Die Anaesthesiologie最新文献

{"title":"[Systemic barriers prevent competence-based teaching in the field of planetary health : An online survey among students and descriptive analysis of the National Competence-based Catalogue of Learning Objectives for Medicine 2.0].","authors":"Philippe Kruse, Mark Coburn, Florian Windler, Birgit Bette, Christian Bode, Se-Chan Kim, Achilles Delis, Maria Wittmann, Gregor Massoth","doi":"10.1007/s00101-025-01525-6","DOIUrl":"https://doi.org/10.1007/s00101-025-01525-6","url":null,"abstract":"<p><strong>Background: </strong>The current medical studentship will be a generation of doctors who will experience the effects of climate change on global health during their clinical practice. This interplay between the integrity of ecosystems and human health is being investigated in the multidisciplinary research field planetary health. To cope with these climate-related health effects, students must be given a profound knowledge of the impact of destabilized natural systems on human health; however, despite the actuality of this topic recent studies show that competence-based teaching on this topic is insufficient. Considering the relevance of this topic, this study aim to identify systemic barriers preventing competence-based teaching in the field of planetary health.</p><p><strong>Methods: </strong>Systemic barriers were first analyzed by means of an anonymous online survey of students. Students who completed the compulsory internship in anesthesiology in the winter semester 2021/2022 were invited to take part in this survey. Obstacles preventing competence-based teaching in the field of planetary health were defined as systemic barriers. Secondly, the frequency of defined terms related to planetary health was determined. This analysis was carried out to investigate the integration of planetary health into the \"National Competence-based Catalogue of Learning Objectives for Medicine 2.0\" (NKLM 2.0).</p><p><strong>Results: </strong>Out of 130 students who participated in the internship, 54% (n = 70) submitted a completed questionnaire. Of these students 96% (n = 67) agreed with the statement that climate change will have a negative impact on patients' health. For 53% (n = 37) of participants, planetary health had not previously been part of teaching courses. In accordance, terms that are thematically related to planetary health were rarely used in the NKLM 2.0.</p><p><strong>Conclusion: </strong>The study identified two systemic barriers to competence-based teaching in the subject of planetary health. The first barrier is the low number of compulsory classes which represents the insufficient integration of planetary health into the curriculum. Secondly, the subject of planetary health has not yet been sufficiently integrated into the NKLM 2.0. The current reform of the NKLM 2.0 represents an opportunity to overcome these two barriers and to implement competence-based teaching through joint efforts.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694564","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":"[Visual estimation of blood losses : Known high error rate-How can it be improved?]","authors":"Katharina Biller-Friedmann, Julian Bayerlein","doi":"10.1007/s00101-025-01517-6","DOIUrl":"https://doi.org/10.1007/s00101-025-01517-6","url":null,"abstract":"<p><p>Every day blood losses are visually estimated by medical personnel (physicians, midwives, paramedics) because an exact quantitative measurement is impossible or impractical. Anesthesiologists are confronted with blood loss in the operating room, in the delivery room, in the emergency room and at the scene of an emergency; however, the literature shows that in all the named areas enormous errors occur in the visual estimation. Errors of 50% and more are not uncommon, which means that, e.g., an estimated blood loss of 2000ml could actually be 3000ml or only 1000ml. General, in all the abovenamed areas blood losses are more likely to be underestimated than overestimated. The ability to make an estimation is not improved by professional experience. The amount of blood loss indicates and \"justifies\" invasive measures and the administration of blood and cost-intensive blood products. This overview is dedicated to the problems in the estimation of blood loss, demonstrates the sequelae of an incorrectly estimated blood loss, provides tips on how the ability to make an estimation can be improved and describes the considerable potential of further education as well as which digital support options are now available.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617879","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":"Frequency of rebound pain and related factors in a multimodal regimen including systemic dexamethasone and dexmedetomidine.","authors":"Funda Atar, Fatma Özkan Sipahioğlu, Filiz Karaca Akaslan, Eda Macit Aydın, Evginar Sezer, Derya Özkan","doi":"10.1007/s00101-025-01502-z","DOIUrl":"10.1007/s00101-025-01502-z","url":null,"abstract":"<p><strong>Background: </strong>This prospective observational study aimed to explore the frequency and risk factors of rebound pain (RP) in patients treated with multimodal analgesia and intravenous dexamethasone following a peripheral nerve block (PNB).</p><p><strong>Material and methods: </strong>All patients who received preoperative PNB were given a standard multimodal analgesia regimen and intravenous dexamethasone. Motor and sensory block durations, RP severity and frequency were measured for the first 24 h post-PNB using a semistructured questionnaire. The RP was identified as acute postoperative pain within the first 12-24 h after sensory blockade resolution. The severity of RP was determined through the rebound pain score. Contributing risk factors to the development of RP were investigated.</p><p><strong>Results: </strong>After the PNB had worn off RP developed in 27.7%. The following were identified as independent risk factors for RP: patient age, with an adjusted odds ratio (AOR) of 2.3 and a 95% confidence interval (CI) of 1.4-3.9, the use of bupivacaine in combination with lidocaine or prilocaine (AOR: 2.1, 95% CI 1.2-3.8), preoperative pain (AOR: 2.8, 95% CI 1.3-5.6), bone surgery (AOR: 1.8, 95% CI 1.0-3.0) and the duration of the surgery (AOR: 2.8, 95% CI 1.5-5.1).</p><p><strong>Conclusion: </strong>An exact identification of risk factors for RP can aid in creating preventative strategies that target changeable elements. A comprehensive understanding of this occurrence by PNB practitioners can lead to more effective use of PNB, decreased RP instances and improved outcome optimization.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"148-155"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484787","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":"[Everything flows, nothing stands still-Anesthesiology and intensive care medicine in the digital age].","authors":"Raimund Huf, Nicolai Andrees, Simone Kagerbauer","doi":"10.1007/s00101-024-01480-8","DOIUrl":"10.1007/s00101-024-01480-8","url":null,"abstract":"<p><p>Anaesthesiology and intensive care medicine are innovative specialist areas that mainly use the advantages of digital documentation. However, to exploit the full potential of the digital age, more than conversion of paper-based documentation into digital formats is required. The German healthcare system needs to catch up; more than money is required to drive digitalisation forward. The willingness of all those involved to adapt to new circumstances is essential-a process known as 'digital transformation'.The drivers of digital transformation in medicine are the need for personalised therapies, technological advances, and shared decision-making between physicians and patients. However, humans should take centre stage in medicine; technology is only a means to an end.As data-driven research is becoming increasingly important, the FAIR principles must apply to routine data in the same way as it is propagated for research: Data must be findable, accessible, interoperable and reusable. Utilising high-quality databases, decision support, and warning systems can be developed for early recognition and prevention of complications.Teleintensive care is a concrete expression of digital transformation. The COVID-19 pandemic paved the way for it to become standard care.Digital technologies in education and training are becoming increasingly popular. Virtual and augmented reality applications enable realistic training scenarios for trainee physicians and experienced teams.In the future, expanding the infrastructure and facilitating data exchange between all healthcare areas is essential. Applications must be reliable and secure, as cybercrime poses a severe threat to our hospitals, making vigilant IT departments and education in IT security crucial. In summary, digitalisation can make patient care safer and better if implemented correctly and involving all stakeholders.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"121-127"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755832","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":"[From bytes to bedside-Anesthesiology remains agile!]","authors":"Sandra Dohmen","doi":"10.1007/s00101-025-01508-7","DOIUrl":"https://doi.org/10.1007/s00101-025-01508-7","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":"74 3","pages":"119-120"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544801","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":"[NAPOK: national register on analysis of (non)invasive treatment procedures for postdural puncture headache-Protocol publication].","authors":"Philipp Helmer, Peter Kranke, Jan Niklas Thon, Antonia Helf, Patrick Meybohm, Markus A Weigand, Benedikt H Siegler","doi":"10.1007/s00101-025-01512-x","DOIUrl":"10.1007/s00101-025-01512-x","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"156-158"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11876252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400837","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":"[Nationwide comparison concerning medical measures by emergency paramedics in Germany].","authors":"Michael S Dittmar, Marina Kraus, Bernhard M Graf","doi":"10.1007/s00101-025-01509-6","DOIUrl":"10.1007/s00101-025-01509-6","url":null,"abstract":"<p><strong>Background: </strong>The medical treatment by emergency paramedics without the presence of an emergency physician in Germany is based primarily on 1) delegation by the Medical Director of Emergency Medical Services (AELRD) or 2) the independent practice of medicine according to § 2a of the German Federal Emergency Paramedic Act (NotSanG). Both possibilities differ with respect to the responsibility for the diagnosis and treatment decision. This article provides for the first time a nationwide overview of who bears which responsibilities for treatment specifications for emergency paramedics.</p><p><strong>Material and methods: </strong>The treatment algorithms for five clinical pictures were evaluated for all German federal states with respect to their geographical validity, the declaration and objective character as the delegation by the AELRD or the practice of medicine (§ 2a NotSanG) and the extension to narcotics. The data collection took place between December 2020 and June 2022.</p><p><strong>Results: </strong>In this study 112 algorithms with 403 individual measures were analyzed. For 11 German states unified treatment specifications were found and in 5 federal states treatment specifications differing from region to region were identified. The AELRD delegation or § 2a NotSanG status was explicitly declared in only 40% of the individual measures. This declaration was consistent with the objective character of the measure in 93%. An independent narcotics administration by paramedics is established in six states.</p><p><strong>Conclusion: </strong>In the majority of measures intended for paramedics it is not obvious whether they are to be applied according to AELRD delegation or § 2a NotSanG. Such a declaration by the preparers could provide more clarity with respect to the responsibilities. Both an AELRD delegation and the administration of narcotics by paramedics without the presence of a physician are not established in all German states. Due to the continuously developing legal situation, the investigated endpoints may have changed in the meantime in some regions.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"136-147"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11876223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484820","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":"[Update PO(N)V-What is new in the prophylaxis and treatment of postoperative nausea and vomiting?]","authors":"S Knoth, B Weber, H Lotz, B Vojnar, L H J Eberhart","doi":"10.1007/s00101-025-01510-z","DOIUrl":"10.1007/s00101-025-01510-z","url":null,"abstract":"<p><p>Postoperative nausea and vomiting (PONV) is defined as the joint or individual occurrence of nausea, retching and vomiting within 24-48h after an operation. The peripheral and central nervous systems are involved in the development of PONV. The pathogenesis of PONV is multifactorial. Patient-related, anaesthesia-related and surgery-related risk factors can be present. Some of the risk factors for PONV were combined to form PONV risk scores (e.g., the simplified risk score for predicting postoperative nausea and vomiting from Apfel et al.), with the help of which the risk of PONV can be estimated with a sensitivity and specificity of 65-70%. For certain collectives specialised PONV risk scores should be prioritised. The antiemetic strategy is divided into three areas: modification of the anaesthetic procedure, pharmacological and nonpharmacological interventions. These can be applied individually or combined in the sense of a multimodal PONV prophylaxis.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"171-186"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506491","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":"[Systematic review of the effectiveness of local anaesthetics in the treatment of neuropathic pain or phantom pain].","authors":"Joanna Kastelik, Karsten Schwerdtfeger, Annette Stolle, Michael Schäfer, Sascha Tafelski","doi":"10.1007/s00101-025-01500-1","DOIUrl":"10.1007/s00101-025-01500-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic pain is still a relevant medical and socioeconomic problem. The treatment focuses not only on pain reduction but also on functional treatment goals. Neuropathic pain includes biological, social and psychological aspects. In September 2023, the updated S3 guidelines for the management of peripheral nerve injuries were published. Multimodal pain management strategies encompassing systemic and local pharmacological, physiotherapeutic and occupational therapeutic interventions, are part of the guidelines. A central question addressed the widely debated treatment option using perineural local anaesthetics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of the study was to evaluate the effectiveness of local anaesthetic infiltration in the treatment of neuropathic pain following nerve injuries through a systematic literature review and evaluation of the evidence by a meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;After formulating a PICO (patient/population, intervention, comparison and outcomes) question (Infobox 1) within the guideline group, a selective literature analysis of controlled trials in databases (PubMed, Cochrane Central Register of Controlled Trials-CENTRAL) was conducted until 31 July 2023. The literature was assessed by two reviewers and systematic reviews were examined for additional references. The studies were assessed using the Risk of Bias Tool 2.0 of the Cochrane Collaboration for randomized trials and the evidence was classified according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 357 publications were identified in the literature search. After removing duplicates (n = 15) 327 publications were evaluated. The literature analysis showed heterogeneity with respect to the pain localization, local anaesthetics and reported outcomes. In an in-depth literature analysis one relevant study was identified and included in the evaluation of the evidence. This study enrolled and randomized 144 patients between December 2013 and October 2018 and evaluated the effectivity of the continuous infusion of local anaesthetics (lidocaine 2% with epinephrine 2.5 µg/ml as an initial bolus in both study groups followed by an infusion of ropivacaine 0.5% in the intervention group over 6 days) on the intensity of the phantom pain in comparison to the placebo group with a continuous infusion of saline over 6 days. The mean pain intensity and pain-related dysfunctions were reduced in the intervention group after 4 weeks. In the intervention group 25 patients and in the placebo group 40 patients received the crossover treatment after 4 weeks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Infiltration with local anaesthetics represents a potential therapeutic option for neuropathic pain and phantom pain after amputations. A randomized, blinded, placebo-controlled study from 2021 demonstrated lower pain intensity and a reduction in pa","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"128-135"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11876198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484836","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":"[Nontechnical skills in anesthesiology-Introduction].","authors":"M St Pierre, F Krischke, H Hellwig, C Neuhaus","doi":"10.1007/s00101-025-01513-w","DOIUrl":"10.1007/s00101-025-01513-w","url":null,"abstract":"<p><p>Over the last two decades the concepts of \"human factors\" and \"nontechnical skills\", which describe the interaction of physical, psychological, cognitive and social characteristics of people with their environment and which have a significant influence on safe patient care, have become established in anesthesiology. Nevertheless, findings from the social sciences and safety research, particularly with respect to understanding human factors and the development and prevention of incidents, have so far only been partially accepted in medicine. In particular, the contribution of people is often problematized in the sense of a \"risk factor\". In the first of two articles, the theoretical foundations of nontechnical skills are explained and an awareness of the fact that it is not human deficiencies but rather normal, evolutionarily sensible thought processes and social practices of the people involved that are responsible for adverse events is created.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"159-170"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460992","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}