Die Anaesthesiologie最新文献

{"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}

{"title":"[Intraoperative hypotension in children-Measurement and treatment].","authors":"Sebastian Bratke, Sebastian Schmid, Vijyant Sabharwal, Bettina Jungwirth, Karin Becke-Jakob","doi":"10.1007/s00101-024-01461-x","DOIUrl":"10.1007/s00101-024-01461-x","url":null,"abstract":"<p><p>Intraoperative hypotension is a common perioperative complication in pediatric anesthesia. Oscillometric blood pressure measurement is therefore an essential part of standard perioperative monitoring in pediatric anesthesia. The optimum measurement site is the upper arm. Attention must be paid to the correct cuff size. Blood pressure should be measured before induction. In children undergoing major surgery or in critically ill children, invasive blood pressure measurement is still the gold standard. Continuous noninvasive measurement methods could be an alternative in the future.Threshold values to define hypotension remain unknown, even in awake children. There are also little data on hypotension thresholds in the perioperative setting. The most reliable measurement parameter for estimating hypotension is the mean arterial pressure. The threshold values for intraoperative hypotension are 40 mm Hg in newborns, 45 mm Hg in infants, 50 mm Hg in young children and 65 mm Hg in adolescents. Treatment should be initiated at a deviation of 10% and intensified at a deviation of 20%.Bolus administration of isotonic balanced crystalloid solutions, vasopressors and/or catecholamines are used as treatment options. Consistent and rapid intervention in the event of hypotension appears to be crucial. So far there is no evidence as to whether this leads to an improvement in outcome parameters.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333695","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":"[Evaluation of the hospital emergency plan based on an exercise for a mass casualty incident].","authors":"Chris Speicher, Thomas Wurmb, Gerhard Schwarzmann, Christian Zech, Hendrik Jansen, Dirk Weismann, Friedrich Anger, Mila Paul, Andreas Münch, Martina Ohr, Patrick Meybohm, Maximilian Kippnich","doi":"10.1007/s00101-024-01475-5","DOIUrl":"https://doi.org/10.1007/s00101-024-01475-5","url":null,"abstract":"<p><strong>Background: </strong>The hospital emergency plan is an important tool for hospitals in the management of a mass casualty incident. It is a legal requirement for hospitals to have such plans in place and to carry out drills. Emergency drills are a useful tool for the training of staff and for the evaluation of existing structures. The emergency plan of the University Hospital Würzburg (UKW) was evaluated during a disaster drill based on predefined drill objectives.</p><p><strong>Methods: </strong>The procedures according to the emergency plan of the UKW were practiced during a large-scale disaster exercise. The exercise objectives were defined as: testing the management structure, deployment of personnel, physical organization, triage, patient flow and communication. Several exercise objectives were defined in advance. An anonymized questionnaire was used to evaluate the achievement of the exercise objectives.</p><p><strong>Results: </strong>When properly trained and practiced the UKW emergency plan is generally well-suited to managing a mass casualty event. Improvements need to be made in the communication structure, responsibilities in the treatment areas and staff knowledge of the existing emergency plans and available material.</p><p><strong>Discussion: </strong>Mass casualty drills are a good tool for the evaluation of hospital emergency plans. A critical and decisive element for success is the existence of a clear management and communication structure. A good knowledge of the available material, the contents of the emergency plan and the consistent application of the procedures defined in this plan are essential for a coordinated course of action. This can be achieved by means of regular and mandatory training sessions.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482267","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":"[Digital tools in residency and continuing medical education within the framework of a digital media concept].","authors":"Ulrike Schlüter, Ralf Sowa, Ingmar Finkenzeller, Thomas Mencke, Daniel A Reuter","doi":"10.1007/s00101-024-01466-6","DOIUrl":"https://doi.org/10.1007/s00101-024-01466-6","url":null,"abstract":"<p><p>There are currently many online resources for medical education during residency and beyond in anesthesiology, intensive care, pain, emergency and palliative medicine. From traditional textbooks and in-person events to learning platforms, apps, podcasts, simulation training and even virtual reality, there are many ways to supplement traditional residency curricula and continuing medical education. The coronavirus disease 2019 (COVID-19) pandemic has been instrumental in making medical education content more accessible and, among other things, accelerate the transfer of knowledge.To include all colleagues in the goal of life-long learning using these modern tools, we recommend the development of a digital media concept that is individually tailored to each department of anesthesiology. First, the goals of the department should be defined, e.g., can existing teaching materials be made more digitally accessible for asynchronous learning? Then, department resources should be compiled, e.g., what learning platforms are already being used and if and how social media should play a role? One or more persons should be named responsible and maintain the new concept. In this context, it is essential to develop quality criteria to properly assess the digital content.With the support of the department, conventional teaching methods can be combined with new digital possibilities in residency education and beyond. In this way, individual shift models, various levels of participation in live teaching events and different types of learners can be taken into account. These diverse digital tools can enrich the training and further education of every team member in an anesthesiology department and will accompany us well into the future.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402205","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":"Erratum zu: 55/m mit beginnender Urosepsis.","authors":"S Eilenberger, O Spring","doi":"10.1007/s00101-024-01467-5","DOIUrl":"10.1007/s00101-024-01467-5","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309255","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}