Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS最新文献

{"title":"[Persistent Postoperative Opioid Use].","authors":"Johannes Dreiling, Winfried Meißner","doi":"10.1055/a-2754-3570","DOIUrl":"https://doi.org/10.1055/a-2754-3570","url":null,"abstract":"<p><strong>Abstract: </strong>Persistent postoperative opioid use (PPOU) has become an important quality indicator in perioperative medicine. While the North American opioid crisis has raised global awareness, data from Germany and other European countries have been limited. Recent population-based and clinical studies now provide robust evidence that PPOU is overall uncommon in Germany, with an incidence of approximately 1-1.4% among previously opioid-naïve patients. However, substantial variation exists between surgical procedures. Major amputations, spine surgery and revision arthroplasty show markedly elevated risks, indicating that the type of surgery is the strongest predictor of PPOU, exceeding the influence of patient-related factors. Psychiatric comorbidities, chronic pain, and especially preoperative opioid therapy significantly increase vulnerability. Perioperative processes also modulate risk: opioid administration on first postoperative day in patients with low pain intensity is associated with a higher likelihood of PPOU, whereas adequate opioid use in patients with severe pain does not increase this risk. High-quality multimodal analgesia, early integration of regional anesthesia, structured acute pain services and clear discharge recommendations are essential to prevent unnecessary long-term opioid use. These findings highlight the multifactorial nature of PPOU and underscore the importance of individualized, guideline-conform perioperative pain management. Targeted risk assessment, optimized perioperative pathways and coordinated follow-up care are key strategies to minimize persistent opioid use and improve postoperative outcomes.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 6","pages":"393-404"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Infection Prevention in the Intensive Care Unit: Evidence-Based Strategies for Reducing Healthcare-Associated Infections].","authors":"Irit Nachtigall, Jana Schroeder","doi":"10.1055/a-2807-7750","DOIUrl":"https://doi.org/10.1055/a-2807-7750","url":null,"abstract":"<p><strong>Abstract: </strong>Healthcare-associated infections (HAIs) remain among the most frequent and preventable complications in intensive care units (ICUs), contributing substantially to morbidity, mortality, prolonged length of stay, and healthcare costs. This review summarizes current evidence-based strategies for infection prevention in critical care settings, focusing on key domains including hand hygiene, prevention of ventilator-associated pneumonia (VAP), central line-associated bloodstream infections (CLABSI), and catheter-associated urinary tract infections (CAUTI).ICUs represent a high-risk environment due to the frequent use of invasive devices, high patient acuity, and complex care processes. Device-associated infections account for a large proportion of HAIs, with incidence rates remaining significant despite advances in care. Hand hygiene remains the single most effective preventive measure, yet compliance is often suboptimal, particularly in high-intensity settings. The appropriate use of gloves as an adjunct, not a substitute, for hand hygiene is critical.Multimodal prevention strategies, particularly structured care bundles, have demonstrated significant reductions in infection rates when consistently implemented. Key interventions include elevation of the head of the bed, daily sedation interruption, early mobilization, aseptic catheter insertion techniques, and strict adherence to maintenance protocols. Daily reassessment of device necessity is among the most effective measures to reduce infection risk.Antimicrobial stewardship and targeted microbiological diagnostics are integral components of infection prevention, reducing unnecessary antibiotic exposure and limiting the emergence of multidrug-resistant organisms. Additionally, digital tools such as automated surveillance systems and predictive analytics offer emerging opportunities to enhance early detection, monitoring, and individualized prevention strategies.Sustainable infection prevention requires a multidisciplinary approach, combining structured protocols, regular staff training, continuous feedback, and strong leadership support. Ultimately, consistent implementation of evidence-based measures can significantly improve patient safety and reduce the burden of HAIs in intensive care.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 6","pages":"405-417"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plötzliche Patientenbewegung bei Kataraktoperation.","authors":"Patrick Meybohm","doi":"10.1055/a-2905-5823","DOIUrl":"https://doi.org/10.1055/a-2905-5823","url":null,"abstract":"","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 9","pages":"548-550"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Types of Pain Management Assessment].","authors":"Gudrun Kindl, Karolin Teichmüller","doi":"10.1055/a-2754-4441","DOIUrl":"10.1055/a-2754-4441","url":null,"abstract":"<p><strong>Abstract: </strong>Pain assessments are essential for the diagnosis and treatment planning of pain disorders. Guided by the biopsychosocial model, they evaluate physical, psychological, and social factors that contribute to pain chronification. Unimodal assessments, typically performed by pain specialists, are often the first step in specialized pain care. If risk factors for chronification or established chronic pain are identified, an interdisciplinary multimodal assessment (IMA) involving physicians, psychologists, and physiotherapists is recommended. The IMA combines medical, functional, and psychological evaluation with an interdisciplinary case conference to develop an individualized treatment plan. Depending on the findings, recommendations may include outpatient, day-clinic, inpatient, rehabilitative, psychosomatic, or psychiatric treatment. More recently, ambulatory interdisciplinary multimodal assessments (A-IMA) have been introduced for patients in the early stages of pain chronification. Early identification of risk factors and timely interdisciplinary intervention may help prevent the progression of chronic pain.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 9","pages":"509-519"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Dexamethasone for Perioperative Analgesia].","authors":"Sebastian Pantke, Andreas Leffler, Mirjam Eberhardt","doi":"10.1055/a-2754-3503","DOIUrl":"https://doi.org/10.1055/a-2754-3503","url":null,"abstract":"<p><strong>Background: </strong>Dexamethasone is a highly potent, long-acting synthetic glucocorticoid that does not exhibit any mineralocorticoid activity. It is commonly used during surgery to prevent postoperative nausea and vomiting (PONV), but also due to its perceived ability to reduce postoperative pain and the associated consumption of opioids.</p><p><strong>Objective: </strong>To summarise the fundamentals relating to the substance, the clinically relevant forms of administration, the common dosages, the contraindications, the adverse effects and the guideline recommendations.</p><p><strong>Results: </strong>Parenteral preparations typically contain dexamethasone-21-dihydrogen phosphate, which has an anti-inflammatory potency approximately thirty times greater than that of cortisol. While higher dosages do not appear to offer a proportional additional benefit, single intravenous doses of 4-8 mg predominate in the literature. At these dosages, dexamethasone is considered safe. Notably, there are no increased rates of postoperative wound infections or delayed wound healing, although there is a mild, transient increase in blood glucose levels. However, specific risks exist in cases of haematological neoplasms due to tumour lysis syndrome, as well as in endocrinological diagnostics due to suppression of the hypothalamic-pituitary-adrenal axis. Current guidelines increasingly position dexamethasone as part of balanced analgesia strategies, sometimes involving repeat doses within ERAS protocols.</p><p><strong>Conclusion: </strong>When the risk-benefit ratio is carefully considered, dexamethasone can contribute to postoperative analgesia as part of a balanced analgesia strategy.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 6","pages":"379-391"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Treatment Expectations in the Perioperative Setting - Influence on Postoperative Pain Treatment].","authors":"Regine Klinger, Elisabeth Winkler, Ana Ocokoljic, Julia Paula Stuhlreyer","doi":"10.1055/a-2754-3626","DOIUrl":"10.1055/a-2754-3626","url":null,"abstract":"<p><strong>Abstract: </strong>Treatment expectations are relevant modulators of postoperative pain and recovery. In perioperative care, patients' expectations are shaped by previous experiences, verbal information, social learning, and the therapeutic context. Positive expectations may enhance analgesic effects via placebo mechanisms, whereas negative expectations may increase pain and reduce treatment efficacy via nocebo mechanisms.For anaesthetists, this offers a practical opportunity to improve perioperative pain management. During the preoperative consultation, patients can be asked about the intensity of pain they expect after surgery. Strongly negative expectations should prompt a targeted discussion of fears, previous negative experiences, and misconceptions. Balanced, empathic communication may help foster realistic positive expectations without compromising informed consent. In the postoperative phase, particularly in the recovery room, open administration of analgesics accompanied by clear and reassuring explanations of their expected effects, as well as consistent communication within the medical and nursing team, may further strengthen patients' confidence in their treatment and support postoperative pain control.Interventions combining empathic physician communication with structured information or digital visualization tools have shown beneficial effects on postoperative pain and opioid consumption. Thus, expectation management should be understood as an adjunct to evidence-based perioperative analgesia. By systematically assessing and realistically aligning expectations, anesthesiologists can help reduce nocebo effects, support placebo-related analgesia, and improve patient-centered outcomes.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 6","pages":"362-377"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Multimodal Pain Management - From the Right Assessment to Lasting Impact].","authors":"Patrick Meybohm","doi":"10.1055/a-2920-7881","DOIUrl":"https://doi.org/10.1055/a-2920-7881","url":null,"abstract":"","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 9","pages":"506-507"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Anaesthesiological Concepts in Paediatric Neurosurgery].","authors":"Josefin Grabert, Ehrenfried Schindler","doi":"10.1055/a-2719-4117","DOIUrl":"10.1055/a-2719-4117","url":null,"abstract":"<p><strong>Abstract: </strong>Paediatric neurosurgery presents a unique set for the anaesthesiologist, necessitating a patient tailored approach for a diverse population, ranging from neonates to adolescents and from healthy to chronically ill children. Understanding the intracranial compartment as the sum of brain tissue, blood volume and cerebral spinal fluid is essential. Given that approximately a quarter of a child's cardiac output is dedicated to cerebral perfusion, intracranial bleeding might cumulate in haemorrhagic shock. Anaesthesiological measures to maintain homeostasis and their influences both on cerebral autoregulation and intracranial pressure need to be considered. Preoperative anaesthesiologic evaluation should incorporate neurological status and identification of underlying syndromes. Key perioperative considerations include airway management, strategic vascular access and haemotherapy. Anaesthetic requirements in common neurosurgical procedures for intracranial tumours, hydrocephalus, craniosynostosis as well as spinal surgery and traumatic brain injury are highlighted, while strategies to cope with complications such as seizure or air embolism are delineated.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 5","pages":"291-303"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Pediatric Anesthesia - Anesthesia for Congenital Heart Defects - Anesthesiological Approaches for Diagnostic and Surgical Procedures].","authors":"Meike Fahrenholz, Christiane E Beck, Franziska Schabinski, Sina Hartung, Christoph M Happel, Alexander Mladenow, Maren Kleine-Brüggeney","doi":"10.1055/a-2719-4253","DOIUrl":"10.1055/a-2719-4253","url":null,"abstract":"<p><strong>Abstract: </strong>Congenital heart disease (CHD) is the most common congenital malformation, affecting approximately 1 in 100 newborns. Due to advances in clinical management of CHD, the population of patients with congenital heart disease is growing. Gaining knowledge and expertise in the perioperative management of patients with CHD is hence becoming increasingly important not only for specialized, but for all anesthetists.The perioperative management of patients with CHD varies depending on the anatomy and pathophysiology of the specific defect and the planned intervention. A pathophysiological classification of CHD differentiates between lesions with shunts, as well as obstructive, regurgitant and mixing lesions. Perioperative planning should be interdisciplinary and extend from careful preoperative assessment through an individualized anesthesia plan and postoperative care.Anticipation of hemodynamic changes induced by anesthesia is essential to choose the optimal anesthesia technique, the optimal drugs, as well as the optimal ventilation and backup strategies. Performing smaller procedures under sedation with or without local or regional anesthesia and while maintaining spontaneous breathing can be advantageous.During general anesthesia measures to control and adjust pulmonary vascular resistance and systemic vascular resistance, including the careful adjustment of ventilation parameters, as well as the management of fluid status, is crucial for a good outcome. This article provides an overview of common CHD lesions and general principles relevant to anesthesia for children with CHD.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 5","pages":"304-321"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The Myth of Predictable Spinal Anaesthesia: What Determines Block Spread?]","authors":"Manuel Wenk, Christina Massoth","doi":"10.1055/a-2841-7239","DOIUrl":"10.1055/a-2841-7239","url":null,"abstract":"<p><strong>Abstract: </strong>The spread of spinal anaesthesia remains only partially predictable despite its long-established clinical use. Although numerous physical, procedural and patient-related factors have been described, many are of limited relevance in routine practice. Dose, baricity and patient positioning represent the main controllable determinants of block spread. Current evidence indicates that lumbosacral cerebrospinal fluid volume is the only patient-specific factor, whereas demographic variables such as height, weight and sex do not reliably predict spread. Spinal anaesthesia should therefore be planned on the basis of modifiable technical variables, while acknowledging that its final spread cannot be predicted precisely in the individual patient.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 5","pages":"343-347"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}