Die Anaesthesiologie最新文献

{"title":"[Environmental sustainability in intensive care medicine].","authors":"Martin Schuster, Thomas Bein","doi":"10.1007/s00101-024-01485-3","DOIUrl":"https://doi.org/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":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-12","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":"[Treatment of cancer-related pain-From pharmacotherapy to invasive procedures].","authors":"Hannes Hofbauer, Stefan Wirz, Peter Steffen, Kristin Kieselbach, Jens Keßler","doi":"10.1007/s00101-024-01488-0","DOIUrl":"https://doi.org/10.1007/s00101-024-01488-0","url":null,"abstract":"<p><p>Depending on the stage of the tumor up to 80% of the patients suffer from cancer-related pain but treatment is often inadequate. Multiple causes can trigger pain and these can be due to the tumor itself, its secondary consequences but also treatment related. A differentiated assessment and individually tailored treatment of cancer-related pain not only improve the quality of life but also reduce the risk of pain chronification. A differentiation between nociceptive pain and pain caused by hypersensitivity is a mandatory requirement for adequate pharmacotherapy. There is a risk of inadequate pain control, particularly with a lack of consideration and treatment of hypersensitivity, e.g., with anticonvulsants or analgesic antidepressants. Opioids are an integral part of drug treatment for cancer-related pain and especially for the treatment of breakthrough cancer pain. The risk of abuse should be considered. Other substance groups are suitable for special pain situations or in cases refractory to treatment. Nonpharmacological treatment options should also be considered, in particular by offering low-threshold access to psychotherapeutic or psycho-oncological options. Invasive procedures can be a useful supplement. These range from patient-controlled subcutaneous or intravenous infusion pump systems and intrathecal drug administration up to neurolytic and ablative procedures. Due to the invasiveness of these procedures, an interdisciplinary approach is recommended to confirm the indications.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820159","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":"Exchange rates of second generation Microcuff® pediatric endotracheal tubes in children weighing more than 3 kg : A retrospective audit.","authors":"Ilka Schmidt-Deubig, Michael Kemper, Pedro D Wendel-Garcia, Markus Weiss, Jörg Thomas, Christian Peter Both, Achim Schmitz","doi":"10.1007/s00101-024-01486-2","DOIUrl":"10.1007/s00101-024-01486-2","url":null,"abstract":"<p><strong>Background: </strong>Cuffed endotracheal tubes (cETT) pose the potential advantage of an infrequent need for reintubation in pediatric patients compared to uncuffed tubes. The aim of this study was to investigate tube exchange rates using second generation Microcuff® pediatric endotracheal tubes (PET) with an adapted sizing recommendation in a large single institution cohort of children and to identify potential variables associated with an elevated risk of tube exchange.</p><p><strong>Methods: </strong>Patient data obtained from the electronic patient data management system of the Department of Anesthesia, University Children's Hospital Zurich, Switzerland, were retrospectively assessed for demographic and anthropometric information, size of the internal tube diameter used for positive pressure ventilation and divergence from the size recommendation chart.</p><p><strong>Results: </strong>Data from 14,188 children younger than 16 years (median 5.3 years) and weighing at least 3 kg who underwent oral or nasal tracheal intubation using second generation Microcuff® PET between 2009 and 2015 were included. Of 13,219 oral tracheal intubations 12,049 (84.9%) were performed according to the manufacturer's size recommendation and 1170 with divergent endotracheal tubes. The odds ratio (OR) of oral reintubation was 0.13% (95% confidence interval 0.08-0.22%) for cases using the manufacture's size recommendation correctly and 22.74% (95% confidence interval 20.42-25.23%) for patients intubated with a not recommended tube (p < 0.0001).</p><p><strong>Conclusion: </strong>These findings indicate that the second generation Microcuff® PETs can be reliably used with low tube exchange rates across the entire pediatric age range when the tube size is selected according to the manufacturer's size recommendation chart. Adherence to the manufacturer's tube size recommendation is urgently advised.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"829-836"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751928","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":"[Smart learning: 5 years (life)long].","authors":"Jens C Kubitz","doi":"10.1007/s00101-024-01478-2","DOIUrl":"https://doi.org/10.1007/s00101-024-01478-2","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":"73 12","pages":"795-796"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775425","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":"[Publish in Die Anaesthesiologie : Open access through DEAL agreement, wide distribution through PubMed listing and tips for submission].","authors":"Ines Wolff, Rolf Rossaint, Bernhard Zwißler","doi":"10.1007/s00101-024-01474-6","DOIUrl":"https://doi.org/10.1007/s00101-024-01474-6","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":"73 12","pages":"791-794"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775492","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":"819-828"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11614957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667996","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":"[Focus on sepsis and general intensive care medicine 2023-2024 : Summary of selected intensive medical care studies].","authors":"C J Reuß, M Bernhard, C Beynon, M O Fiedler-Kalenka, A Hecker, C Jungk, C Nusshag, D Michalski, F C F Schmitt, T Brenner, M A Weigand, M Dietrich","doi":"10.1007/s00101-024-01456-8","DOIUrl":"10.1007/s00101-024-01456-8","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"852-860"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302442","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":"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":" ","pages":"797-809"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402205","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":"[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":"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":"843-851"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633808","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":"[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":"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":"861-870"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","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}