Die Anaesthesiologie最新文献

{"title":"[Preoperative risk prediction models for noncardiac surgery patients : Interpret and use risk scores correctly].","authors":"René M'Pembele, Sebastian Roth, Giovanna Lurati Buse","doi":"10.1007/s00101-024-01481-7","DOIUrl":"https://doi.org/10.1007/s00101-024-01481-7","url":null,"abstract":"<p><p>Risk prediction models are an established component of the preoperative evaluation. In its guidelines the European Society for Cardiology proposes several risk scores but the benefit of these is mostly unclear for clinicians. This article describes the individual steps in the preparation of a valid prediction model with a focus on the parameters, discrimination, calibration and external validation. The clinical benefits of the risk scores proposed in the guidelines with respect to these parameters was investigated. All proposed risk scores appear to show a good discrimination in the validation cohorts. Only a few reliable data for a good calibration could be compiled. The external validity of the individual models is unclear. The general benefit of the risk scores cannot be recommended as data for calibration or discrimination in external cohorts are lacking. A precise estimation of the risk cannot be expected.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689873","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 golden approach to trauma. Which blood products are needed for optimization of prehospital trauma care?]","authors":"Maximilian Lothar Bamberg, Christian Grasshoff, Jessica Gerstner, Matthias Fabian Boos, Michael Bentele, Tim Viergutz, Johann Fontana, Peter Rosenberger, Robert Wunderlich","doi":"10.1007/s00101-024-01482-6","DOIUrl":"10.1007/s00101-024-01482-6","url":null,"abstract":"<p><strong>Background: </strong>The golden hour of trauma denotes the critical first hour after severe injury where timely medical response is crucial, although scientific support for this time frame is inconsistent. This study emphasizes optimizing trauma care by tailoring treatment to the specific injury rather than focusing solely on the speed of treatment. The aim is to document the need for improvement in prehospital trauma care, particularly by the use of blood and coagulation products.</p><p><strong>Methods: </strong>After a pilot study, a purpose-designed online questionnaire targeted at German physicians and rescue service personnel was utilized to collect their views on general trauma care and specifically on the use of blood and coagulation products in prehospital settings. It also assessed the appropriateness of nine specific blood and coagulation products via a 5-point Likert scale. The percentages for each item were calculated for both physicians (n = 110) and rescue service personnel (n = 142) separately as well as an overall score to delineate patterns of agreement or disagreement.</p><p><strong>Results: </strong>The study reached 9837 individuals, whereby 371 initially answered the questionnaire and 252 participants from Germany were finally included in the statistical analysis. The majority of both physicians (89.1%) and rescue service personnel (90.8%) agreed on the need to improve prehospital trauma care, particularly through the use of blood and coagulation products. Specifically, 60.9% of physicians and 83.8% of rescue personnel supported the prehospital administration of these products. Red blood cell concentrates and fibrinogen were notably endorsed, with 76.2% and 67.1% approval, respectively, for their potential to enhance survival in patients with significant blood loss; however, opinions varied on other blood products.</p><p><strong>Conclusion: </strong>The data demonstrated a readiness to change the trauma approach and confirmed that effective options are available. The utilization of certain products is supported by existing research, underlining the need for their practical implementation in preclinical settings. Here, the emphasis shifts from the isolated time components to the quality of care delivered in an optimized time interval. Ideally, timely and high-quality care should complement each other, leveraging all available therapeutic resources. This could lead to the development of a golden approach to trauma to optimize outcomes in trauma care.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667996","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":"[Successful resuscitation after energy drink consumption in a patient with unknown right ventricular dysplasia].","authors":"A Molitor, S Bitaraf, S G Sakka","doi":"10.1007/s00101-024-01473-7","DOIUrl":"https://doi.org/10.1007/s00101-024-01473-7","url":null,"abstract":"<p><p>This case report describes a 28-year-old man who successfully underwent cardiopulmonary resuscitation (CPR) for ventricular fibrillation after consuming an energy drink containing a nonlethal dose of caffeine. The caffeine-naive patient, without previously known diseases, had rapidly drunk 3 cans of an energy drink (480 mg caffeine, i.e., an amount he had never consumed before according to his own statement) after a football training before he collapsed lifelessly and required resuscitation. After successful CPR, the patient was admitted to the intensive care unit and extubation was carried out on the following day. In parallel, differential diagnostic cardiological procedures were carried out. These revealed a previously unknown right ventricular dysplasia, so that after exclusion of an accessory atrioventricular conduction pathway in the electrophysiological examination, a single chamber implantable cardioverter defibrillator (ICD) for secondary prevention was implanted. The patient was discharged home without neurological deficits on day 14 after hospital admission. This case presentation is intended to show that the consumption of caffeine-containing energy drinks, even in a nonlethal dose, can be potentially dangerous in the presence of an unknown cardiac disease, even if physical performance is not impaired.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649559","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":"[Cell salvage in obstetrics-Background and practical implementation].","authors":"Mischa J Kotlyar, Vanessa Neef, Florian Rumpf, Patrick Meybohm, Kai Zacharowski, Peter Kranke","doi":"10.1007/s00101-024-01479-1","DOIUrl":"https://doi.org/10.1007/s00101-024-01479-1","url":null,"abstract":"<p><p>Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality worldwide, with an increasing incidence in western countries over the past decades. During this period the numbers of PPH-related allogeneic red blood cell (RBC) transfusions have also significantly increased. Given the increasing scarcity and risks of allogeneic RBC transfusions, which are also associated with adverse maternal outcomes, optimized blood management strategies are urgently needed in obstetrics. In recent years, patient blood management (PBM) has been increasingly integrated into medical care, resulting in a significant improvement in patient outcomes. Cell salvage (CS) is one of the PBM blood-sparing techniques that enables the collection, processing and retransfusion of the patient's own blood during major bleeding events. Although recent evidence indicates that CS can significantly reduce the demand for allogeneic RBC transfusions and improve patient outcomes, the utilization in obstetrics in German hospitals remains low, with a usage rate of only 0.07% of births with peripartum hemorrhage. It must be assumed that concerns about patient-related complications, such as amniotic fluid embolism and maternal alloimmunization contribute to this hesitancy, alongside a lack of familiarity with the technique. This article provides an overview of the current evidence on the use and safety of CS in obstetrics. To facilitate a practical implementation, fundamental considerations and organizational precautions were prepared based on the experiences of the University Hospitals in Würzburg and Frankfurt and presented in the form of graphics and checklists for the perioperative use of CS during cesarean sections.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633808","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":"[Palliative neurology].","authors":"K Amadori, T Steiner","doi":"10.1007/s00101-024-01476-4","DOIUrl":"10.1007/s00101-024-01476-4","url":null,"abstract":"<p><p>Palliative medicine represents the holistic multiprofessional treatment of severely and incurably ill people and their relatives, addressing their complex physical, psychological, social and spiritual needs. The central therapeutic goals are the quality of life and alleviation of suffering. In the course of many neurological diseases, high symptom burden, long and variable trajectories and unfavorable prognosis at times create a need for palliative care even at an early stage, which is currently still inadequately met. This can be countered by qualified neuropalliative care. In addition to intensifying interdisciplinary collaboration, this requires neurologists to have core competencies in palliative care. These include a team-oriented attitude, communication skills, expertise in symptom control and knowledge of biomedical ethics including palliative options at the end of life.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"781-790"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514052","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":"[Prehospital blood transfusion : Opportunities and challenges for the German emergency medical services].","authors":"Jens Schwietring, Dirk Wähnert, Lucas Sebastian Scholl, Karl-Christian Thies","doi":"10.1007/s00101-024-01463-9","DOIUrl":"10.1007/s00101-024-01463-9","url":null,"abstract":"<p><strong>Background: </strong>Exsanguination is the leading cause of preventable death in severe trauma. Immediate hemorrhage control and transfusion of blood products are critical to maintain oxygen delivery and address trauma-induced coagulopathy. While prehospital blood product transfusion (PHBT) is established in neighboring countries, the fragmented configuration of Germany's emergency medical service (EMS) infrastructure has delayed the adoption of widespread PHBT programmes. This review aims to provide an updated perspective on the evolution, international practices and research needs of PHBT within the German context.</p><p><strong>Methods: </strong>This narrative review is based on a PubMed search using the search terms \"prehospital\" and \"blood*\". From an initial 4738 articles, 333 were directly related to PHBT and were subjected to further detailed examination. The literature, including referenced studies, was categorized into areas such as history, rationale, international practices, and evidence, and analyzed for quality.</p><p><strong>Results: </strong>The benefit of early blood transfusion in major trauma has been established since WW1, explaining the efforts to initiate this lifesaving intervention as early as possible in the care pathway, including the prehospital field. Recent randomized trials have faced design and recruitment challenges, reflecting the complexity of the research question. These trials have yielded inconclusive results regarding the survival benefits of PHBT in civilian settings. This scenario raises doubts about the capability of randomized trials to resolve questions concerning survival advantages. Despite these difficulties, there is a discernible trend indicating potential improvements in patient outcomes. In Germany, the incidence of trauma-associated shock stands at 38 per 100,000 individuals per year. It is estimated that between 300 and 1800 patients annually possibly benefit from PHBT.</p><p><strong>Conclusion: </strong>Prehospital Blood Transfusion appears to be promising but identifying patient groups most likely to benefit as well as the most suitable blood products remain unresolved issues. In Germany PHBT programs are not yet widely established. Paradoxically, this situation, paired with the extensive German Trauma Registry, provides a prime opportunity for comprehensive prospective cohort studies, addressing the balance between PHBT benefits, logistical feasibility, and implementation strategies. Such studies are essential for establishing guidelines and integrating PHBT efficiently into German trauma care protocols.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"760-770"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360714","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":"Inferior vena cava collapsibility index for predicting hypotension after spinal anesthesia in patients undergoing total knee arthroplasty.","authors":"Yang Liu, Ziyu Han, Jianhua Wang, Qiujun Wang, Xiaojuan Qie","doi":"10.1007/s00101-024-01468-4","DOIUrl":"10.1007/s00101-024-01468-4","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify risk factors associated with hypotension in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia.</p><p><strong>Method: </strong>A total of 200 patients (50-75 years of age) who underwent elective TKA under spinal anesthesia between October 2023 and January 2024 were enrolled. Patients were divided into two groups (hypotensive and nonhypotensive) depending on the occurrence of postspinal anesthesia hypotension (PSAH). Patient characteristics (age, sex, body mass index, and medical history), blood pressure, heart rate, and ultrasound data before anesthesia were documented. Multivariate logistic regression models were used to determine risk factors for hypotension after spinal anesthesia. Furthermore, a nomogram was constructed according to independent predictive factors. The area under the curve (AUC) and calibration curves were employed to assess the performance of the nomogram.</p><p><strong>Results: </strong>In total, 175 patients were analyzed and 79 (45.1%) developed PSAH. Logistic regression analysis revealed that variability of the inferior vena cava (odds ratio, OR, 1.147; 95% confidence interval, CI: 1.090-1.207; p < 0.001) and systolic arterial blood pressure (SABP, OR 1.078; 95% CI: 1.043-1.115; p < 0.001) were independent risk factors for PSAH. Receiver operating characteristic (ROC) curve analysis showed that the AUC of the inferior vena cava collapsibility index (IVCCI) and SABP alone were 0.806 and 0.701, respectively, while the AUC of both combined was 0.841. Specifically, an IVCCI of > 37.5% and systolic arterial blood pressure of > 157 mm Hg were considered threshold values. Furthermore, we found that the combination had a better predictive value with higher AUC value, sensitivity, and specificity than the index alone. The nomogram model and calibration curves demonstrated the satisfactory predictive performance of the model.</p><p><strong>Conclusion: </strong>Elevated preoperative systolic arterial blood pressure and a higher IVCCI were identified as independent risk factors for hypotension in patients receiving spinal anesthesia, which may help guide personalized treatment.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"735-742"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395715","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":"[\"I know that I know nothing\"-Intraoperative blood pressure management in pediatric anesthesiology].","authors":"Katharina Röher, Bernd Saugel","doi":"10.1007/s00101-024-01470-w","DOIUrl":"https://doi.org/10.1007/s00101-024-01470-w","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":"73 11","pages":"721-723"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549304","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":"[Focus emergency medicine 2023/2024-Summary of selected studies in emergency medicine].","authors":"S Katzenschlager, M Obermaier, N Kaltschmidt, J Bechtold, W Spöttl, M Dietrich, M A Weigand, F Weilbacher, E Popp","doi":"10.1007/s00101-024-01465-7","DOIUrl":"10.1007/s00101-024-01465-7","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"746-759"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333693","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":"Anesthesia management of a patient with severe post-rheumatic mitral stenosis undergoing cesarean section.","authors":"Stanislaw Vander Zwaag, Johan Winata, Cahit Birdir, Barbara Seipolt, Stephan Haussig, Jens Fassl","doi":"10.1007/s00101-024-01469-3","DOIUrl":"10.1007/s00101-024-01469-3","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"743-745"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402206","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}