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  • 1
    Electronic Resource
    Electronic Resource
    Elternkontrollierte Analgesie PCA bei einem dreijährigen Kind nach traumatischer Amputation (1998)
    Springer
    Der Anaesthesist 47 (1998), S. 238-242 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Postoperative Schmerztherapie ; Elternkontrollierte Analgesie ; Kinderanästhesie ; Patientenkontrollierte Analgesie (PCA) ; Opioide ; Key words Patient-controlled analgesia (PCA) Parent-controlled analgesia ; Pediatric analgesia ; Opioids
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract We report the case of a 3-year-old boy, who received long-term parent-controlled analgesia after traumatic amputation of one leg. He underwent surgery 17 times for a period of 25 days. Parent-controlled analgesia was started four days after admission because analgesia with non-opioid analgetics (acetaminophen) proved to be insuffient. The pump was set to a bolus-dose of 23 µg kg−1 piritramide (dipidolor®) and a lockout interval of 10 minutes. Permitted maximum cumulative dose in four hours was 5 mg piritramide. There was no continuous infusion of opioid. PCA and possible adverse effects were explained to the mother. A monitoring regimen was used to assess efficacy (pain intensity estimated by the mother), adverse effects (sedation score, occurrence of nausea and vomiting) and piritramide consumption. For fear of side effects opioid administration was insufficient in the beginning. After three days the mother used the PCA effectively and no additional analgesic medication was required. Nausea or other side effects were not observed. After seven days opioid consumption nearly doubled. Apart from tolerance, this might have resulted from the mother’s caution in the first days. After 17 days the PCA was discontinued. Oral analgetics (tramadol) controlled the pain adequately. Management of postoperative pain in childrens is difficult and too often insufficient. PCA is a safe and effective method of providing postoperative pain relief. Feasability was shown in adolescents and, more recently, in children aged five years and over. Only few reports are available describing long term use of PCA in children younger than five years. Our case suggests that PCA may also be used effectively and safely in children younger than five years, if experienced staff, a monitoring regimen and cooperative and well instructed parents are available.
    Notes: Zusammenfassung Die Patientenkontrollierte Analgesie (PCA) gilt als effiziente Methode zur Therapie postoperativer Schmerzen bei Erwachsenen. Bei Kindern ist die Schmerztherapie oft noch unzulänglich. Verantwortlich dafür ist u.a. die Angst vor unerwünschten Nebenwirkungen und einer Überdosierung von Opioiden. Die Wirkung peripherer Analgetika allein ist in der postoperativen Phase aber oft unzureichend. Kasuistiken berichten über die Anwendung der PCA bei Kindern. Als untere Altersgrenze für eine erfolgreiche Anwendung gilt dabei das vierte bis fünfte Lebensjahr. Bei jüngeren Patienten besteht die Möglichkeit einer eltern- bzw. pflegekraftkontrollierten Analgesie. Dieser Fallbericht beschreibt eine elternkontrollierte Analgesie zur postoperativen Schmerztherapie bei einem knapp dreijährigen Kind, bei dem nach einem Trauma des Unterschenkels insgesamt 17 Eingriffe in Allgemeinanästhesie in einem Zeitraum von 25 Tagen erforderlich waren. Dabei zeigte sich, daß mittels PCA die Schmerzen des Patienten effizient und sicher behandelt werden konnten. Unabdingbare Voraussetzungen sind dabei adäquates Monitoring, gut geschultes Personal auf der Station und eingehend über die Technik aufgeklärte Eltern.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050552
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  • 2
    Electronic Resource
    Electronic Resource
    Intravenöse versus thorakale-epidurale patientenkontrollierte Analgesie bei ausgedehnten Oberbauch- und Thoraxeingriffen (1997)
    Springer
    Der Anaesthesist 46 (1997), S. S172 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Thorakotomie ; Epiduralanalgesie ; Patientenkontrollierte Analgesie ; Opioide ; Lokalanästhetika ; Key words Postthoracotomy pain relief ; Epidural analgesia ; Patient-controlled analgesia ; Opioids ; Local anaesthetics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background: Intravenous patient-controlled analgesia (PCA-IV) has markedly improved postoperative pain-relief. Alternatively, peridural anesthesia has been used successfully in high risk patients with the disadvantage of a more intense postoperative care. In this study we compared the applicability of intravenous vs. peridural patient-controlled analgesia on a general ward. Methods: In a prospective double blinded study 40 patients were randomized after extensive thoracic or abdominal surgery in two groups and received either intravenous PCA (n = 20) or epidural PCA (n = 20). Postoperative monitoring was performed on the general ward by specifically trained nurses. Physiological data, neurological status, the effects of the analgesia and complications were registered before and 48 hours after surgery. Pain intensity was determined by using the visual analog scale (VAS). For the evaluation of wellness and cognitive efficacy psychological tests were performed. Results: Our results show that epidural PCA without administration of a basal rate is a safe method and can be performed on a general ward. Relevant postoperative complications or negative side effects were not registered in both groups. Sufficient analgesia was achieved with both methods. Patients treated with PCA-PDK had a significantly better score regarding vigilance and subjective wellness when compared to patients in the PCA-IV group. Conclusion: This study demonstrates that epidural PCA can be used on a general surgical ward as an alternative method compared to intravenous PCA. PCA-PDK may be advantageous over intravenous PCA since both techniques require similar intense monitoring and side effects in the PCA-PDK group appear to be less.
    Notes: Zusammenfassung Die intravenöse patientenkontrollierte Opioidanalgesie (PCA) hat zu einer deutlichen Verbesserung der postoperativen Schmerztherapie beigetragen. Alternativ wurden insbesondere bei Risikopatienten rückenmarknahe Verfahren erfolgreich eingesetzt, die in der Regel aber einen hohen Aufwand an Überwachung erfordern. Eine Lösung bietet möglicherweise die Anwendung einer patientenkontrollierten Analgesie. Im Rahmen einer randomisierten prospektiven Doppelblindstudie wurde überprüft, ob eine Epiduralanalgesie nach ausgedehnten thorakalen oder abdominellen Eingriffen mittels PCA (PDK-Gruppe) auf Allgemeinstationen durchführbar ist und im Vergleich zur intravenösen PCA (IV-Gruppe) eine ausreichende Analgesie bei geringerer Rate an unerwünschten Wirkungen bzw. Komplikationen beobachtet wird. Insgesamt wurden 20 Patienten in die PDK-Gruppe und 20 in die IV-Gruppe aufgenommen. Die Ergebnisse zeigen, daß eine epidurale Analgesie mittels PCA ohne Basalrate auf chirurgischen Allgemeinstationen durchführbar ist. Bei keinem Patienten in beiden Gruppen wurden im postoperativen Verlauf Komplikationen oder relevante unerwünschte Wirkungen beobachtet. Mit beiden Verfahren konnte eine befriedigende Analgesie – gemessen mit der Visuellen Analogskala – erreicht werden. Statistisch signifikant bessere Werte fanden sich in der PDK-Gruppe für Vigilanz und subjektive Befindlichkeit.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002488
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  • 3
    Electronic Resource
    Electronic Resource
    Effects of extreme lateral posture on hemodynamics and plasma atrial natriuretic peptide levels in critically ill patients (1996)
    Springer
    Intensive care medicine 22 (1996), S. 651-655 
    Details
    ISSN: 1432-1238
    Keywords: Lateral posture ; Hemodynamic effects ; Kinetic therapy ; Respiratory failure ; Kight ventricular function ; Atrial natriuretic peptide
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To quantify the hemodynamic effects of turning critically ill, mechanically ventilated patients to the extreme left and right lateral postures. Design Prospective investigation. Setting Eight-bed intensive care unit in a university hospital. Patients Twelve consecutive patients presenting with severe respiratory failure and requiring continuous positive inotropic support. Interventions All patients were mechanically ventilated and placed in a kinetic treatment system. They were positioned in the supine, left dependent, and right dependent postures, resting for 15 min in each position. Measurements and results Hemodynamic measurements, assessments of right ventricular function, and determinations of intrathoracic blood volume were performed in three different positions. Concentrations of atrial natriuretic peptide in plasma were quantified. In three patients, the findings were controlled by transesophageal echocardiography. Cardiac index [median (range) 5.5 (3.2–8.1) vs 4.3 (3.2–7.5) l/min per m2,p〈0.01], intrathoracic blood volume [1125 (820–1394) vs 1037 (821–1267) ml/m2,p〈0.01], and right ventricular end-diastolic volume [130 (83–159) vs 114 (79–155) ml/m2,p〈0.05] increased significantly in the left dependent position compared to supine. Mean arterial pressure did not change. Atrial natriuretic peptide levels rose from 140 to 203 pg/ml. In the right dependent position, we found a marked decrease in the mean arterial pressure [85 mmHg (supine) to 72 mmHg (right dependent),p〈0.01]. Cardiac index and intrathoracic blood volume were unchanged, but right ventricular enddiastolic volume decreased from 114 to 102 ml/m2 (p〈0.05) Additionally, atrial natriuretic peptide levels decreased significantly (median Δ value: 37 pg/ml). In echocardiographic controls we found an increase in right ventricular end-diastolic diameters in the left dependent position and shortened diameters in the right dependent position. Conclusions Extreme lateral posture affects the cardiovascular system in critically ill, mechanically ventilated patients: in the left dependent position a “hyperdynamic state” is reinforced, while the right decubitus position impairs right ventricular preload and predisposes to hypotension. Echocardiography and changes in plasma atrial natriuretic peptide values indicate that these findings are due to altered distensibility of the right ventricle caused by regional intrathoracic gravitational changes. We conclude that the duration and the angle of lateral posture should be restricted in hemodynamically unstable patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709741
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Effects of extreme lateral posture on hemodynamics and plasma atrial natriuretic peptide levels in critically ill patients (1996)
    Springer
    Intensive care medicine 22 (1996), S. 651-655 
    Details
    ISSN: 1432-1238
    Keywords: Key words Lateral posture ; Hemodynamic effects ; Kinetic therapy ; Respiratory failure ; Right ventricular function ; Atrial natriuretic peptide
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To quantify the hemodynamic effects of turning critically ill, mechanically ventilated patients to the extreme left and right lateral postures. Design: Prospective investigation. Setting: Eight-bed intensive care unit in a university hospital. Patients: Twelve consecutive patients presenting with severe respiratory failure and requiring continuous positive inotropic support. Interventions: All patients were mechanically ventilated and placed in a kinetic treatment system. They were positioned in the supine, left dependent, and right dependent postures, resting for 15 min in each position. Measurements and results: Hemodynamic measurements, assessments of right ventricular function, and determinations of intrathoracic blood volume were performed in three different positions. Concentrations of atrial natriuretic peptide in plasma were quantified. In three patients, the findings were controlled by transesophageal echocardiography. Cardiac index [median (range) 5.5 (3.2–8.1) vs 4.3 (3.2–7.5) l/min per m2, p〈0.01], intrathoracic blood volume [1125 (820–1394) vs 1037 (821–1267) ml/m2, p〈0.01], and right ventricular end-diastolic volume [130 (83–159) vs 114 (79–155) ml/m2, p〈0.05] increased significantly in the left dependent position compared to supine. Mean arterial pressure did not change. Atrial natriuretic peptide levels rose from 140 to 203 pg/ml. In the right dependent position, we found a marked decrease in the mean arterial pressure [85 mmHg (supine) to 72 mmHg (right dependent), p〈0.01]. Cardiac index and intrathoracic blood volume were unchanged, but right ventricular end-diastolic volume decreased from 114 to 102 ml/m2 (p〈0.05) Additionally, atrial natriuretic peptide levels decreased significantly (median Δ value: 37 pg/ml). In echocardiographic controls we found an increase in right ventricular end-diastolic diameters in the left dependent position and shortened diameters in the right dependent position. Conclusions: Extreme lateral posture affects the cardiovascular system in critically ill, mechanically ventilated patients: in the left dependent position a ”hyperdynamic state“ is reinforced, while the right decubitus position impairs right ventricular preload and predisposes to hypotension. Echocardiography and changes in plasma atrial natriuretic peptide values indicate that these findings are due to altered distensibility of the right ventricle caused by regional intrathoracic gravitational changes. We conclude that the duration and the angle of lateral posture should be restricted in hemodynamically unstable patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709741
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
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