the intensive care unit. Crit Care Med 28:854–866CrossRefPubMed Young C, Knudsen N, Hilton A, Reves JG (2000) Sedation in the intensive care unit. Crit Care Med 28:854–866CrossRefPubMed
Metadaten
Titel
Analgesie und Sedierung in der Intensivmedizin
verfasst von
Dr. E. Schaffrath
R. Kuhlen
P. H. Tonner
Publikationsdatum
01.11.2004
Verlag
Springer-Verlag
Erschienen in
Die Anaesthesiologie / Ausgabe 11/2004
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI
https://doi.org/10.1007/s00101-004-0773-2

Weitere Artikel der Ausgabe 11/2004

Der Anaesthesist 11/2004 Zur Ausgabe

Notfallmedizin

Der Tauchunfall

Akuter Schwindel: Wann lohnt sich eine MRT?

28.04.2024 Schwindel Nachrichten

Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.