Die Anaesthesiologie最新文献

{"title":"[Epidural anesthesia in thoracic and abdominal surgery : Current perspectives and practical implications].","authors":"Daniel M Pöpping, Wiebke Gogarten","doi":"10.1007/s00101-025-01528-3","DOIUrl":"https://doi.org/10.1007/s00101-025-01528-3","url":null,"abstract":"<p><p>With the rise of minimally invasive and robot-assisted surgical techniques, the role of epidural anesthesia (EA) in modern practice necessitates careful re-evaluation. This review explores the relevance of EA in thoracic and abdominal surgery, examining its practical applications, residual indications and considerations for its use. Additionally, alternative pain management strategies, including systemic analgesia, regional nerve blocks and novel perioperative approaches, are assessed for advantages and limitations compared to EA.Traditionally the gold standard for perioperative pain control in thoracic and abdominal procedures, EA provides superior analgesia, reduced pulmonary complications and promotes early postoperative mobilization; however, the shift towards less invasive types of surgery has raised questions about the necessity and risk-benefit profile of EA. Complications such as hypotension, hematoma and rare neurological injuries emphasize the importance of thorough risk assessment.Emerging data show that alternative methods, such as transversus abdominis plane (TAP) blocks, paravertebral blocks and multimodal analgesia provide comparable efficacy in specific patient groups while often demonstrating a better safety profile. Nevertheless, EA remains essential in extensive thoracic surgery, complex abdominal resections and in patients with a high risk for severe postoperative pain or respiratory compromise. Combining EA with enhanced recovery after surgery (ERAS) protocols has also shown promise in improving outcomes.In conclusion, while minimally invasive surgical techniques have transformed perioperative care, EA retains a critical role in selected indications. Individualized planning of anesthesia, weighing EA against evolving alternatives and tailored to surgical and patient-specific factors, is essential. This review highlights the integration of evidence-based strategies to optimize the role of EA in contemporary surgical treatment.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805022","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":"https://doi.org/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":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","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}

{"title":"[Environmental sustainability in intensive care medicine].","authors":"Martin Schuster, Thomas Bein","doi":"10.1007/s00101-024-01485-3","DOIUrl":"10.1007/s00101-024-01485-3","url":null,"abstract":"<p><p>Intensive care medicine is an area with a particularly high consumption of resources. This review presents important new findings relating to the environmental sustainability of intensive care medicine. For example, the drugs used in intensive care medicine can end up in the environment and cause relevant ecotoxicity. The consumption of material items is very high in intensive care medicine and the increasing replacement of reusable items by disposable items is a major problem. Simple measures can reduce the ecological footprint of materials and introduce the recycling of waste in intensive care units. The high energy consumption of air conditioning, lighting and medical technology varies between facilities but in most cases is substantial and can be significantly reduced through appropriate measures. Ideally, the consumption should be measured and analyzed in detail. In the future, support from artificial intelligence is conceivable in this aspect. Sustainability must be given a much higher priority in the training, continued and advanced education in intensive care medicine than it has been to date and in intensive care research sustainability aspects should be given equal consideration alongside economic aspects when it comes to assessing otherwise equivalent treatments. It is particularly important to avoid the misuse and overuse of intensive care. It brings no benefit to patients and hinders needs-based treatment that is oriented towards the patient's well-being. In addition, misuse and overuse increases costs and drives up the consumption of resources and thus the ecological footprint. Sustainability in the intensive care unit can only be achieved as a team. Various approaches are presented on how a networked Green Team can promote sustainability in the intensive care unit.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"189-203"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820188","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":"[Neuromuscular management: state of the art and outlook].","authors":"Thomas Fuchs-Buder, Harald J Sparr","doi":"10.1007/s00101-025-01526-5","DOIUrl":"https://doi.org/10.1007/s00101-025-01526-5","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":"74 4","pages":"204-206"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736197","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":"[Nontechnical skills in anesthesiology-Implementation].","authors":"M St Pierre, H Hellwig, F Krischke, C Neuhaus","doi":"10.1007/s00101-025-01514-9","DOIUrl":"10.1007/s00101-025-01514-9","url":null,"abstract":"<p><p>In the second of two articles the practical application of nontechnical skills in anesthesiological patient care is presented. Based on the categories of the behavioral marker system anesthesia nontechnical skills (ANTS), the skills situational awareness, decision making, task management, teamwork and communication are discussed. For each category the terminology is clarified and the reasons for support through nontechnical skills and their specific application are given. Tips for everyday life should make practical implementation easier. Finally, the health economic question of the extent to which there is a return on investment for the training of nontechnical skills is discussed and the perspective of safety research on the demands of evidence-based medicine (EBM) for analytical empiricism and measurability of the effects of training of nontechnical skills on patient safety is presented.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"229-243"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460989","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":"[Work sustainably as a guarantee for the future?]","authors":"Janett Kreutziger","doi":"10.1007/s00101-025-01522-9","DOIUrl":"https://doi.org/10.1007/s00101-025-01522-9","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":"74 4","pages":"187-188"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736198","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":"[Recommendations for time-limited trial in neurocritical care].","authors":"Angelika Alonso, Annette Rogge, Patrick Schramm, Urs Münch, Susanne Jöbges","doi":"10.1007/s00101-025-01516-7","DOIUrl":"10.1007/s00101-025-01516-7","url":null,"abstract":"<p><p>Many acute brain disorders are associated with acute disorders of consciousness. In an emergency situation, life-saving measures are usually taken first and intensive care is initiated. If there is no significant improvement with recovery of consciousness in the first few days, very complex decision-making situations arise regularly. In neurointensive care, a time-limited therapy trial (TLT) is an important structuring element in treatment planning and communication, as a binding agreement between the treatment team and the patient or legal representative on a treatment concept for a defined period of time. Due to the prolonged neurological rehabilitation phase, the TLT in neurointensive care can also last weeks or months. This often requires interdepartmental communication (acute/rehabilitation/long-term care), re-evaluation and implementation in neurointensive care. The recommendations include the definition, empirical evidence and implementation suggestions for a TLT for critically ill neurointensive care patients.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"221-228"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652327","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":"[Management of neuromuscular block during general anesthesia : Results of a survey in Germany in 2020 compared to the recommendations of the first European guidelines in 2023].","authors":"Jens Soukup, Friederike Sophie Menzel, Michael Bucher, Matthias Menzel","doi":"10.1007/s00101-025-01511-y","DOIUrl":"10.1007/s00101-025-01511-y","url":null,"abstract":"<p><p>Since the last surveys on the utilization of muscle relaxants in general anesthesia in 2000 and 2005, it can be assumed that the introduction of sugammadex for the rapid and safe reversal of neuromuscular blocks as well as the establishment of new surgical techniques, have had an impact on the use of muscle relaxants in general anesthesia. A web-based questionnaire was used to survey anesthesia departments and outpatient surgery centers regarding the use of neuromuscular blocking agents. The aim was a comparison with previous surveys and the statistical analysis was descriptive. The response rate of the 1027 anesthesia departments contacted was 16.5%. The availability of neuromuscular monitoring in hospitals continues to improve. The most frequently used drug for rapid sequence induction is now rocuronium rather than succinylcholine. Sugammadex is now available as a drug in 86% of the responding anesthesia departments. The concept of complete relaxation for laparoscopic surgery called deep block is used by 60% of those surveyed. The results are analyzed and discussed in the context of the first European guidelines published in 2023 by the European Society of Anaesthesiology and Intensive Care (ESAIC). They show that with respect to the use of succinylcholine and the support by new surgical techniques have changed the management of neuromuscular block since the last surveys. The use of neuromuscular monitoring to control the management of muscle relaxation is still not standard in all hospitals, so that an additional patient risk cannot be ruled out.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"207-217"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560268","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":"[Flumazenil infusion in subacute bromazepam intoxication due to chronic abuse].","authors":"Philippe Conter, Antonia Fritz","doi":"10.1007/s00101-025-01523-8","DOIUrl":"10.1007/s00101-025-01523-8","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"218-220"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560266","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":"[Effects of \"new\" antidiabetic drugs on management of anesthesia].","authors":"Bernd Rupprecht, Christian Dumps","doi":"10.1007/s00101-025-01521-w","DOIUrl":"https://doi.org/10.1007/s00101-025-01521-w","url":null,"abstract":"<p><p>Around 9 million people live with diabetes mellitus (DM) in Germany. Around 500,000 new cases are documented every year. In addition, it must be assumed that there are at least 2 million unreported cases. The proportion of patients with type 2 DM is by far the highest and it is currently estimated that around 340,000 adults and 32,000 children are affected by type 1 DM [1]. People with diabetes have an increased mortality rate; however, this has decreased in recent years, particularly due to a reduction in cardiovascular mortality. \"New\" antidiabetic drugs have certainly played a relevant role in this. Various studies have shown that sodium-glucose Cotransporter 2 inhibitors (SGLT2 inhibitors) in particular but also glucagon-like peptide‑1 receptor agonists (GLP1-RA), have a significant benefit in patients with heart failure [2-5]. Surprisingly, this effect was also detectable in patients without DM [6]. Thus, the group of people who are treated with an SGLT2 inhibitor or a GLP1-RA has been expanded to include people who suffer from heart failure not associated with diabetes. This applies both to patients with reduced left ventricular systolic function (heart failure with reduced ejection fraction, HFrEF) and with preserved or mildly reduced systolic function (heart failure with preserved/mildly reduced ejection fraction, HFpEF/HFmrEF) [7]. In Germany heart failure is the most common diagnosis for hospitalization (40.6 cases/10,000 insurance years) and diseases of the cardiovascular system are the most common cause of death [8]. The increased risk of morbidity and mortality is also reflected in the perioperative setting.In addition to the risks posed by DM itself or associated diseases, the treatment with antidiabetic drugs can also lead to perioperative complications. This article focuses on the drug-related risks of the \"new\" antidiabetic drugs and draws conclusions regarding the management of anesthesia. The potentially life-threatening euglycemic diabetic ketoacidosis (eDKA) can be a perioperative side effect of SGLT2 inhibitors; however, the diagnosis is associated with hurdles. The GLP1-RAs are also increasingly being prescribed as they reduce cardiovascular risk and make weight loss much easier. GLP1-RAs delay gastric emptying, which potentially results in an increased risk of aspiration. In particular, if other risk factors for aspiration exist, patients should not be considered fasting, if the recommended break in GLP1‑RA intake has not been followed.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756276","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}