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Hier erfahren sie die Neuigkeiten der Medizin. Es werden Neuigkeiten und Forschungen über Krankheiten sowie Berichte veröffentlicht. Es gibt Berichte über die Themen: 1.Allgemeinmedizin 2.Anästhesie, Intensivmedizin und Schmerztherapie 3.Gynäkologie und Geburtshilfe 4.Kardiologie 5.Radiologie 6.Pathologie 7.Augenheilkunde 8.Hals-Nasen-Ohren Heilkunde 9.Chirurgie 10.Strahlentherapie 11.Kinderheilkunde 12.Suchtmedizin 13.Neuroradiologie 14.Palliativmedizin 15.Geriaterie 16.Logopädie 17.Psychatrie 18.Medizingeschichte 19.Gesundheitsökonomie 20.Epidemiologie


MedizinBearbeiten

"Die Medizin ist eine praxisorientierte Erfahrungswissenschaft. Ziele sind die Prävention (Vorbeugung) von Erkrankungen oder von deren Komplikationen; die Kuration (Heilung) von heilbaren Erkrankungen, oder die Palliation (Linderung) der Beschwerden in unheilbaren Situationen. Auch die Rehabilitation (Wiederherstellung) der körperlichen und geistigen Fähigkeiten der Patienten ist Aufgabe der Medizin. Ärzte und nichtärztliche Therapeuten erstellen dafür Behandlungspläne und überwachen den Behandlungsverlauf in der Patientenakte. Diese patientenbezogenen Unterlagen sind gleichzeitig Dokumente von juristischer Bedeutung. Im medizinischen Alltag werden im Idealfall wissenschaftliche Erkenntnisse mit den Resultaten der Anamnese sowie der ärztlichen Intuition und Erfahrung kombiniert, um dem individuellen Patienten gerecht zu werden."

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In diesem Blog geht es um verschiedene Studien:
'Anesth Analg.' '2001' Apr;92(4):997-1005.

The effects of an increase of central blood volume before spinal anesthesia for cesarean delivery: a qualitative systematic review.

Morgan PJHalpern SHTarshis J.

Source

Department of Anesthesia, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario, Canada. pam.morgan@utoronto.ca

Abstract

We evaluated in this qualitative systematic review the efficacy of increasing central blood volume on the incidence of hypotension after spinal anesthesia for elective cesarean delivery. Randomized controlled trials investigating any method of increasing central blood volume before the initiation of obstetric spinal anesthesia were sought by using MEDLINE (1966-2000), Embase (January 1988-April 2000), and the Cochrane Library (Issue 1, 2000). Additional reports from retrieved and review articles, hand searching of non-MEDLINE journals, and abstracts of major anesthesia meetings (1994-1999) were located. The primary outcome was the incidence of hypotension. Secondary outcomes included: ephedrine use, Apgar scores, umbilical cord pH values, and maternal nausea and vomiting. Twenty-three articles met our inclusion criteria with the use of crystalloid preload, colloid preload, and mechanical methods of increasing central volume. Crystalloid preload was inconsistent in preventing hypotension, whereas colloid appeared to be effective in all but one study. Leg wrapping and thromboembolic stockings decreased the incidence of hypotension compared with leg elevation or control. Few differences in fetal outcomes or maternal nausea and vomiting were reported. Increasing central blood volume by using colloid and leg wrapping decreases but does not abolish the incidence of hypotension before spinal anesthesia for elective cesarean delivery. IMPLICATIONS: We performed a systematic review to determine whether fluid loading reduced the incidence of low blood pressure after spinal anesthesia for cesarean delivery. Although no technique totally eliminates the occurrence of hypotension, colloid administration (starch or gelatin containing fluids) and leg wrapping were the most effective.

Can J Anaesth. 2010 Jan;57(1):24-31. doi: 10.1007/s12630-009-9206-7. Epub 2009 Oct 27.

Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis.

Banerjee AStocche RMAngle PHalpern SH.

Source

Division of Obstetrical Anesthesia and the Obstetrical Anesthesia Research Unit of the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre at Women's College Hospital, University of Toronto, Toronto, Ontario, M5S 1B2, Canada.

Abstract

BACKGROUND:

Hypotension following spinal anesthesia for Cesarean delivery is common. Fluid loading is recommended to prevent hypotension, but preload is often ineffective. In non-pregnant patients, coloading has been shown to better maintain cardiac output after spinal anesthesia. The purpose of this meta-analysis was to determine whether the timing of the fluid infusion, before (preload) or during (coload) induction of spinal anesthesia for Cesarean delivery, influences the incidence of maternal hypotension or neonatal outcome.

METHODS:

We retrieved randomized controlled trials that compared a fluid preload with coload in patients undergoing spinal anesthesia for elective Cesarean delivery. We graded the articles for quality of reporting (maximum score = 5) and recorded the incidence of hypotension, lowest blood pressure, the incidence of maternal nausea and vomiting, umbilical cord pH, and Apgar scores. We combined the results using random effects modelling.

RESULTS:

We retrieved eight studies comprised of 518 patients. The median quality score for the published studies was three. The incidence of hypotension in the coload group was 159/268 (59.3%) compared with 156/250 (62.4%) in the preload group (odds ratio [OR] = 0.93; 95% confidence interval [CI] 0.54-1.6). There were no significant differences between groups in any of the other outcomes.

CONCLUSIONS:

It is unnecessary to delay surgery in order to deliver a preload of fluid. Regardless of the fluid loading strategy, the incidence of maternal hypotension is high. Prophylactic or therapeutic vasopressors may be required in a significant proportion of patients.

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