Die Anaesthesiologie最新文献

[Informed consent and documentation in anesthesiology]. [麻醉学中的知情同意和文件]。

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Die Anaesthesiologie Pub Date : 2025-10-09 DOI: 10.1007/s00101-025-01601-x

Christina Schumann, Stephanie Wiege, Philipp Simon

引用次数: 0

Breaking with tradition: perioperative care without fasting or medication changes for diabetic foot surgery. 打破传统：糖尿病足手术的围手术期护理，无需禁食或药物改变。

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Die Anaesthesiologie Pub Date : 2025-10-06 DOI: 10.1007/s00101-025-01598-3

Ahmet Murat Gül, Gülsen Keskin, Aslı Dönmez, Serkan Solak, İbrahim Yılmaz, Hikmet Erhan Güven

{"title":"Breaking with tradition: perioperative care without fasting or medication changes for diabetic foot surgery.","authors":"Ahmet Murat Gül, Gülsen Keskin, Aslı Dönmez, Serkan Solak, İbrahim Yılmaz, Hikmet Erhan Güven","doi":"10.1007/s00101-025-01598-3","DOIUrl":"https://doi.org/10.1007/s00101-025-01598-3","url":null,"abstract":"Background: This study explores a new approach for managing high-risk diabetic patients undergoing diabetic-foot surgery, where traditional practices like preoperative fasting and medication changes are bypassed. We aimed to assess the safety and complications of using a popliteal-sciatic nerve block in this unique scenario, while also evaluating the impact on blood glucose levels and surgeon satisfaction.Methods: The study included high-risk patients classified in the American Society of Anesthesiologists (ASA) III group, where general anesthesia was avoided due to elevated risk factors. Crucially, patients maintained their regular daily routines, with no changes to their medication regimen and they were not required to fast. After enjoying a light breakfast, patients were prepped with standard monitoring and an ultrasound-guided popliteal-sciatic block was performed with the patient in the prone position. Data on patient outcomes and surgeon satisfaction were recorded and analyzed.Results: A total of 320 blocks were performed as some of the 142 patients required multiple surgical interventions. All of these patients successfully underwent surgery without the need for general anesthesia. Surgeon satisfaction was remarkable high, with a mean score of 4.6 ± 0.8 on a 5-point Likert scale (1 = very poor, 5 = very good), and only 1 patient (0.3%) developed a postoperative hematoma. Patients who did not require sedatives (midazolam) and additional analgesics (fentanyl) had higher surgeon satisfaction scores.Conclusion: Our findings reveal that for high-risk patients with chronic conditions, a popliteal-sciatic nerve block offers a safe and effective alternative for diabetic foot surgery, eliminating the need for fasting or medication adjustments. This method not only ensures patient safety but also potentially setting a new standard in perioperative care.","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234449","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}

引用次数: 0

[Words like medicine-Therapeutic communication in anesthesia]. [医学类词汇-麻醉中的治疗沟通]。

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Die Anaesthesiologie Pub Date : 2025-10-01 DOI: 10.1007/s00101-025-01588-5

Ernil Hansen

引用次数: 0

[Arrival times of emergency services in out-of-hospital cardiac arrest-Survival-relevant differences between federal states in Germany]. [院外心脏骤停急诊服务到达时间——德国联邦各州与生存相关的差异]。

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Die Anaesthesiologie Pub Date : 2025-10-01 Epub Date: 2025-09-16 DOI: 10.1007/s00101-025-01592-9

Matthias Fischer, Ulf Harding, Harald Genzwürker, Stephan Seewald, Peter Gretenkort, Florian Reifferscheid

{"title":"[Arrival times of emergency services in out-of-hospital cardiac arrest-Survival-relevant differences between federal states in Germany].","authors":"Matthias Fischer, Ulf Harding, Harald Genzwürker, Stephan Seewald, Peter Gretenkort, Florian Reifferscheid","doi":"10.1007/s00101-025-01592-9","DOIUrl":"10.1007/s00101-025-01592-9","url":null,"abstract":"Background: The response time (\"Hilfsfrist\") in Germany is an important planning parameter that determines the arrival times of emergency medical services and is regulated by state legislation. This study analyzes arrival times in the German federal states.Material and method: The German Resuscitation Registry uniformly records arrival times for the first vehicle on the scene and the complete team (team arrival time: ambulance and emergency physician) nationwide. The statistical testing of the null hypothesis, equality between the federal states, was conducted using the Kruskal-Wallis test. Binary logistic regression analyses were used to examine the impact of arrival times on survival rates.Results: The null hypothesis had to be rejected (p < 0.001), indicating that arrival times differ between the federal states (first vehicle: mean arrival times ranged from 5.7 ± 2.6 min to 7.4 ± 3.5 min; 90th percentile: 9-13 min; team arrival time ranged from 8.6 ± 3.6 min to 11.9 ± 5.9 min; 90th percentile: 13-21 min; 2014-2024: n = 104,657; 201 ambulance services). In 10 out of 16 federal states, fewer than 80% of patients were reached by the first vehicle within 8 min. The regression analyses showed that longer arrival and team arrival times were negatively associated with good neurological recovery at discharge (team arrival time ≥ 12 min: odds ratio, OR =0.54, confidence interval, CI =0.39-0.75, p < 0.001; n = 45,873; 71 reference emergency medical services, EMS, sites).Conclusion: Patients receive qualitatively different levels of care across the federal states due to variations in arrival times. Shorter arrival times are associated with better chances of survival. Equal quality of care is a constitutional requirement by the German constitution but it is not being achieved.","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"634-645"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12484265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076587","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}

引用次数: 0

[Treatment and support for adults at the end of life in intensive care. A recommendation by the Ethics Section of DIVI and the German Society for Palliative Medicine. : Part 2: Therapeutic measures and support at the end of life in intensive care]. [在重症监护中为生命末期的成年人提供治疗和支持。DIVI伦理科和德国姑息医学学会的建议。[第2部分：重症监护生命末期的治疗措施和支持]。

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Die Anaesthesiologie Pub Date : 2025-10-01 Epub Date: 2025-08-29 DOI: 10.1007/s00101-025-01570-1

Kathrin Knochel, Iris Barndt, Gunnar Duttge, Jochen Dutzmann, T Johanna Eggardt, Kristina Fuest, Stefan Meier, Andrej Michalsen, Friedemann Nauck, Martin Neukirchen, Ulrike Olgemöller, Raffael Riegel, Manuela Schallenburger, Alexander Supady, Susanne Jöbges

{"title":"[Treatment and support for adults at the end of life in intensive care. A recommendation by the Ethics Section of DIVI and the German Society for Palliative Medicine. : Part 2: Therapeutic measures and support at the end of life in intensive care].","authors":"Kathrin Knochel, Iris Barndt, Gunnar Duttge, Jochen Dutzmann, T Johanna Eggardt, Kristina Fuest, Stefan Meier, Andrej Michalsen, Friedemann Nauck, Martin Neukirchen, Ulrike Olgemöller, Raffael Riegel, Manuela Schallenburger, Alexander Supady, Susanne Jöbges","doi":"10.1007/s00101-025-01570-1","DOIUrl":"10.1007/s00101-025-01570-1","url":null,"abstract":"Life in an intensive care unit (ICU) involves the successful use of life-sustaining treatment and patients dying. In intensive care medicine, allowing a patient to die often means discontinuing life-sustaining measures. Together with the severity of the illness, this has a significant impact on the course of the dying process. End of life treatment and support focus on alleviating symptoms. The interprofessional team's task in the ICU is to anticipate, plan and implement palliative measures. A family-centered approach to palliative care requires providing human resources for psychosocial support and spiritual care for those affected. Implementing internal recommendations for action improves the quality of care. Training in the necessary skills to support people at the end of life is an integral component of education and ongoing professional development. This training includes basic knowledge of palliative care as well as specific knowledge about terminating life-sustaining measures.","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"675-682"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12484259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980879","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}

引用次数: 0

[Sodium-Glucose Cotransporter-2 (SGLT-2) inhibitors in perioperative medicine : Effects, side effects and current recommendations]. [钠-葡萄糖共转运蛋白-2 （SGLT-2）抑制剂在围手术期医学中的作用、副作用和目前的建议]。

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Die Anaesthesiologie Pub Date : 2025-10-01 DOI: 10.1007/s00101-025-01580-z

Johannes Nienhaus, Theresa Tenge, Sophia Riesemann, Detlef Kindgen-Milles, Giovanna Lurati Buse, René MʼPembele, Sebastian Roth

{"title":"[Sodium-Glucose Cotransporter-2 (SGLT-2) inhibitors in perioperative medicine : Effects, side effects and current recommendations].","authors":"Johannes Nienhaus, Theresa Tenge, Sophia Riesemann, Detlef Kindgen-Milles, Giovanna Lurati Buse, René MʼPembele, Sebastian Roth","doi":"10.1007/s00101-025-01580-z","DOIUrl":"10.1007/s00101-025-01580-z","url":null,"abstract":"Sodium-glucose Cotransporter 2 (SGLT-2) inhibitors are oral antidiabetic drugs that were developed for the treatment of patients with diabetes mellitus and are now also approved for treating chronic heart failure and chronic kidney disease. By inhibiting SGLT‑2 in the proximal renal tubule, urinary excretion of glucose is increased. Large randomized trials have demonstrated improved glycemic control, reduced cardiovascular events and lower mortality but also an increased risk of urogenital infections and dehydration. Of particular concern is an increasing number of reports describing postoperative (euglycemic) ketoacidosis in patients on treatment with SGLT-2 inhibitors, which is a rare but potentially life-threatening side effect which is difficult to detect. The extremely limited data situation is reflected in the heterogeneous recommendations, surgical stress, prolonged fasting and metabolic changes are considered key triggers. International guidelines recommend withholding SGLT-2 inhibitors 3-4 days before elective surgery, whereas an increase in undesired events has been described when discontinuing the medication in patients with heart failure. This indicates that a one-size-fits-all approach is unsuitable and an individualized, risk-stratified strategy that considers the risk of surgery, fasting duration and ketone monitoring appears to be more appropriate. The lack of evidence for the approach in emergency situations, limited availability of blood ketone testing and unclear guidance on when to restart treatment further complicate perioperative management. This review outlines the effects and side effects of SGLT-2 inhibitors and summarizes the current recommendations for perioperative management.","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"655-664"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031260","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}

引用次数: 0

[Anticoagulation During Hospitalization for COVID-19]. 【COVID-19住院期间抗凝治疗】。

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Die Anaesthesiologie Pub Date : 2025-10-01 DOI: 10.1007/s00101-025-01585-8

Walter Hasibeder

引用次数: 0

[Chronic Opioid use After Surgical Procedures]. [外科手术后慢性阿片类药物使用]。

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Die Anaesthesiologie Pub Date : 2025-10-01 DOI: 10.1007/s00101-025-01586-7

Gerhard Fritsch

引用次数: 0

[Perioperative antibiotic prophylaxis-The new German S3 guideline]. [围手术期抗生素预防-新德国S3指南]。

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Die Anaesthesiologie Pub Date : 2025-10-01 Epub Date: 2025-07-29 DOI: 10.1007/s00101-025-01567-w

Rika Draenert, Alexandra Weber, Jette Jung, Lukas Arenz

{"title":"[Perioperative antibiotic prophylaxis-The new German S3 guideline].","authors":"Rika Draenert, Alexandra Weber, Jette Jung, Lukas Arenz","doi":"10.1007/s00101-025-01567-w","DOIUrl":"10.1007/s00101-025-01567-w","url":null,"abstract":"Antimicrobial stewardship (AMS) is a relatively new movement in Germany that aims to rationalize the use of antibiotics. The primary aim is to halt the global rise of bacterial resistance which of course also affects Germany. Perioperative antibiotic prophylaxis is an important topic for AMS. In December 2024 the new S3 guideline on perioperative prophylaxis was published by the Association of the Scientific Medical Societies in Germany (AWMF), which are also presented here.Surgical site infections (SSI) have greatly increased in Germany in recent years. These should be prevented with perioperative antibiotic prophylaxis. Nevertheless, for AMS reasons, the antibiotic prescription of perioperative prophylaxis should be judicious. As many studies have shown, the optimal time for administering antibiotics is 30-60 min before the surgical incision. This interval ensures an adequate antibiotic concentration in skin and subcutaneous tissue. A history of penicillin allergy should be preoperatively questioned as only a small proportion of patients who report a penicillin allergy actually have one; however, beta-lactams are the most important substances for perioperative prophylaxis, alternative substances such as clindamycin are less effective and resistance rates have greatly increased. Multidrug-resistant pathogens (MRE) are now given special consideration: the new guideline lists surgical procedures where MRE should be considered as well as the recommended screening and adjustment of substance selection in this situation. The most important point from the perspective of infectious diseases, however, is the duration of the perioperative antibiotic prophylaxis: it is specified also in the new guidelines (with a few exceptions) as a single dose (plus intraoperative re-dosing in the event of a long duration of surgery or high intraoperative blood loss).The new guidelines excellently summarize the existing data and based on these provide clear recommendations. It thus supports AMS efforts in this area in an exemplary manner.","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"627-633"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735852","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}

引用次数: 0

[Science or art? Perioperative antibiotic prophylaxis from the perspective of anesthesiology]. 科学还是艺术？从麻醉学角度探讨围手术期抗生素预防[j]。

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Die Anaesthesiologie Pub Date : 2025-10-01 DOI: 10.1007/s00101-025-01591-w

Wolfgang A Krüger

引用次数: 0