Die Anaesthesiologie最新文献

{"title":"Erratum zu: Extrakorporale Verfahren bei der Sepsis.","authors":"Alice Bernard, Michael Koeppen","doi":"10.1007/s00101-025-01548-z","DOIUrl":"https://doi.org/10.1007/s00101-025-01548-z","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153052","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":"[Ecological sustainability in prehospital emergency medicine : Analysis of the usage of medical consumables].","authors":"Julia Johanna Grannemann, Annika Elsner, Kai Johanning, Bernd Strickmann, Gerrit Jansen","doi":"10.1007/s00101-025-01536-3","DOIUrl":"https://doi.org/10.1007/s00101-025-01536-3","url":null,"abstract":"<p><strong>Background: </strong>Despite the growing emphasis on ecological sustainability in healthcare, limited studies have addressed waste generation, reduction, reuse, and recycling strategies in time-critical preclinical emergencies.</p><p><strong>Objective: </strong>In this study, we aimed to explore waste reduction opportunities in the packaging of nonsterile medical consumables and assess the recycling potential of packaging materials for sterile items in preclinical emergency medicine.</p><p><strong>Methods: </strong>The packaging of medical consumables used by emergency medical services in the district of Gütersloh, North Rhine-Westphalia, Germany, was analysed for type, quantity and waste reduction and recycling potential following the 5R (reduce, reuse, recycle, rethink, and research) approach. Originally, this concept was proposed for in-hospital waste management. The study covered the period 2018-2021. The district of Gütersloh, with a population of 370,000, is served by 22 ambulances and 5 physician-staffed ambulance vehicles across 10 rescue stations. The total material usage was analysed through the central material management system. The 10 most frequently used sterile and nonsterile medical consumables were identified, and their percentage relative to the total number of used items was calculated. Waste reduction potential was evaluated for nonsterile plastics packaged in plastic. The recycling potential of paper and plastic components from paper-plastic packaging of sterile medical consumables was assessed.</p><p><strong>Results: </strong>Key waste reduction opportunities were identified for nonsterile consumables, including packaging of single-use patient blankets (n = 51,560; 35.3% of the total consumables), disposable sheets (n = 35,499; 24.3%) and oxygen masks (n = 10,834; 7.4%). For sterile products, recycling potential was found in the packaging of syringes (n = 44,745; 23.5% of the total consumables), infusion systems (n = 26,005; 13.7%) and intravenous catheters (n = 24,590; 12.9%). These items are packaged in a paper-plastic combination, where the paper and plastic components can be recycled separately, if uncontaminated.</p><p><strong>Conclusions: </strong>Significant potential for waste reduction and recycling of preclinical emergency medicine packaging was identified, contributing to ecological sustainability. Sustainable workflow concepts should be developed. Further studies involving collaboration with hygienists and logistics experts are required to evaluate concepts and the feasibility of resource-saving workflows. However, resource conservation efforts must not compromise the quality of care provided to emergency patients.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121582","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":"[Risk factors and treatment of post-dural puncture headache-an analysis of the German patients of the international EPIMAP study].","authors":"Sarah-Katharina Kroegel, Christian von Heymann, Schyns van den Berg, K Becke, P Kranke, Heidrun Lewald, S Müller, E Muggleton, C Neumann, H Ohnesorge, S Piper, Lutz Kaufner","doi":"10.1007/s00101-025-01540-7","DOIUrl":"https://doi.org/10.1007/s00101-025-01540-7","url":null,"abstract":"<p><strong>Background: </strong>Accidental dural puncture (ADP) is a rare but serious complication that can lead to post-dural puncture headache (PDPH), a condition known to significantly impair the well-being of affected women.</p><p><strong>Objectives: </strong>The present study examines the patient characteristics, symptoms, management and outcomes of women with PDPH after ADP and focuses on differences between conservative management and epidural blood patch (EBP).</p><p><strong>Materials and methods: </strong>The data of nine German study sites of the European prospective, multicenter cohort EPIMAP (European Practice in the Management of Accidental Dural Puncture in Obstetrics) trial were analyzed. Only descriptive analyses were performed due to the small sample size.</p><p><strong>Results: </strong>Data were collected between 2016 and 2018 and 73 patients were included in Germany. Of the 73 patients (76.7%), 56 received an EBP and 17 were treated conservatively (23.3%). In the conservative treatment group, the median numeric rating score of pain (NRS) plus interquartile range (IQR) during the hospital stay was 2 (1; 3) at rest and 7 (5; 8) while sitting or standing. Upon discharge, the NRS had decreased to 0 (0; 1) at rest and 2 (1; 4) while sitting or standing. In the EBP group NRS was 3 (1; 7) at rest and 8.5 (7; 10) while sitting or standing 6-12 h before the intervention. Furthermore, 24 h after the EBP, NRS was 0 (0; 2) at rest and 1 (0; 2) while sitting or standing. A total of 15 women were readmitted to the hospital for recurrent PDPH after EBP (26.8%). A second EBP was administered to 9 patients (60%).</p><p><strong>Conclusion: </strong>The EBP is an effective treatment option for post-puncture dural headache. The choice between the EBP and a conservative treatment seems to be influenced by the intensity of the PDPH. These results underline the importance of an individual treatment approach in patients with PDPH.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112370","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":"[Knowledge and attitudes toward assisted suicide : Survey of members of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI)].","authors":"Yann-Nicolas Batzler, Manuela Schallenburger, Jacqueline Schwartz, Till Brune, Susanne Feit, Theresa Tenge, Remo Küppers, Stefan Meier, Martin Neukirchen","doi":"10.1007/s00101-025-01547-0","DOIUrl":"https://doi.org/10.1007/s00101-025-01547-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The ban on assisted suicide \"intended as a recurring pursuit\" was lifted by the German Federal Constitutional Court in 2020. Consequently, the German Medical Council repealed § 16 sentence 3 of the (model) professional code (\"They [doctors] may not provide assistance for suicide\"). Two legislative proposals to regulate assisted suicide failed in the German Bundestag in 2023. To date, medical staff lack a basis for action when dealing with patients who wish to die. The opinions, attitudes and perspectives of professional groups are important with regard to assisted suicide in order to be able to draw up practical regulations that can be implemented in everyday medical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The aim of this survey is to assess the knowledge about the legal situation in Germany as well as perceptions and attitudes towards assisted suicide among members of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;The study group developed a questionnaire in repeated interdisciplinary and multiprofessional discussions based on a literature review and a previous survey among younger physicians. The questionnaire consisted of questions on the legal and statutory situation of assisted suicide in Germany, personal attitudes and demographic data. It was distributed via the DGAI member newsletter using an online link.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;From 08/2023-01/2024, out of 25,573 reachable members, 1056 viewed the survey (view rate: 4%), 822 participated, of which 686 completed the questionnaire (completion rate: 83%). Of all participants, 99% (n = 676/686) were physicians; 56% (n = 385/686) were older than 50 years. 45% (n = 310/686) of participants stated that they were aware of the judgment on the invalidity of section 217 of the German criminal code. 86% (n = 589/686) of respondents incorrectly believed that it is prohibited in Germany to offer assisted suicide intended as a recurring pursuit and 21% (n = 142/686) of respondents falsely believed that assisted suicide is a criminal offense in Germany. 77% (n = 527/686) would prefer a new legal regulation on assisted suicide in order to achieve greater legal certainty. 55% (n = 374/686) stated that healthcare workers are the appropriate point of contact to decide on the permissibility of assisted suicide. Of all respondants, 45% (n = 305/686) have asked patients about the existence of death wishes in their professional career; 23% (n = 159/686) of respondents have never done so. 71% (n = 486/686) declined to participate in assisted suicide for patients regardless of the health condition; 65% (n = 443/686) indicated they could only envision participation in a palliative care setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Participating members of the DGAI show a lack of knowledge regarding the current legal framework surrounding assisted suicide in Germany. They express the hope that future","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082492","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":"[Empirical antibiotic therapy in life-threatening infections-current concepts and controversies].","authors":"A Brinkmann, U Chiriac, C Eckmann, O R Frey, B Grabein, S Hagel, D Richter, U Liebchen","doi":"10.1007/s00101-025-01531-8","DOIUrl":"https://doi.org/10.1007/s00101-025-01531-8","url":null,"abstract":"<p><p>Along with early administration and the selection of the right drug, it is important to consider pharmacokinetic and pharmacodynamic principles, especially in life-threatening infections. Therefore, successful antibiotic therapy requires a clear understanding of the relationship between microbiology, pharmacology, and intensive care medicine. Open and transparent communication among professionals is essential for improving the quality of care. This article discusses current concepts and controversies by presenting a relevant case study of community-acquired pneumonia. It aims to help clinicians select the right drug for each patient, including the correct dose, the appropriate administration, and the right duration of treatment.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082489","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":"[7 or 14 days antibiotic treatment for bloodstream infections?]","authors":"Lennart Wild, Christian Bode","doi":"10.1007/s00101-025-01541-6","DOIUrl":"https://doi.org/10.1007/s00101-025-01541-6","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000742","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":"[Utilization of apneic oxygenation in anesthesiology: a nationwide survey in Germany].","authors":"Davut Deniz Uzun, Felix Hezel, Stefan Mohr, Markus A Weigand, Felix C F Schmitt","doi":"10.1007/s00101-025-01529-2","DOIUrl":"10.1007/s00101-025-01529-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and research question: &lt;/strong&gt;While patient safety during general anesthesia has improved in recent years, incidents still occur during anesthesia, particularly in the area of extended airway management. During the induction of general anesthesia, spontaneous breathing is routinely suspended thereby increasing the risk of hypoxemia during the apneic phase. To prevent desaturation and clinically significant hypoxemia, preoxygenation is performed before anesthesia induction. While preoxygenation can extend the safe apnea time, certain high-risk patient groups, such as obese patients, pregnant women, children and those with difficult airways, may require additional stabilization strategies. Apneic oxygenation (ApOx), a technique first described in the early twentieth century, delivers 100% oxygen at a flow rate of 15 l per min or more during the apneic phase to prolong oxygenation. While current airway management guidelines recommend ApOx during the laryngoscopy phase for patients at risk, its widespread utilization in clinical practice remains limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study presents the findings of a multicenter, web-based survey investigating the use of ApOx in anesthesiology departments across Germany, highlighting the challenges in implementation and identifying areas for further improvement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Between 1 July 2024 and 3 September 2024 a multicenter, exploratory, anonymous survey of anesthetists in various German hospitals was conducted. The survey was conducted via the online platform Lime Survey (Hamburg/Germany). Participants were asked about their personal and institutional background and the use of ApOx in their institution The study is based on descriptive statistics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The survey was completed by a total of n = 310 anesthetists and after excluding incomplete data sets, n = 306 questionnaires could be analyzed. The majority of participants were male (63%), with an average age of 41 years (± 10.4). In terms of professional roles, there was an even split between senior physicians (34%) and residents (34%), followed by consultants (25%) or heads of departments (8%). The work settings included university hospitals (37%), maximum care hospitals (27%), intermediate care hospitals (19%) and basic and standard care hospitals (15%). The majority of the participants (59%) had an additional qualification in emergency medicine. In addition, 48% of the respondents had an additional qualification in intensive care medicine. In 84% of cases it was found that neither in-hospital nor prehospital standard operating procedures on ApOx exist. Of the respondents 18% indicated that they regularly perform ApOx. The procedure is employed in the following scenarios: 54% for respiratory insufficiency, 42% for expected difficult airway and 34% for rapid sequence intubation. In the clinical practice 51% of procedures utilize a high-flow nasal cannul","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"283-293"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Updated position paper on \"Ecological sustainability in anesthesiology and intensive care medicine\" with specific recommendations for action of the German Society for Anesthesiology and Intensive Care Medicine and the Professional Association of German Anesthesiologists-Update 2024 : Compiled by the Forum Sustainability in Anesthesiology from the Professional Association of German Anesthesiologists (BDA) and the German Society for Anesthesiology and Intensive Care Medicine (DGAI)].","authors":"Martin Schuster, Hannah Richter, Sabine Pecher, Thomas Bein, Linda Grüßer, Ana Kowark, Ferdinand Lehmann, Charlotte Samwer, Thorsten Brenner, Mark Coburn","doi":"10.1007/s00101-025-01519-4","DOIUrl":"10.1007/s00101-025-01519-4","url":null,"abstract":"<p><p>Anthropogenic climate change is progressing, with global warming now reaching 1.1 °C. At the same time, further environmental crises that jeopardize the conservation of our natural resources can be observed. The effects on health are obvious and we are already witnessing them in Germany.The healthcare sector itself contributes to a relevant extent to national greenhouse gas emissions and the field of anesthesiology and intensive care medicine is a particularly resource-intensive area. For this reason, the Professional Association of German Anesthesiologists (BDA) and the German Society of Anesthesiology and Intensive Care Medicine (DGAI) were among the first professional associations and medical societies to publish a position paper entitled \"Ecological sustainability in anesthesiology and intensive care medicine\" in 2020. This is now available in an updated version from November 2024.It contains 33 specific recommendations in the following 7 areas: 1) the use of volatile anesthetics and other medications, 2) the use of consumables, 3) waste management, 4) sustainable mobility concepts, 5) energy-saving measures in the operating theater and intensive care unit, 6) research and teaching and 7) strategies to mitigate the impact of environmental changes on healthcare services in our discipline. This paper summarizes the recommendations. It explains the main changes compared to the 2020 version, with a particular focus on the new evidence behind the recommendations. The specific recommendations are intended to help anesthetists to initiate changes in everyday clinical practice, interprofessionally and in cooperation with other disciplines, which affect their own area of work and the entire hospital.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"294-304"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702348","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":"[Avalanche rescue 2024-Current recommendations].","authors":"Bernd Wallner, Frederik Eisendle, Simon Rauch, Peter Paal","doi":"10.1007/s00101-025-01520-x","DOIUrl":"10.1007/s00101-025-01520-x","url":null,"abstract":"<p><p>Avalanche accidents in which winter sports enthusiasts are involved have significantly increased but the number of deaths remains stable due to better prevention and rescue. Avalanche accidents are frequent in mountainous regions and there are around 100 fatalities each year in Europe. The chances of survival are mainly determined by the degree and duration of avalanche burial, a possible airway obstruction, the presence of an air pocket, the snow characteristics and possible severe injuries. The most frequent cause of death is asphyxia, followed by trauma. Hypothermia accounts for only a minority of deaths. Hypothermic cardiac arrest has a favorable prognosis and justifies prolonged resuscitation and extracorporeal rewarming. The distinction between asphyxial and hypothermic cardiac arrest enables an optimized triage. This article deals with the pathophysiology of avalanche accidents and the management of avalanche victims in the field.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"327-338"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411943","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":"[Point of care coagulation diagnostics-Absolutely necessary or only a reasonable supplement?]","authors":"Martin Mirus, Herbert Schöchl, Philipp Groene, Mirjam Bachler, Jürgen Koscielny, Dietmar Fries, Lars Heubner","doi":"10.1007/s00101-025-01524-7","DOIUrl":"10.1007/s00101-025-01524-7","url":null,"abstract":"<p><p>Point of care (POC) coagulation diagnostics have become an integral part of clinical patient care. In particular, the strengths of POC viscoelastometry (VET) lie not only in the rapid availability of test results but also in the fact that VET provides insights into coagulation that cannot be detected by standard laboratory tests. The relevance of POC-VET in the optimal management of patients with acutely acquired bleeding disorders, such as trauma-induced coagulopathy, is now unquestioned and is also reflected in the corresponding guidelines; however, VET also provides important information about fibrinolysis and fibrinolytic activity and in combination with other laboratory values can possibly also be sensitive for prothrombotic coagulation disorders. Therefore, POC-VET is increasingly being used in intensive care medicine. The use of POC diagnostics is not subject to the same standards as central laboratory testing. In order to maintain high quality and avoid harming patients, the requirements for medical device manufacturers in particular have been increased as part of the in vitro diagnostic reagents (IVDR) regulations, which places high demands on quality management in particular. The variety of POC devices and the lack of comparability between them remains an unsolved problem. It should be critically discussed to what extent medical device manufacturers and pharmaceutical companies could be legally required to keep unique and urgently needed technologies on the market, especially if no comparable alternatives will be available in the foreseeable future. Overall, from today's perspective, the use of POC coagulation diagnostics is essential for optimal patient care.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"264-274"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766007","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}