Anaesthesist最新文献

{"title":"Surgical treatment of proximal femoral fractures in high-risk geriatric patients under peripheral regional anesthesia : A prospective feasibility study.","authors":"Ronald Seidel,&nbsp;Eduard Barbakow,&nbsp;Stefan Schulz-Drost","doi":"10.1007/s00101-021-00935-6","DOIUrl":"https://doi.org/10.1007/s00101-021-00935-6","url":null,"abstract":"<p><strong>Background and objective: </strong>Due to changing demographics geriatric patients with multiple comorbidities and proximal femoral fractures are an increasing patient population. In these patient groups, peripheral regional anesthesia could become increasingly more important besides established procedures, such as neuraxial or general anesthesia. The aim of this single center feasibility study was to evaluate a combined blockade technique of the lumbosacral plexus for three predefined subgroups depending on the type of hip fracture.</p><p><strong>Methods: </strong>We used a unilateral double injection three-step technique to block the sacral (parasacral block) and lumbar plexus (anterior quadratus lumborum and psoas compartment block, n = 78). The blockade was performed both under ultrasound guidance and simultaneous nerve stimulation and 20 ml ropivacaine 0.375% was injected at each of the 3 injection sites (total dose 225 mg).</p><p><strong>Results: </strong>In 42% of cases the surgery was opioid-free (n = 33). In 5 patients a conversion to general anesthesia (insertion of a laryngeal mask and pressure-controlled or pressure-supported ventilation) was necessary (6%). The overall success rate of combination anesthesia (peripheral nerve blocks with supplemental sedative (propofol 1-2 mg/kg*h) or analgesic (incremental doses of 5 µg sufentanil) medication) was 94%, regardless of fracture type and surgical treatment.</p><p><strong>Conclusion: </strong>The combined anesthetic technique presented in this study enables surgical treatment of proximal femoral fractures. The associated effort and requirement for expert knowledge in regional anesthesia indicates that this method should be considered especially in cases with high anesthetic risk, suitable sonoanatomy, and non-compromised coagulation.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":"70 12","pages":"1022-1030"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00101-021-00935-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25472724","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":"Implementation of anesthesia quality indicators in Germany : A prospective, national, multicenter quality improvement study.","authors":"S Ziemann,&nbsp;M Coburn,&nbsp;R Rossaint,&nbsp;J Van Waesberghe,&nbsp;H Bürkle,&nbsp;M Fries,&nbsp;M Henrich,&nbsp;D Henzler,&nbsp;T Iber,&nbsp;J Karst,&nbsp;O Kunitz,&nbsp;R Löb,&nbsp;W Meißner,&nbsp;P Meybohm,&nbsp;B Mierke,&nbsp;F Pabst,&nbsp;G Schaelte,&nbsp;J Schiff,&nbsp;M Soehle,&nbsp;M Winterhalter,&nbsp;A Kowark","doi":"10.1007/s00101-020-00773-y","DOIUrl":"https://doi.org/10.1007/s00101-020-00773-y","url":null,"abstract":"<p><strong>Background: </strong>In 2016 the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthetists (BDA) published 10 quality indicators (QI) to compare and improve the quality of anesthesia care in Germany. So far, there is no evidence for the feasibility of implementation of these QI in hospitals.</p><p><strong>Objective: </strong>This study tested the hypothesis that the implementation of the 10 QI is feasible in German hospitals.</p><p><strong>Material and methods: </strong>This prospective three-phase national multicenter quality improvement study was conducted in 15 German hospitals and 1 outpatient anesthesia center from March 2017 to February 2018. The trial consisted of an initial evaluation of pre-existing structures and processes by the heads of the participating anesthesia departments, followed by a 6-month implementation phase of the QI as well as a final re-evaluation phase. The implementation procedure was supported by web-based implementation aids ( www.qi-an.org ) and internal quality management programs. The primary endpoint was the difference in the number of implemented QI per center before and after implementation. Secondary endpoints were the number of newly implemented QI per center, the overall number of successful implementations of each QI, the identification of problems during the implementation as well as the kind of impediments preventing the QI implementation.</p><p><strong>Results: </strong>The average number of implemented QI increased from 5.8 to 6.8 (mean of the differences 1.1 ± 1.3; P < 0.01). Most frequently the QI perioperative morbidity and mortality report (5 centers) and the QI temperature management (4 centers) could be implemented. After the implementation phase, the QI incidence management and patient blood management were implemented in all 16 centers. Implementation of other quality indicators failed mainly due to a lack of time and lack of structural resources.</p><p><strong>Conclusion: </strong>In this study the implementation of QI was proven to be mostly feasible in the participating German hospitals. Although several QI could be implemented with minor effort, more time, financial and structural resources would be required for some QI, such as the QI postoperative visit.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"38-47"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00101-020-00773-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37908874","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":"Coronavirus disease 2019 (COVID-19): update for anesthesiologists and intensivists March 2020.","authors":"D Thomas-Rüddel,&nbsp;J Winning,&nbsp;P Dickmann,&nbsp;D Ouart,&nbsp;A Kortgen,&nbsp;U Janssens,&nbsp;M Bauer","doi":"10.1007/s00101-020-00760-3","DOIUrl":"https://doi.org/10.1007/s00101-020-00760-3","url":null,"abstract":"<p><p>The current outbreak of coronavirus disease (COVID-19) has reached Germany. The majority of people infected present with mild disease, but there are severe cases that need intensive care. Unlike other acute infectious diseases progressing to sepsis, the severe courses of COVID19 seemingly show prolonged progression from onset of first symptoms to life-threatening deterioration of (primarily) lung function. Diagnosis relies on PCR using specimens from the respiratory tract. Severe ARDS reflects the hallmark of a critical course of the disease. Preventing nosocomial infections (primarily by correct use of personal protective equipment) and maintenance of hospitals' operational capability are of utmost importance. Departments of Anaesthesia, Intensive Care and emergency medicine will envisage major challenges.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00101-020-00760-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37770557","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":"[S3 guidelines on \"full-term vaginal birth\" from an anesthesiological perspective : Worthwhile knowledge for anesthesiologists].","authors":"P Helmer,&nbsp;T Skazel,&nbsp;M Wenk,&nbsp;C von Kaisenberg,&nbsp;M Abou-Dakn,&nbsp;M Papsdorf,&nbsp;F Abu Hmeidan,&nbsp;S Kehl,&nbsp;P Meybohm,&nbsp;Peter Kranke","doi":"10.1007/s00101-021-01024-4","DOIUrl":"https://doi.org/10.1007/s00101-021-01024-4","url":null,"abstract":"<p><p>The publication of the new S3 guidelines on \"full-term vaginal birth\" and the guidelines on cesarean section, also published in 2020, provide further steps towards the promotion of evidence-based medicine in obstetrics, even if the exact configuration of neonatal monitoring during birth, in particular, is still the subject of current discussions. The multiprofessionality in the medical supervision of a birth is also fundamentally well-represented in the compilation of the S3 guidelines by the participating actors and specialist societies. Important from an anesthesiological perspective is the fact that neuraxial procedures still represent the gold standard in obstetric analgesia. With remifentanil PCA an alternative option is available that enables a reliable analgesia to be accomplished, e.g. when there are contraindications to performing neuraxial methods, if this is appropriate under the prevailing circumstances (1:1 support and appropriate monitoring). During an uncomplicated birth the strict fasting rules are relaxed. Overall, the guidelines underline the importance of self-determination and self-control for the expectant mother and give the highest priority to the safety and well-being of mother and child; however, this presupposes that the expectant mother is sufficiently informed about the value of neuraxial analgesia. For this it appears to be of importance to initiate information proposals, which go beyond the usual information sessions for parents that are often organized exclusively by midwives.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":"70 12","pages":"1031-1039"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39388471","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":"[Differentiate neuropathic pain].","authors":"Sascha Tafelski","doi":"10.1007/s00101-021-01049-9","DOIUrl":"https://doi.org/10.1007/s00101-021-01049-9","url":null,"abstract":"","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":"70 12","pages":"991-992"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39797535","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":"[Palliative care in patients with left ventricular assist devices: systematic review].","authors":"T Tenge,&nbsp;D Schlieper,&nbsp;M Schallenburger,&nbsp;S Meier,&nbsp;J Schwartz,&nbsp;M Neukirchen","doi":"10.1007/s00101-021-00967-y","DOIUrl":"https://doi.org/10.1007/s00101-021-00967-y","url":null,"abstract":"<p><strong>Background: </strong>An increasing number of patients reach the final stage of heart failure with heart transplantation as the only curative treatment. Mechanical circulatory support, such as left ventricular assist devices (LVAD) are becoming increasingly more important at this stage of the disease. An LVAD improves the quality of life and prolongs the lifespan. The LVAD is used as a bridge to transplantation (BTT) for patients waiting for a donor heart or as a destination therapy (DT) with no transplantation intended; nevertheless, implantation is often associated with complications and the prognosis remains unfavorable in DT cases or after transition from BTT to DT. For patients the device may be a source of physical and psychological distress and can become a burden for families and caregivers. So far it remains unclear whether LVAD treatment is an indication for concurrent palliative care.</p><p><strong>Objective: </strong>The aim of this study was to collect the current data on the influence of palliative care in LVAD patients and to identify possible formats of palliative care in clinical practice.</p><p><strong>Material and methods: </strong>In May 2020, a systematic literature search was performed using the PICOS instrument in six different databases, i.e. PubMed, Cochrane library, Google scholar, Scopus, Web of Science and Journals@Ovid. We included quantitative and qualitative studies in English and German. Case reports, comments and pediatric studies were excluded.</p><p><strong>Results: </strong>A total of 21 publications from an initial number of 491 were included in this review. The integration of palliative care in the context of LVAD implantation increased the number of advance directives and documented surrogate decision makers. Studies found a positive influence of palliative care on the conditions and place of death, family involvement and symptom and pain management. Involvement in the decision-making process may improve patient selection for LVAD treatment and helps patients to make the decision on informed consent. Various formats for the integration of palliative medical concepts into LVAD treatment are reported. It is not clear when palliative care involvement should start; however, most articles support an early and continuous integration in the LVAD process. We have aggregated possible topics for palliative care consultations from a number of publications. Mutual teaching of both LVAD and palliative care teams is recommended. Integration of a dedicated LVAD palliative care specialist as part of the LVAD team can support care for patients as well as clinicians.</p><p><strong>Conclusion: </strong>The role of palliative care in LVAD patients in clinical practice in the German-speaking area is not standardized. Early and continuous integration of palliative care into the course of LVAD treatment can improve the quality of care. Benefits for LVAD patients, caregivers and clinicians are described. For this purpose,","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":"70 12","pages":"1044-1050"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00101-021-00967-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38869493","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":"[Erratum to: Mortality in sepsis and septic shock in Germany. Results of a systematic review and meta-analysis].","authors":"Michael Bauer,&nbsp;Heinrich Volker Groesdonk,&nbsp;Franziska Preissing,&nbsp;Petra Dickmann,&nbsp;Tobias Vogelmann,&nbsp;Herwig Gerlach","doi":"10.1007/s00101-021-00985-w","DOIUrl":"https://doi.org/10.1007/s00101-021-00985-w","url":null,"abstract":"","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"78-79"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00101-021-00985-w","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39251632","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":"[Diagnostics and therapy of neuropathic pain].","authors":"G Gossrau,&nbsp;R Sabatowski","doi":"10.1007/s00101-021-01039-x","DOIUrl":"https://doi.org/10.1007/s00101-021-01039-x","url":null,"abstract":"<p><p>Neuropathic pain is pain caused by a lesion or disease of the somatosensory nervous system. Scientific studies have shown that neuropathic pain is the result of complex altered signalling processes in the peripheral and central nervous system. Current forms of treatment of neuropathic pain are causally oriented but also aim at symptomatic analgesia by pharmacological and nonpharmacological methods. Furthermore, psychological pain management techniques are used in a supportive role. This review summarizes the contemporary diagnostics of neuropathic pain using frequent diseases as examples and presents the evidence from randomized controlled trials on the treatment of neuropathic pain. Treatment guidelines for pharmacological management of neuropathic pain include evidence-based use of antidepressants, anticonvulsants, opioids, capsaicin and lidocaine.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":"70 12","pages":"993-1002"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39539415","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":"[Focus on nephrology : Intensive medical care studies 2020/2021].","authors":"Christian Nusshag,&nbsp;C J Reuß,&nbsp;M Dietrich,&nbsp;A Hecker,&nbsp;C Jungk,&nbsp;D Michalski,&nbsp;M O Fiedler,&nbsp;M Bernhard,&nbsp;C Beynon,&nbsp;M A Weigand,&nbsp;T Brenner","doi":"10.1007/s00101-021-00980-1","DOIUrl":"https://doi.org/10.1007/s00101-021-00980-1","url":null,"abstract":"","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":"70 12","pages":"1053-1058"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39543253","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":"[Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure : Short version of the S3 guideline].","authors":"Udo Boeken,&nbsp;Stephan Ensminger,&nbsp;Alexander Assmann,&nbsp;Christof Schmid,&nbsp;Karl Werdan,&nbsp;Guido Michels,&nbsp;Oliver Miera,&nbsp;Florian Schmidt,&nbsp;Stefan Klotz,&nbsp;Christoph Starck,&nbsp;Kevin Pilarczyk,&nbsp;Ardawan Rastan,&nbsp;Marion Burckhardt,&nbsp;Monika Nothacker,&nbsp;Ralf Muellenbach,&nbsp;York Zausig,&nbsp;Nils Haake,&nbsp;Heinrich Groesdonk,&nbsp;Markus Ferrari,&nbsp;Michael Buerke,&nbsp;Marcus Hennersdorf,&nbsp;Mark Rosenberg,&nbsp;Thomas Schaible,&nbsp;Harald Köditz,&nbsp;Stefan Kluge,&nbsp;Uwe Janssens,&nbsp;Matthias Lubnow,&nbsp;Andreas Flemmer,&nbsp;Susanne Herber-Jonat,&nbsp;Lucas Wessel,&nbsp;Dirk Buchwald,&nbsp;Sven Maier,&nbsp;Lars Krüger,&nbsp;Andreas Fründ,&nbsp;Rolf Jaksties,&nbsp;Stefan Fischer,&nbsp;Karsten Wiebe,&nbsp;Christiane Hartog,&nbsp;Omer Dzemali,&nbsp;Daniel Zimpfer,&nbsp;Elfriede Ruttmann-Ulmer,&nbsp;Christian Schlensak,&nbsp;Malte Kelm,&nbsp;Andreas Beckmann","doi":"10.1007/s00101-021-01058-8","DOIUrl":"https://doi.org/10.1007/s00101-021-01058-8","url":null,"abstract":"<p><p>In Germany, a remarkable increase regarding the usage of extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) systems has been observed in recent years with approximately 3000 ECLS/ECMO implantations annually since 2015. Despite the widespread use of ECLS/ECMO, evidence-based recommendations or guidelines are still lacking regarding indications, contraindications, limitations and management of ECMO/ECLS patients. Therefore in 2015, the German Society of Thoracic and Cardiovascular Surgery (GSTCVS) registered the multidisciplinary S3 guideline \"Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure\" to develop evidence-based recommendations for ECMO/ECLS systems according to the requirements of the Association of the Scientific Medical Societies in Germany (AWMF). Although the clinical application of ECMO/ECLS represents the main focus, the presented guideline also addresses structural and economic issues. Experts from 17 German, Austrian and Swiss scientific societies and a patients' organization, guided by the GSTCVS, completed the project in February 2021. In this report, we present a summary of the methodological concept and tables displaying the recommendations for each chapter of the guideline.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"942-950"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39530577","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}