Anaesthesist最新文献

{"title":"[Practice of pharmaceutical thrombosis prophylaxis and anticoagulation in patients with sepsis and pre-existing anticoagulation or heparin-induced type II thrombocytopenia-Results of a nationwide survey in German intensive care units].","authors":"Thomas Schmoch,&nbsp;Thorsten Brenner,&nbsp;Andrea Becker-Pennrich,&nbsp;Ludwig Christian Hinske,&nbsp;Markus A Weigand,&nbsp;Josef Briegel,&nbsp;Patrick Möhnle","doi":"10.1007/s00101-021-01011-9","DOIUrl":"https://doi.org/10.1007/s00101-021-01011-9","url":null,"abstract":"<p><strong>Background: </strong>A pre-existing anticoagulation treatment and predisposing diseases for thromboembolic events represent common problems in patients with sepsis or septic shock; however, these conditions are not addressed in current national guidelines for sepsis and septic shock. One of the aims of this nationwide survey in Germany was therefore to determine how intensive care physicians deal with these problems.</p><p><strong>Methods: </strong>From October 2019 to May 2020, we conducted a nationwide survey among German medical directors of intensive care units (ICU) addressing anticoagulation and drug-based prophylaxis of venous thromboembolism (VTE) in patients with sepsis and sepsis-induced coagulopathy. One focus was the procedure for patients with a pre-existing anticoagulation treatment or a previously known heparin-induced thrombocytopenia (HIT) type 2 (acute symptomatic vs. dating back years).</p><p><strong>Results: </strong>In most of the participating ICUs pre-existing anticoagulation is largely continued with low molecular weight heparin preparations or unfractionated heparin. In patients with pre-existing HIT type 2 both acute symptomatic and dating back years, argatroban represents the drug of choice. There is a high degree of variability in the definition of the target values, usually being well above the range for pure VTE prophylaxis.</p><p><strong>Conclusion: </strong>Data on the continuation of anticoagulation beyond VTE prophylaxis with a subsequently increased risk of bleeding in patients with sepsis and septic shock is limited and treatment decisions are in many cases subject to individual consideration by the practitioner. The results of our survey imply the need for a systematic work-up of this topic in order to support daily practice in many ICUs with the required evidence.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":"71 3","pages":"193-200"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00101-021-01011-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10262383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Volatile anesthetics for prehospital analgesia by paramedics-An overview].","authors":"Helmut Trimmel,&nbsp;Alexander Egger,&nbsp;Reinhard Doppler,&nbsp;Christoph Beywinkler,&nbsp;Wolfgang G Voelckel,&nbsp;Janett Kreutziger","doi":"10.1007/s00101-021-01051-1","DOIUrl":"https://doi.org/10.1007/s00101-021-01051-1","url":null,"abstract":"<p><p>Treatment of acute pain is a central task in emergency medicine. Yet, prehospital pain relief is often insufficient or delayed since the administration of potent intravenous analgesic drugs (such as opioids) is mostly limited to physicians due to legal restrictions or training deficiencies in Germany and Austria. Frequently, prehospitally operating emergency physicians have to be demanded later for anguished patients limiting disposability of physicians for patients who are in a potentially life-threatening condition. Thus, inhaled analgesics could represent an interesting alternative.A mixture of 50% nitrous oxide and 50% oxygen (N₂O, Livopan®) has been available in Germany and Austria for several years; however, prehospital use of Livopan has been merely realized and only one trial has been published. In addition, methoxyflurane (Penthrop®), a volatile anesthetic from the group of the dialkyl esters (2-dichloro-1:1-difluoroethyl-methyl-ester) was approved for the treatment of moderate to severe pain following trauma in adults in many European countries in recent years and was brought onto the market in Austria in 2018. Several in-hospital trials demonstrated high effectiveness in this setting.This article discusses the effects and prehospital areas of application of both substances in the light of the existing literature. We provide a narrative overview of the current study situation and report on a recently performed prehospital application study of methoxyflurane (Penthrop®) from Austria.The need for pressurized gas cylinders for the use of N₂O represents a certain limitation in prehospital use. Furthermore, in certain injuries such as of the inner ear or a pneumothorax N₂O should not be used and the risk of diffusion hypoxemia has to be addressed. Users should be particularly careful and limit the use in alcohol addicts and vegans. The advances of N₂O are that it is odorless, has a fast onset of action, the usability in patients over 1 month old and has stabilizing effects on the circulation. Plenty of literature regarding prehospital as well as in-hospital use of nitrous oxide in emergency, obstetric and pediatric settings show its effectiveness as a single drug as well as in combination with other analgesics, such as paracetamol or various opioids. Its long tradition in Anglo-American countries is also based on its safety and low rate of side effects.Methoxyflurane is easier to store and handle and may be slightly more effective in severe pain after trauma; however, its approval is restricted to adults, where it works significantly better with increasing age, based on the declining minimal alveolar concentration (MAC) of all inhaled anesthetics with increasing age. Furthermore, decades of use of inhaled methoxyflurane in Australia have shown the drug is effective, safe and low in side effects and has a broad spectrum of applications. The use of methoxyflurane is limited in patients with sev","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"233-242"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8522536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39529780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Significance of patient-specific risk factors for regional cerebral oxygen saturation in beach chair position].","authors":"Florian Fuchsgruber,&nbsp;Lisa Tölke,&nbsp;Patrick Friederich","doi":"10.1007/s00101-021-01014-6","DOIUrl":"https://doi.org/10.1007/s00101-021-01014-6","url":null,"abstract":"<p><strong>Background: </strong>Despite numerous studies on the regional cerebral oxygen saturation (rSO₂) measured by near infrared spectroscopy (NIRS) in orthopedic patients in the beach chair position, it is still unclear whether patient-specific factors, such as concomitant cardiovascular diseases, are more frequently associated with the occurrence of cerebral desaturation events (CDE).</p><p><strong>Objective: </strong>The aim of the present study was therefore to identify possible patient-specific risk factors that enable prediction of CDE.</p><p><strong>Methods: </strong>Data were collected on 397 orthopedic patients undergoing shoulder surgery in the beach chair position. Routine anesthesia management and standard monitoring was used in all patients. Target value for the inspiratory oxygen concentration (F_IO₂) was set to 50% and for the end-tidal carbon dioxide partial pressure to 35-45 mm Hg. RSO₂ was quantified using NIRS. The responsible anesthesiologist was blinded to the rSO₂ data. A decrease in rSO₂ > 20% or a value < 50% in the beach chair position was defined as CDE. Patients with and without CDE were analyzed with respect to different classifications, American Society of Anesthesiologists (ASA) and Revised Cardiac Risk Index (RCRI) as well as existing arterial hypertension and age. A value of p <0.05 was considered statistically significant.</p><p><strong>Results: </strong>Patients with CDE (n = 238) were significantly more often classified as ASA > 2 (p = 0.01) and RCRI > 1 (p = 0.01), suffered more often from arterial hypertension (p = 0.01) and were older (median: 60 years compared to 55 years; p = 0.01) than patients without CDE (n = 159) in the beach chair position (Wilcoxon rank sum test). Arterial hypertension remained significant after removing the effect of age (p = 0.03) and RCRI classification (p = 0.04; two-way ANOVA multivariate analysis).</p><p><strong>Conclusion: </strong>On the basis of our study, patient-specific prognosis and risk factors for the occurrence of CDE, such as higher age, ASA > 2 and RCRI > 1 classification as well as pre-existing arterial hypertension could be determined. Arterial hypertension represents the main risk factor for the occurrence of CDE in the beach chair position. RCRI > 1 classification or age, however, only has an effect on the occurrence of pathological rSO₂ values due to the greater probability of simultaneous arterial hypertension.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"201-209"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00101-021-01014-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39259422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A German-German fate: Heinz Ruppert-A forgotten pioneer of peridural anaesthesia and the last ship's doctor of the PAMIR].","authors":"Michael Goerig","doi":"10.1007/s00101-021-01028-0","DOIUrl":"https://doi.org/10.1007/s00101-021-01028-0","url":null,"abstract":"<p><p>In the fall of 1957 there was a momentous ship disaster, during which the four-masted barque PAMIR sank in the Hurricane Carrie northwest of the Azores and 80 crew members were killed. Among the crew members killed was the ship's doctor Dr. med. Heinz Ruppert, a specialist in anesthesiology, gynecology and obstetrics from the University Women's Hospital of the Charité in East Berlin. Since he was also a specialist in anaesthesiology he was primarily responsible for the anaesthesiological care of patients at the University Women's Hospital at the Charité. As an avid supporter of neuraxial conduction anaesthesia techniques, he primarily worked on this topic scientifically and tried to establish peridural anaesthesia in obstetrics. In 1954 he was able to habilitate at the Charité with a thesis on this subject and was appointed as lecturer. His scientific oeuvre has so far not been appreciated, a reason to remember this forgotten German protagonist of gynecological obstetric anaesthesia.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"220-232"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00101-021-01028-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39357026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Twentieth anniversary of the German Interdisciplinary Working Group for Clinical Hemotherapy : A reason to commemorate!]","authors":"Thomas Frietsch","doi":"10.1007/s00101-022-01105-y","DOIUrl":"10.1007/s00101-022-01105-y","url":null,"abstract":"","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"190-192"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8907091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39657180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Medical liability and criminal law in emergency medicine].","authors":"Christina Schumann,&nbsp;Stephanie Wiege","doi":"10.1007/s00101-021-01053-z","DOIUrl":"https://doi.org/10.1007/s00101-021-01053-z","url":null,"abstract":"<p><p>Medical liability is booming. Malpractice can entail both civil and criminal consequences. Besides financial and custodial penalties, at worst the license to practice medicine can be withdrawn. Physicians owe their patients a treatment according to current standards. Furthermore, physicians are obliged to fulfill their duty of care. Nevertheless, the patient's right of self-determination must not be violated. Especially in emergency situations, physicians have to focus on taking protective measures in order to avert further dangers to the health of patients. This article analyses common pitfalls in emergency medical treatment with respect to the legal aspects.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"243-252"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39658425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Update of the Surviving Sepsis Campaign guidelines 2021-What is new?]","authors":"Josef Briegel,&nbsp;Patrick Möhnle","doi":"10.1007/s00101-022-01087-x","DOIUrl":"https://doi.org/10.1007/s00101-022-01087-x","url":null,"abstract":"<p><p>The revised and redefined \"International Guidelines for Management of Sepsis and Septic Shock 2021\" of the Surviving Sepsis Campaign were published on 4 October 2021. As in the previous version from 2016, the focus of these international guidelines is on the diagnosis and acute treatment measures in sepsis. The topics long-term outcome and treatment targets for rehabilitation are extensively discussed and accompanied by specific recommendations. These recommendations and the underlying studies reflect the increasing awareness about the long-term consequences of severe diseases requiring intensive medical care. This article summarizes the updates in a clearly comprehensible form.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"214-219"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39964064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cardiogenic shock following yew needle poisoning : Digoxin immune fab, va-ECMO and albumin dialysis for the treatment of a suicidal yew leaf poisoning].","authors":"Jonas Ajouri,&nbsp;R M Muellenbach,&nbsp;C B Rolfes,&nbsp;K Weber,&nbsp;F Schuppert,&nbsp;A A Peivandi,&nbsp;C Reyher","doi":"10.1007/s00101-021-01048-w","DOIUrl":"https://doi.org/10.1007/s00101-021-01048-w","url":null,"abstract":"<p><p>We present the case of a 46-year-old male who developed refractory bradycardia with cardiogenic shock after attempting suicide by ingestion of yew leaves. Due to delayed availability of the Digoxin immune fab, a va-ECMO was established to maintain sufficient circulation. Administration of the digoxin fab resulted in recovery of spontaneous circulation. Continuous venovenous hemodiafiltration with hemoadsorption and albumin dialysis were initiated with the intention to remove immune fab-toxin complexes and as organ support in acute kidney and liver failure. Within 5 days the patient was successfully weaned from ECMO, liver support and renal replacement and discharged without physical sequelae.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"210-213"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39486454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Implications of prehospital estimation of trauma patients for the treatment pathway-An evaluation of the TraumaRegister DGU®].","authors":"C Jaekel,&nbsp;L Oezel,&nbsp;D Bieler,&nbsp;J P Grassmann,&nbsp;C Rang,&nbsp;R Lefering,&nbsp;J Windolf,&nbsp;S Thelen","doi":"10.1007/s00101-021-01001-x","DOIUrl":"https://doi.org/10.1007/s00101-021-01001-x","url":null,"abstract":"<p><strong>Background: </strong>In the prehospital acute treatment phase of severely injured patients, the stabilization of the vital parameters is paramount. The rapid and precise assessment of the injuries by the emergency physician is crucial for the initial treatment and the selection of the receiving hospital.</p><p><strong>Objective: </strong>The aim of this study was to determine whether the prehospital emergency medical assessment has an influence on prehospital and emergency room treatment.</p><p><strong>Material and methods: </strong>Data from the TraumaRegister DGU® between 2015 and 2019 in Germany were evaluated. The prehospital emergency medical assessment of the injury pattern and severity was recorded using the emergency physician protocol and compared with the in-hospital documented diagnoses using the abbreviated injury scale.</p><p><strong>Results: </strong>A total of 47,838 patients with an average injury severity score (ISS) of 18,7 points (SD 12.3) were included. In summary, 127,739 injured body regions were documented in the hospitals. Of these, a total of 87,921 were correctly suspected by the emergency physician Thus, 39,818 injured body regions were not properly documented. In 42,530 cases a region of the body was suspected to be injured without the suspicion being confirmed in the hospital. Traumatic brain injuries and facial injuries were mostly overdiagnosed (13.5% and 14.7%, respectively documented by an emergency physician while the diagnosis was not confirmed in-hospital). Chest injuries were underdocumented (17.3% missed by an emergency physician while the diagnosis was finally confirmed in-hospital). The total mortality of all groups was very close to the expected mortality calculated with the revised injury severity classification II(RISC II)-score (12.0% vs. 11.3%).</p><p><strong>Conclusion: </strong>In the prehospital care of severely injured patients, the overall injury severity is often correctly recorded by the emergency physician and correlates well with the derived treatment, the selection of the receiving hospital as well as the clinical course and the patient outcome; however, the assessment of injuries of individual body regions seems to be challenging in the prehospital setting.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"94-103"},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00101-021-01001-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39179328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Guidelines of the European Resuscitation Council (ERC) on cardiopulmonary resuscitation 2021: update and comments].","authors":"Guido Michels,&nbsp;Johann Bauersachs,&nbsp;Bernd W Böttiger,&nbsp;Hans-Jörg Busch,&nbsp;Burkhard Dirks,&nbsp;Norbert Frey,&nbsp;Carsten Lott,&nbsp;Nadine Rott,&nbsp;Wolfgang Schöls,&nbsp;P Christian Schulze,&nbsp;Holger Thiele","doi":"10.1007/s00101-021-01084-6","DOIUrl":"https://doi.org/10.1007/s00101-021-01084-6","url":null,"abstract":"<p><p>The European guidelines on cardiopulmonary resuscitation, which are divided into 12 chapters, have recently been published. In addition to the already known chapters, the topics \"epidemiology\" and \"life-saving systems\" have been integrated for the first time. For each chapter five practical key statements were formulated. In the present article the revised recommendations on basic measures and advanced resuscitation measures in adults as well as on postresuscitation treatment are summarized and commented on.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"129-140"},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39874494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}