[The Guideline "Sedation for Gastrointestinal Endoscopy"].

The guideline "Sedation for gastrointestinal endoscopy" (AWMF-register-no. 021/014) was published initially in 2008. Because of new and developing evidence, the guideline was updated in 2015.

Additives used to reduce perioperative opioid consumption 1: Alpha2-agonists.

Because of their significant side effects, especially in obese patients, the routine perioperative use of opioids has been questioned recently. Alpha-agonists are drugs with a considerable analgesic potency with the potential to reduce opioid consumption. Alpha-agonists bind to alpha-adrenergic receptors in the CNS and peripherally.

Neuron-Specific Enolase Predicts Poor Outcome After Cardiac Arrest and Targeted Temperature Management: A Multicenter Study on 1,053 Patients.

Objective: Outcome prediction after cardiac arrest is important to decide on continuation or withdrawal of intensive care. Neuron-specific enolase is an easily available, observer-independent prognostic biomarker. Recent studies have yielded conflicting results on its prognostic value after targeted temperature management.

Airway reactions and emergence times in general laryngeal mask airway anaesthesia: a meta-analysis.

Background: Desflurane's short emergence time supports fast track anaesthesia. Data on the rate of upper airway complications and emergence time when desflurane is used with laryngeal mask airway (LMA) are controversial and limited.

Objectives: To compare recovery time variables and the rates of upper airway adverse events in patients with an LMA undergoing general surgery with desflurane, sevoflurane, isoflurane or propofol anaesthesia.

[DGAI-certified seminar series: anaesthesia focussed echocardiography: module 4 cardiosonography].

The use of ultrasonography in perioperative medicine has developed rapidly within the last decade. Today ultrasonic techniques are established methods for peripheral and central venous access as well as for regional anaesthesia. However, transthoracic ultrasonography by non-cardiologists has not yet been routinely established perioperatively, in intensive care medicine or in emergency medicine.

Safety and tolerability of fentanyl iontophoretic transdermal system: findings from a pooled data analysis of four clinical trials.

Acute postoperative pain remains inadequately managed. Although patient-controlled analgesia (PCA) represents a significant advance in postoperative pain management, drawbacks may include invasiveness and the potential for programming errors. The analysis presented here is based on pooled patient-level safety data from four multicenter, randomized, active-controlled trials that evaluated the safety and tolerability of the needle-free, preprogrammed fentanyl HCl iontophoretic transdermal system (ITS) versus morphine intravenous PCA for postoperative pzin management; the results for patients who received fentanyl ITS are presented here.

Paracetamol versus metamizol in the treatment of postoperative pain after breast surgery: a randomized, controlled trial.

Background And Objective: Intravenously administered paracetamol is an effective analgesic in postoperative pain management. However, there is a lack of data on the effect of intravenous (i.v.

Effects of clonidine and midazolam premedication on bispectral index and recovery after elective surgery.

Background And Objectives: Alpha-2 agonists offer useful effects that make these drugs an interesting alternative for pharmacological premedication.

Methods: In a randomized, double-blind study, effects of clonidine (150 microg orally), midazolam (7.5 mg orally) and placebo administered 60-90 min prior to estimated anaesthesia induction time were investigated in 60 healthy ASA I or II patients.

A comparison of auditory evoked potentials derived from a monitor integrated module versus standard technique.

Purpose: Measurement of brain stem auditory evoked potentials (BAEP) and midlatency auditory evoked potentials (MLAEP) using a new monitor integrated module was compared with an established device. The aim of this study was to evaluate if the new system could replace the more inconvenient established technique.

Material And Methods: MLAEP and BAEP were obtained from 19 anesthetized male patients using the AEP-Module for Monitor S/5 [GE, Helsinki, Finland (S/5)] and Neuropack 4 mini [Nihon Kohden, Tokyo, Japan (Neuropack)].

Propofol sedation is reduced by delta9-tetrahydrocannabinol in mice.

Background: Delta9-tetrahydrocannabinol (Delta9-THC) induces analgesic effects and alterations of alertness. It has been reported that propofol increases endocannabinoid levels in the brain, but the effects of Delta9-THC on propofol sedation remain unclear. Our aim was to characterize the interaction between Delta9-THC and propofol in terms of sedation and analgesia.

Differential effects of alpha 2-adrenoceptors in the modulation of the thermoregulatory response in mice induced by meperidine.

Background: Meperidine proved to be more effective in treatment of shivering than equianalgesic doses of other opioids, especially pure mu-agonists. Further, meperidine has well known nonopioid actions including agonistic effects at alpha2-adrenoceptors in vitro. Accordingly, the authors investigated nonopioid receptor-mediated effects of meperidine on thermoregulation using a mice model of nonshivering thermogenesis.

Meperidine, remifentanil and tramadol but not sufentanil interact with alpha(2)-adrenoceptors in alpha(2A)-, alpha(2B)- and alpha(2C)-adrenoceptor knock out mice brain.

alpha(2)-adrenoceptor agonists like clonidine or dexmedetomidine increase the sedative and analgesic actions of opioids. Furthermore opioids like meperidine show potent anti-shivering effects like alpha(2)-adrenoceptor agonists. The underlying molecular mechanisms of these effects are still poorly defined.

The anesthetic effects of etomidate: species-specific interaction with alpha 2-adrenoceptors.

Background: The IV anesthetic, etomidate, has structural and clinical similarities to specific alpha2-adrenoceptor agonists such as dexmedetomidine. We investigated whether the sedative effects of etomidate may be mediated by alpha2-adrenoceptors.

Methods: The anesthetic potency of etomidate (1-20 microM) was determined in Xenopus laevis tadpoles in the absence and presence of the specific alpha2-adrenoceptor antagonist atipamezole (10 microM).

The reliability of pulse contour-derived cardiac output during hemorrhage and after vasopressor administration.

Background: Reliable measurement of cardiac output (CO) is important in the critically ill. Pulse contour-derived CO (PCCO) has been evaluated during stable hemodynamics, but is sensitive to changes in vascular tone and has not been validated under conditions of changing hemodynamics. Furthermore, PCCO requires calibration for the individual vascular impedance by transpulmonary thermodilution CO (TPCO), and the required frequency of recalibration to maintain accurate measurements, especially during changing conditions, has not been confirmed.

Multicenter randomized comparison of xenon and isoflurane on left ventricular function in patients undergoing elective surgery.

Background: Volatile anesthetics are commonly used for general anesthesia. However, these can induce profound cardiovascular alterations. Xenon is a noble gas with potent anesthetic and analgesic properties.

Sedation and analgesia in the intensive care unit.

Purpose Of Review: Sedation and analgesia are important means of providing care for the critically ill patient.

Recent Findings: It is now clear that posttraumatic stress disorders resulting from an intensive care unit stay may be prevented by the right level of sedation. New drug developments but also recent findings in new ventilation strategies allow for a sedation management that is better tailored to an individual's need.

Propofol infusion syndrome in anaesthesia and intensive care medicine.

Purpose Of Review: Propofol infusion syndrome is a rare but often fatal syndrome, characterized by lactacidosis, lipaemic plasma and cardiac failure, associated with propofol infusion over prolonged periods of time. As propofol is used worldwide, knowledge of propofol infusion syndrome is essential for all anaesthesiologists and intensive care physicians. This review will provide an update on reported cases, and describe recent findings relevant to the pathophysiology and clinical presentation of propofol infusion syndrome.

[Preoperative identification of cardiac risk patients and perioperative management].

The demographic trend challenges anaesthesiologists with a growing number of elderly requiring surgery. The anaesthetist needs to identify risk patients and to optimize his strategies for perioperative management. The present article gathers the current data and summarizes effective strategies for anaesthesia in patients with ischemic heart disease.

Monitoring consciousness in intensive care medicine.

Sedation and analgesia are important components of care for critically ill patients. Avoiding over-as well as undersedation is of utmost importance as both states carry considerable risks and may influence outcome. The management of sedation has changed dramatically over the past two decades from providing a dosage level by which the patient was kept in a deep stage of anaesthesia to a current dosing strategy allowing the administration of drugs in line with individual need, resulting in most cases in a slightly sedated, cooperative patient.