Zusammenfassung: Fentanyl und Sufentanil sind zwei synthetisch hergestellte Opioide, die in der Anästhesiologie für die intraoperative Analgesie eingesetzt werden. Sie weisen ein unterschiedliches pharmakodynamisches Profil auf. Im Jahr 2014 wurde das Opioidregime für minimal-invasive Standardeingriffe im Klinikum Fulda von Fentanyl auf Sufentanil umgestellt. In der geplanten retrospektiven Datenerhebung sollten Daten von Patienten, die vor 2014 mit Fentanyl analgesiert wurden, verglichen werden mit Daten von Patienten, bei denen nach 2014 Sufentanil in die Narkoseführung implementiert war. Untersucht werden sollte, ob der Wechsel auf ein Opioid mit einem vermeintlich geeigneteren Profil für die Narkoseführung tatsächlich die kalkulierten Vorteile erbracht hat. Die retrospektive Datenerhebung sollte aufzeigen, ob Patienten während und nach MIC-CHE oder MIC-TEP von einer Sufentanil-Gabe gegenüber der Fentanyl-Gabe profitieren: Verkürzt sich die Ausleitungsphase, haben die Patienten bei Ankunft im Aufwachraum (AWR) eine bessere Oxygenierung und/oder eine stabilere Kreislaufsituation? Leiden die Patienten nach Sufentanil unter weniger postoperativer Übelkeit und Erbrechen (PONV), benötigen sie weniger Schmerzmittel? Die Untersuchung sollte zudem klären, ob biometrische Faktoren wie Geschlecht, Alter, Gewicht und BMI in Zusammenhang mit dem eingesetzten Opioid eine relevante Rolle für das postoperative Befinden der Patienten spielten, und ob sich aus der Umstellung von Fentanyl auf Sufentanil ökonomische Vorteile ergaben. Ergebnis: Kombination Desfluran mit Sufentanil für alle untersuchten Gruppen von klinischem Vorteil. Bevorzugter Einsatz bei MIC-Eingriffen in der Allgemein- und Viszeralchirurgie empfehlenswert. - Geringerer postoperativer Schmerzmittelbedarf - Bessere postoperative Oxygenierung - Kürzere postoperative Aufwachzeit - Niedrigerer intraoperativer Opioidbedarf - Wirtschaftlich/ökonomische Gleichwert Begründete Aussage, dass Sufentanil bei MIC-Eingriffen in der Allgemein- und Viszeralchirurgie im Vergleich zu Fentanyl das überlegene Medikament ist. (überwiegend statistisch signifikant) Steigerung dieses Effekts über die Kombination mit Desfluran möglich. / Summary: Fentanyl and sufentanil are two synthetically produced opioids that are used in anesthesiology for intraoperative analgesia. They have a different pharmacodynamic profile. In 2014, the opioid regime for minimally invasive standard interventions at the clinic in Fulda was changed from fentanyl to sufentanil. In the planned retrospective data collection, data from patients who were analgesized with fentanyl before 2014 should be compared with data from patients in whom sufentanil was implemented in anesthesia after 2014. It should be investigated whether the change to an opioid with a supposedly more suitable profile for anesthesia has actually produced the calculated benefits. The retrospective data collection should show whether patients benefit from administration of sufentanil compared to administration of fentanyl during and after MIC-CHE or MIC-TEP: Shorter elimination phase? Better oxygenation-situation on arrival in the recovery room or a more stable circulatory situation? Do the patients suffer less postoperative nausea and vomiting (PONV) after sufentanil, do they need less pain-medication? The investigation should also clarify whether biometric factors such as gender, age, weight and BMI in connection with the opioid used to play an important role in the postoperative condition of the examined patients and whether there were any economic benefits in switching from fentanyl to sufentanil. Result: The combination of desflurane with sufentanil was of clinical advantage for all examined groups. Recommended for use in MIC- operations in visceral surgery. - Less need for post-operative pain medication - Better post-operative oxygenation - Shorter post-operative wake-up time - Lower intraoperative opioid requirement - Economic / economic equivalence Well-founded statement that sufentanil is the superior drug compared to fentanyl in MIC-procedures in visceral surgery. (mostly statistically significant) This effect can be increased by combining it with desflurane.

Excerpt: Gavronsky, Koeniger-Donohue, Steller, and Hawkins (2012) concluded that, 48 hours after major pelvic surgeries for cancer, the women in their study experienced equivalent pain relief from either manual acupuncture or percutaneous electrical nerve stimulation. This statement was not supported by the study data because of the lack of blinding and insufficient controls. Despite the numerous strengths of the study, due to weaknesses in the study design with regard to blinding and control groups, the addition of acupuncture to percutaneous electrical nerve stimulation should not yet be ruled out as a method of obtaining enhanced pain relief.

Vulvovaginal candidiasis is a common gynecologic diagnosis that can be treated empirically with fluconazole. We present a patient that developed post-operative () fungemia after being empirically treated for vulvuovaginal candidiasis with fluconazole multiple times throughout the year prior to robotic total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. is becoming increasingly resistant to azole antimycotic therapy. It is likely that this patient had undertreated fluconazole-resistant vulvovaginitis prior to surgery, and that the pelvic infection was the source of fungemia.

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Development of cataracts is a relatively frequent ocular disease of the dog and cataract extraction via phacoemulsification (PE) is commonly performed by veterinary ophthalmologists. Postoperative ocular hypertension (POH) describes the elevation of pressures within the eye during the acute postoperative period and can result in vision loss and poor surgical outcome. Relatively little is known about risk factors or efficacy of prophylactic treatment for POH, and current clinical practice with regard to pressure monitoring and medication administration are highly variable. The literature on POH prophylaxis in humans indicates that improved efficacy may be achieved with a multi-dose approach and that dorzolamide hydrochloride/timolol maleate (DHTM) may be more efficacious than other pressure lowering medications. The canine literature on POH prophylaxis is limited and DHTM has not yet been evaluated despite common use in the clinical setting. Our objectives, therefore, were to investigate risk factors for POH and to test the hypothesis that perioperative topical ophthalmic dorzolamide hydrochloride 2%/timolol maleate 0.5% (DHTM) reduces the prevalence and/or severity of postoperative ocular hypertension (POH) in dogs undergoing cataract extraction by phacoemulsification (PE). We employed a randomized double-masked placebo-controlled study and enrolled 103 dogs (180 eyes) presenting for unilateral or bilateral PE. Select historical, signalment, ophthalmic examination, and surgical data was collected. Dogs were treated with DHTM or Blink Contacts (BC) placebo at 14- and 2-h preoperatively and at conclusion of surgical closure. Intraocular pressures were assessed by rebound tonometry at 2, 4, 6, and 8 hours after surgery and at 8 am the following morning. POH was defined as IOP>25 mmHg and intervention consisted of latanoprost 0.005% if IOP rose to 26 mmHg - 45 mmHg or surgeon treatment of choice if >45 mmHg. Our investigation of risk factors yielded a statistically significant association only with surgeon and surgical time, which were also associated with one another. DHTM significantly reduced the prevalence of POH in comparison with BC (26% versus 49% of eyes, OR=0.36; 34% versus 62% of dogs, OR=0.32). There was also a trend toward reduction of POH severity in DHTM-treated eyes (POH value 37.17±10.47 mmHg with BC, 32.67±6.39 mmHg with DHTM). DHTM-treated eyes that developed POH were significantly more likely to respond favorably (1 hour post-treatment IOP <25 mmHg) to treatment with latanoprost than those in the BC group (76% versus 51%, OR=3.87). We conclude that multi-dose perioperative administration of DHTM may be recommended in dogs undergoing PE to reduce the risk of POH and improve responsiveness of POH to treatment with latanoprost. / Master of Science