Die Anaesthesiologie最新文献

{"title":"[Nonpharmacological interventions in perioperative pain management].","authors":"Marco Richard Zugaj, Joachim Erlenwein, Winfried Meißner, Jens Keßler","doi":"10.1007/s00101-026-01750-7","DOIUrl":"https://doi.org/10.1007/s00101-026-01750-7","url":null,"abstract":"<p><p>Nonpharmacological interventions can substantially improve the effectiveness of perioperative pain management. Positive, realistic information and goal setting, together with the deliberate use of communication strategies and placebo effects, can positively influence the experience of pain. Maladaptive cognition and an unnecessary focus on pain can intensify pain perception. Physiotherapy, transcutaneous electrical nerve stimulation (TENS) and acupuncture can be used as adjunctive treatment for selected indications. Music, quiet, appropriate lighting, a pleasant environment and personal belongings are easily implemented environmental factors with potential benefits. Nonpharmacological interventions are not a substitute for established postoperative pharmacological analgesia; however, as low-risk, patient-centered components they should form an integral part of multimodal treatment strategies. Clear responsibilities, appropriate training, interprofessional coordination and realistic patient selection are prerequisites for successful implementation. This article provides a practical overview of the targeted use of these techniques and strategies.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229414","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":"[Local anesthetic systemic toxicity-Part 2: treat and prevent : Acute management including lipid rescue and preventive strategies].","authors":"Stephanie Nolte, Thomas Wiesmann, Wolfgang Zink, York Zausig, Felix C F Schmitt, Ann-Kristin Schubert","doi":"10.1007/s00101-026-01744-5","DOIUrl":"https://doi.org/10.1007/s00101-026-01744-5","url":null,"abstract":"<p><p>In cases of local anesthetic systemic toxicity (LAST) early recognition, the immediate establishment of adequate oxygenation and hemodynamic stability and adherence to specific considerations regarding resuscitation are of critical importance. Intravenous lipid emulsion treatment remains a central component of therapeutic management in this context. Preventive measures aimed at avoiding LAST rely less on isolated interventions than on an integrative, multimodal concept that encompasses both human factors and procedure-specific risk reduction strategies. These measures include, among others, the selection and dosing of the local anesthetic, the consistent use of ultrasound guidance (where the procedure permits), fractionated injection and repeated aspiration as well as the availability of standardized emergency algorithms alongside regular team training. Only through the interplay of these measures can effective prevention and successful management of LAST be achieved in daily clinical practice.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225285","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":"[Using opportunities, whilie putting effectiveness into perspective: Perioperative pain therapy without drugs].","authors":"Michael Schäfer","doi":"10.1007/s00101-026-01755-2","DOIUrl":"https://doi.org/10.1007/s00101-026-01755-2","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198089","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":"[What is new … in blood management for Jehovah's Witnesses. Updated position on the use of blood components].","authors":"Florian Piekarski, Josefin Grabert","doi":"10.1007/s00101-026-01756-1","DOIUrl":"https://doi.org/10.1007/s00101-026-01756-1","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186621","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":"[Local anesthetic systemic toxicity-Part 1: recognizing and understanding : Pathophysiology, risk factors and clinical presentation].","authors":"Stephanie Nolte, Thomas Wiesmann, Wolfgang Zink, York Zausig, Felix C F Schmitt, Ann-Kristin Schubert","doi":"10.1007/s00101-026-01743-6","DOIUrl":"https://doi.org/10.1007/s00101-026-01743-6","url":null,"abstract":"<p><p>Local anesthetic systemic toxicity (LAST) is a rare but potentially life-threatening complication of regional anesthesia. The increasing popularity of regional anesthesia of all kinds means that the risk of encountering LAST in clinical practice is nevertheless real.Part 1 of this CME-article focuses on the recognition and understanding of LAST, providing an up-to-date overview of its pathophysiology, risk factors, and clinical presentation.The pathophysiological processes underlying local anesthetic systemic toxicity (LAST) stem from the interplay of various complex molecular mechanisms involving ion channels within the central nervous system, the myocardium and peripheral vasculature. Furthermore, the cardiac toxicity associated with LAST can be partly explained by a pronounced dysregulation of mitochondrial energy metabolism. Clinically, LAST manifests as a broad and often atypical spectrum of neurological and cardiac symptoms, which do not necessarily occur in a defined sequence. Specific and important risk factors arise from extreme age groups, pre-existing medical conditions (particularly those affecting the cardiac and metabolic systems), the choice of regional anesthesia technique and the dosing of the local anesthetic. Building upon this foundation, part 2 of this article addresses the management and prevention of LAST and presents strategies for acute management (including lipid rescue) and prophylaxis.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186658","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":"[Airway management in penetrating cervicofacial trauma: importance of fiberoptic intubation in anticipated difficult airways].","authors":"Ladina Jungck, Christoph Konrad, Thomas Arnold, Michèle Schöb, Robert Herr","doi":"10.1007/s00101-026-01749-0","DOIUrl":"https://doi.org/10.1007/s00101-026-01749-0","url":null,"abstract":"<p><p>Penetrating injuries of the face and neck region pose a particular challenge for airway management. In a 54-year-old male patient with a penetrating mandibular injury caused by an industrial robotic arm, an awake nasal fiberoptic intubation (FOI) was performed in the sitting position because a difficult airway was anticipated. This case highlights the importance of this procedure in situations where a difficult airway is expected.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168291","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":"Therapeutische Verarmung in der Anästhesiologie – schneller als gedacht? Remimazolam als aktuelles Menetekel.","authors":"Peter Kranke, Daniel Chappell","doi":"10.1007/s00101-026-01741-8","DOIUrl":"https://doi.org/10.1007/s00101-026-01741-8","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149255","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":"[Core data set telemedicine in intensive care medicine. Requirement catalogue via Delphi study].","authors":"Sandra Dohmen, Bettina Jungwirth, Felix Balzer, Jens-Christian Schewe, Daniel Röder, Christiane Maria Schewe","doi":"10.1007/s00101-026-01745-4","DOIUrl":"https://doi.org/10.1007/s00101-026-01745-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Telemedicine in intensive care medicine has not yet been uniformly defined or standardized in its implementation in Germany. While the evidence predominantly comes from nonrandomized US studies, German randomized controlled studies (RCT) show potential for improving guideline-compliant treatment. The aim is to develop a consensus-based core data set that standardizes teleconsultations, strengthens data-based care processes and enables future artificial intelligence (AI)-supported analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;The Delphi study, conducted according to the CREDES standard, comprised three rounds with a panel of experts from the German Society of Anesthesiology and Intensive Care Medicine. Documentation templates were extracted, parameters catalogued and iteratively evaluated. Consensus threshold-controlled inclusion or exclusion. Anonymized data analysis was performed descriptively using Excel, supplemented by approval rates and consensus levels.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the first round, 8 of the 12 participants (66.6%) submitted their documentation templates. The initial catalogue created on this basis contained 95 parameters (e.g., patient name, body temperature, mean arterial pressure), which the steering committee classified into 16 categories, such as consultation-related data, imaging and diagnostics, or laboratory values. In the second round, feedback was received from all participants (12/12, 100%) of the expert panel. After applying the exclusion criteria, 7 parameters were removed from the catalogue and 37 new parameters were added. These 125 parameters were then reassigned by the steering group to the categories formed in the first round. In the third round evaluation of the remaining 125 parameters was received from 10 of the 12 participants (83.3%) of the expert panel. Of these, 31 parameters (24.8%) were excluded, 73 (58.4%) were classified as optional and 21 parameters (16.8%) were classified as mandatory. The consensus level rose from 75% to 90%. All categories achieved stable consensus values, thus fulfilling the termination criterion of content saturation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This consensus-based core data set could contribute to consistent and reproducible documentation of telemedicine consultations. Also, a mandatory integration of the required parameters into existing clinical documentation systems as well as the early adaptation of technical interfaces, are further key prerequisites for sustainable implementation. Beyond implementation, the catalogue can support harmonization among Tele-ICU networks, facilitate the benchmarking of consultation processes and provide a structured foundation for future multicenter analyses. In particular, the distinction between mandatory and optional parameters enables a pragmatic balance between clinical relevance, documentation burden and local technical readiness. Consistent use of the core data set supports guideline-based pr","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119583","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":"[Stress, allostasis and organ failure : On the 90th anniversary of the first description of the \"general adaptation syndrome\"].","authors":"Michael Bauer, Reinhard Wetzker","doi":"10.1007/s00101-026-01735-6","DOIUrl":"10.1007/s00101-026-01735-6","url":null,"abstract":"<p><p>A groundbreaking paper by the endocrinologist Hans Selye was published in Nature 90 years ago in which he developed a comprehensive theory of the g adaptation syndrome in organisms responding to harmful stimuli. Selye observed stereotypical hormonal reactions in rats subjected to a wide variety of physical and chemical irritants and later on introduced the now ubiquitous term \"stress\" to describe these phenomena. He borrowed the term from physics (stress and strain), where it describes the deformation of a solid body by applied forces. Selye later conceded that in a biomedical context, it would have been more accurate to use the effects of stress, i.e., strain, to describe the general adaptation syndrome rather than the triggering factors. Analogous to overstretching a solid until it fractures, exceeding the repair and defence systems of living organisms leads to a point of no return, characterized by organ damage and ultimately death. Selye's research has fundamentally contributed to our understanding of injury responses particularly in intensive care medicine. For example, trauma-induced stress effects in surgical patients can be successfully modulated through analgesia and sedation. This review aims to explain the advances in medical stress research, particularly the concepts of allostasis and hormesis and their underlying molecular mechanisms for medical actions, using the paradigm of organ failure in sepsis as an example.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"723-730"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042261","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":"[Left ventricular heart failure during elective pediatric tonsillectomy].","authors":"Eric Haffner, Rouven Kubicki, Olaf Ebeling, Georg Mols","doi":"10.1007/s00101-026-01718-7","DOIUrl":"10.1007/s00101-026-01718-7","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"716-719"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610716","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}