Die Anaesthesiologie最新文献

{"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":" ","pages":"724-734"},"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":" ","pages":""},"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":" ","pages":""},"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":" ","pages":"712"},"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}

{"title":"[Focus on ventilation, oxygen therapy and weaning 2022-2024 : Summary of selected intensive care studies].","authors":"M O Fiedler-Kalenka, T Brenner, M Bernhard, C J Reuß, C Beynon, A Hecker, C Jungk, C Nusshag, D Michalski, M A Weigand, M Dietrich","doi":"10.1007/s00101-024-01455-9","DOIUrl":"10.1007/s00101-024-01455-9","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"698-711"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115602","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":"[Water, taken in moderation, cannot hurt anybody].","authors":"Felix Kork","doi":"10.1007/s00101-024-01472-8","DOIUrl":"10.1007/s00101-024-01472-8","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":"73 10","pages":"645-646"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360715","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":"[Collaborations in publications on pediatric anesthesiology in the D-A-CH countries].","authors":"Alexander Dejaco, M Nemeth, A Sablewski, J Rosenberger, C Miller","doi":"10.1007/s00101-024-01459-5","DOIUrl":"10.1007/s00101-024-01459-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Collaborations are an essential element of scientific activity and particularly important in fields such as pediatric anesthesiology, where the evidence base in general is relatively limited. A recent scientometric analysis revealed a geographic diversification of publication activity in pediatric anesthesiology within the last two decades, accompanied by a surge in international collaborations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Given the hypothesis of a similar growth in the activity and dynamics of publications in pediatric anesthesiology, the objective of this scientometric study was to analyze the publication activity and collaboration habits in research in pediatric anesthesiology from Germany, Austria and Switzerland (D-A-CH).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;This secondary analysis identified all publications on pediatric anesthesiology with an affiliation from the D‑A-CH countries between 2001 and 2020 from PubMed and Web of Science. The query parameters included the timeframe 2001-2020, authors' affiliations tied to anesthesiology departments (using various forms of the term \"anesthesia\"), and the mention of pediatric interest in titles or abstracts. The data underwent standardization to account for linguistic variations. The publications were assigned to a state, city and institution based on the correspondence address, to a year based on the publication date and to a source based on the journal. The primary endpoint was publication activity and dynamics, represented by the number of publications and the respective growth rates (calculated as the linear regression slope). Secondary endpoints included the share of collaborations within and outside the D‑A-CH region (at the country and institutional level), the distribution of publication activity and the most prominent sources of publications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between 2001 and 2020 a total of 3406 publications on pediatric anesthesiology involving authors from the D‑A-CH countries were identified. Of these 2807 (82.4%) had a correspondence address in D‑A-CH. The average annual growth rate of publications with a correspondence address was + 2.9% for the D‑A-CH countries and + 7.7% for publications with collaborations. The number of publications in which an institution from D‑A-CH was named as a coauthor from a correspondence address outside D‑A-CH also increased by an average of 7.4% per year during the study period. The majority of collaborations occurred between institutions within the D‑A-CH region, although Swiss institutions exhibited a much higher proportion of collaborations outside the region. Of all publications with a correspondence address 90% originated from 46 cities. The most prominent source was Die Anästhesiologie for publications from Germany, and Pediatric Anesthesia for publications from Austria and Switzerland.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The number of publications in pediatric anesthesiology from the D‑A-CH countrie","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"676-684"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309254","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":"[Retrospective analysis of the resuscitation room management of nontraumatic critically ill children in a university emergency department (OBSERvE-DUS-PED study)].","authors":"Claudia Priebe, Hans Martin Bosse, Mark Michael, Olaf Picker, Michael Bernhard, Juliane Tautz","doi":"10.1007/s00101-024-01457-7","DOIUrl":"10.1007/s00101-024-01457-7","url":null,"abstract":"<p><strong>Background: </strong>The establishment of a resuscitation room management for nontraumatic critically ill children appears to make sense. This study collected data of pediatric patients suffering from nontraumatic critically ill conditions treated in a resuscitation room.</p><p><strong>Methods: </strong>The retrospective OBSERvE-DUS-PED study (November 2019-October 2022) recorded pediatric patients (age < 18 years) who were admitted to the emergency department (ED) for resuscitation room care. The routinely documented data on treatment were taken from the hospital information system MEDICO® and the patient data management system COPRA® in accordance with the OBSERvE dataset. The study was approved by the Ethics Committee of the Medical Faculty of the Heinrich Heine University (2023-2377).</p><p><strong>Results: </strong>The study included 52 pediatric resuscitation room patients. Adolescents aged 14-17 years were the most frequent in the cohort representing 37% of the total and neonates/infants (0-1 year) were lowest at 8%. The most common symptoms categorized according to ABCDE problems were disturbance of consciousness (D) at 61%, cardiovascular failure (C) at 25%, respiratory insufficiency (B) at 6%, airway obstruction (A) and exposure/environment (E) problems each at 4%. The out-of-hospital and in-hospital emergency procedures were performed with the following frequencies: venous (58% vs. 65%), intraosseous (14% vs. 2%) and central venous access (0% vs. 12%), invasive airway management (35% vs. 8%), cardiopulmonary resuscitation (21% vs. 10%), vasopressors (15% vs. 17%), and intra-arterial pressure measurement (0% vs. 17%). The mean duration of resuscitation room management was 70 ± 43 min. The 30-day mortality was 17%.</p><p><strong>Conclusion: </strong>The OBSERvE-DUS-PED study demonstrates the major challenges in the care of critically ill nontraumatic pediatric patients, both in out-of-hospital and in-hospital management. The variety and complexity of the referral diagnoses as well as the immediate vital threat to the patients make it appear sensible to treat such patients primarily in a resuscitation room of the ED due to the available material, infrastructural and personnel resources.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"656-667"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11447138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115603","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":"[Transport of severely injured trauma patients in an ambulance with and without a rigid neck orthosis: comparative biomechanical measurements].","authors":"Martin Kieninger, Corinna Schneider, Simon Auer, Lukas Reinker, Ina Adler, Sebastian Dendorfer, Johanna Rosenberger, Daniel Popp, Christoph Eissnert, Dominik Ludsteck, Christopher Cyrus, Johannes Hoffmann, Sarah Morag, Bernhard Graf, Bärbel Kieninger","doi":"10.1007/s00101-024-01462-w","DOIUrl":"10.1007/s00101-024-01462-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The actual significance of prehospital immobilization of the cervical spine in severely injured trauma patients remains unclear. In view of possible negative implications, such as an increase in intracranial pressure due to the application of a rigid cervical spine orthosis, the long-term use must be critically questioned. Further studies are required to justify the long-term use of a rigid cervical spine orthosis in the prehospital setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Comparative measurements of the mobility of the cervical spine during immobilization using a vacuum mattress with or without the additional application of a rigid cervical spine orthosis after positioning on the stretcher were carried out.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;Biomechanical measurements of the movement of the cervical spine were carried out by attaching inertial measurement units to a test person during the loading and unloading process in a modern ambulance and during the journey along a predefined parkour. The test person on whom the measurements were carried out was immobilized on a vacuum mattress with the option of lateral fixation of the head and chin and forehead strap on an electrohydraulic stretcher. The complete standard monitoring was set up to simulate as realistic a transport of a severely injured patient as possible. A total of 30 test runs were realized. In one half of the tests, the cervical spine was additionally immobilized using a rigid orthosis and in the other half a cervical spine orthosis was not used. For each of the 30 tests, the angles, axial rotation, lateral bending and flexion/extension as well as the first and second derivatives were considered for loading, transport and unloading and the parameters mean deviation from the zero position, size of the swept angle range and maximum were calculated for each test run.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Statistically significant differences were only found for some biomechanical parameters in the sagittal plane (flexion and extension). No significant differences were found for the measured parameters in the other directions of movement (axial rotation, lateral flexion). In general, only very small angular deflections were measured both in the tests with the cervical spine orthosis and without the cervical spine orthosis (on average in the range of 1-2° for axial rotation and flexion/extension and up to 3° for lateral flexion).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;If immobilization is carried out correctly using a vacuum mattress with the option of lateral stabilization of the head and chin and a forehead strap on an electrohydraulic stretcher with a loading system, there are no relevant advantages with respect to the restriction of movement of the cervical spine by the additional use of a rigid cervical spine orthosis for the loading and unloading process or during the transport in a modern ambulance. It could therefore be advantageous to remove the ri","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"668-675"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11447079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333696","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":"[Anesthesia for cesarean section with diastrophic dysplasia].","authors":"Michaela Sieker, Thomas Weber, Heike Vogelsang, Peter Kern","doi":"10.1007/s00101-024-01440-2","DOIUrl":"10.1007/s00101-024-01440-2","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"694-697"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894935","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}