Die Anaesthesiologie最新文献

{"title":"[Quality assurance of extracorporeal membrane oxygenation (ECMO) - optimization through evidence-based quality indicators].","authors":"Susanne Al Riz, Patrick Friederich","doi":"10.1007/s00101-025-01506-9","DOIUrl":"https://doi.org/10.1007/s00101-025-01506-9","url":null,"abstract":"<p><strong>Background: </strong>The high mortality rates associated with extracorporeal membrane oxygenation (ECMO) treatment in Germany compared to international benchmarks indicate potential issues with treatment quality and require an analysis of the quality assurance of ECMO treatment.</p><p><strong>Objective: </strong>Firstly, this article aims to analyze whether the legal requirements for quality standards of complex medical and technical measures as well as the demands of professional societies for guideline adherence in treatment can currently be verified. Secondly, the goal is to develop cross-procedural, evidence-based quality indicators (QI) for a specific comprehensive quality management system (QMS) for ECMO treatment in Germany, to enable a comparison of centers and a continuous improvement process.</p><p><strong>Material and methods: </strong>A review of the literature concerning quality management for ECMO treatment was conducted. Data from relevant quality reporting platforms were analyzed. Strong recommendations from guidelines on ECMO treatment were used to derive specific cross-procedural QIs. These were categorized by structural, process and outcome quality and compared with existing registry data.</p><p><strong>Results: </strong>Three data registers for ECMO treatment in Germany were identified, revealing a lack of specific QIs and effective monitoring of guideline adherence. Consequently, a comprehensive analysis of treatment quality is currently not possible. From the guideline recommendations 22 QIs were defined to be integrated into a standardized quality management system for ECMO treatment.</p><p><strong>Conclusion: </strong>Implementing evidence-based QIs can enhance quality assurance, improve transparency regarding legal requirements and guideline adherence, while also facilitating continuous improvement and enabling benchmarking. Recommendations on the indications and minimum implementation numbers can be made based on evaluation of the data obtained.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484827","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":"[Avalanche rescue 2024-Current recommendations].","authors":"Bernd Wallner, Frederik Eisendle, Simon Rauch, Peter Paal","doi":"10.1007/s00101-025-01520-x","DOIUrl":"https://doi.org/10.1007/s00101-025-01520-x","url":null,"abstract":"<p><p>Avalanche accidents in which winter sports enthusiasts are involved have significantly increased but the number of deaths remains stable due to better prevention and rescue. Avalanche accidents are frequent in mountainous regions and there are around 100 fatalities each year in Europe. The chances of survival are mainly determined by the degree and duration of avalanche burial, a possible airway obstruction, the presence of an air pocket, the snow characteristics and possible severe injuries. The most frequent cause of death is asphyxia, followed by trauma. Hypothermia accounts for only a minority of deaths. Hypothermic cardiac arrest has a favorable prognosis and justifies prolonged resuscitation and extracorporeal rewarming. The distinction between asphyxial and hypothermic cardiac arrest enables an optimized triage. This article deals with the pathophysiology of avalanche accidents and the management of avalanche victims in the field.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411943","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's new … in the pediatric anesthesia fellowship : Structured professional development 2.0].","authors":"Jens Krösche","doi":"10.1007/s00101-025-01503-y","DOIUrl":"10.1007/s00101-025-01503-y","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"109-110"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082460","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":"Emergency cesarean section under general anesthesia using remimazolam in a pregnant woman with Fontan circulation : Case report with literature review.","authors":"Sun Woo Nam, Haesun Jung, Jiwon Han","doi":"10.1007/s00101-025-01507-8","DOIUrl":"10.1007/s00101-025-01507-8","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"97-102"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415966","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":"[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":"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":"63-71"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","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":"Current airway management practice among Swiss anesthesiologists : Results of a national survey.","authors":"Simone Mackert, Manuel Walker, Nina Pirlich, Jörg C Schäuble, Abimael Cardenas Marban, Michael T Ganter, Urs Eichenberger, Matthias Nübling, Thomas Heidegger","doi":"10.1007/s00101-024-01499-x","DOIUrl":"10.1007/s00101-024-01499-x","url":null,"abstract":"<p><strong>Background: </strong>While limited data on the impact of implementing guidelines in airway management on outcomes exist, there is a consensus that the implementation and the adherence to guidelines enhance patient safety. Recently, the Swiss Society for Anesthesiology and Perioperative Medicine (SSAPM) endorsed the guidelines of The Fondation Latine des Voies Aériennes (FLAVA) as the official guidelines for airway management in Switzerland. This study aimed to determine current practice of airway management in Switzerland.</p><p><strong>Objective: </strong>To determine the available equipment, the differences between institutions and between specialists and residents in dealing with airway management.</p><p><strong>Methods: </strong>In collaboration with the SSAPM, a covering letter with a survey link to the questionnaire used in the online airway management survey among German anesthesiologists was sent to all heads of departments of anesthesia and members of the SSAPM in August 2023. The participants (residents and specialists) were asked about their personal and institutional backgrounds, access to airway management devices, awareness of recognized airway management guidelines and the importance and application of airway management techniques.</p><p><strong>Results: </strong>Overall, 555 anesthesiologists participated in the survey (response rate 21%). The main findings were: in general, Swiss anesthesia departments are well-equipped and adhere to airway management guidelines. The guidelines of FLAVA are only known by just over 50%. The vast majority used the traditional screening tests to identify an airway that might be potentially difficult to manage. Of the respondents, 25% still adhere to the myth that a mask ventilation check is necessary before the administration of a muscle relaxant and 14% said that their institution used video laryngoscopy as the primary intubation device. More than 80% think that the expertise to perform awake fiberoptic intubation is important for their daily practice; however, 31% consider their expertise in this technique to be insufficient. In other words, there is a big safety gap.</p><p><strong>Conclusion: </strong>Swiss anesthesia departments are well-equipped and adhere to airway management guidelines. The need for regular training to gain and maintain expertise in managing difficult airways, especially to future specialists, still prevails. Thus, developing and establishing a nationwide educational program in airway management and its continuous evaluation would be a milestone for patient safety.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"89-96"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070026","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":"[Pain management for tumor-associated pain-The extended role of anesthesia].","authors":"Benjamin Luchting","doi":"10.1007/s00101-024-01489-z","DOIUrl":"https://doi.org/10.1007/s00101-024-01489-z","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":"74 2","pages":"61-62"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442850","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":"[User behavior during functional testing of the ventilator: analysis of the use of the QUICKcheck and detection of misconnected ventilation tubes].","authors":"Davut D Uzun, Johannes Schäfer, Sascha Klemm, Christoph Lichtenstern, Markus A Weigand, Christopher Neuhaus","doi":"10.1007/s00101-024-01496-0","DOIUrl":"10.1007/s00101-024-01496-0","url":null,"abstract":"<p><strong>Background and research question: </strong>While patient safety during general anesthesia has improved in recent years, incidents still occur in anesthesia, particularly in the area of airway management and ventilation. In addition to a mandatory daily system test before using a ventilator, a QUICK check is recommended by the German Society of Anesthesiology and Intensive Care Medicine (DGAI) before connecting a patient; however, misconnections of breathing tubes are still possible and not necessarily detected by the device self-test. The aim of the present study was to analyze user behavior at modern anesthesia workstations regarding the verification and functionality of the QUICK check.</p><p><strong>Material and methods: </strong>A monocentric prospective recording of user behavior in handling the QUICKcheck was carried out as part of a medical simulation training course as well as a prospective, multicenter, explorative, anonymous survey of anesthesiology staff in various German hospitals.</p><p><strong>Results: </strong>Out of 30 participating physicians 93.3% (n = 28) carried out a QUICK check immediately before connecting the simulation patient to the ventilator. Only 1 (96.6%) of the physicians did not recognize the incorrect connection of the ventilation tubes during their QUICK check. Of the participating physicians, 80% did not use the separate bag valve mask despite persistent ventilation problems on the ventilator. The online survey was answered by n = 187 participants, 64.7% of the participants stated that they always carry out the QUICK check, 31.5% sometimes and 3.7% never. The presence of a separate bag valve mask is always checked by 66.3% of respondents, by 29.8% sometimes and by 3.8% never. Of the physicians, 32% believed that the integrated self-test always recognizes a misconnection of the ventilation tubes.</p><p><strong>Conclusion: </strong>The present study reveals a heterogeneous picture of the application and understanding of the QUICK check as recommended by the DGAI. The lack of understanding of a standardized implementation of the check can be seen as further evidence of the importance of interdisciplinary training with a focus on human factors, communication and cooperation as opposed to a mere procedural implementation of established tools.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"72-80"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070018","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":"[Current state of patient knowledge regarding the preoperative impact and causes of anemia].","authors":"Janna Mock, Lotta Hof, Theresa Dhein, Esther Pollok, Vanessa Neef, Jochen Kaiser, Kai Zacharowski, Patrick Meybohm, Suma Choorapoikayil","doi":"10.1007/s00101-024-01498-y","DOIUrl":"10.1007/s00101-024-01498-y","url":null,"abstract":"<p><strong>Background: </strong>Despite being treatable, the prevalence of anemia is relatively high, affecting up to 30% of the general population and 35% of patients undergoing surgery. Symptoms are often misinterpreted and patients frequently do not recognize anemia as a disease. As a result, it is often not discussed during medical consultations. Additionally, the limited time between diagnosis and surgery makes preoperative anemia management challenging.</p><p><strong>Objective: </strong>The aim of the present study was to assess the state of knowledge about anemia and to identify areas of deficits to develop a strategy for future improvement.</p><p><strong>Material and methods: </strong>Patients undergoing surgery with a transfusion probability of > 10% were interviewed at the department for anesthesiology, intensive care medicine and pain therapy of the University Hospital Frankfurt in May and October 2023.</p><p><strong>Results: </strong>A total of 196 completed questionnaires were evaluated. Most correct answers were given in the category \"treatment of anemia\" with 54.3% (n = 426/784), followed by 50.1% (n = 393/784) correct answers in the category \"diagnosis of anemia\", 48.8% (n = 478/980) in the category \"perioperative influence of anemia\" and 44.6% (n = 350/784) correct answers in the category \"influence of nutrition\". The patients showed the greatest knowledge deficits in the category \"symptoms of anemia\" with 38.1% (n = 598/1568) correct answers and \"causes of anemia\" with 36.1% (n = 354/980). Only 3% (n = 5/196) of the participants rated their knowledge as \"good\", 16% (n = 31/196) as \"fairly good\", 48% (n = 94/196) as \"fairly poor\" and 29% (n = 56/196) as \"poor\". There is a weak to medium positive linear correlation between the self-assessment and the correct answers given (correlation coefficient 0.44). Approximately 70% of participants had a higher level of education, such as vocational training, a university degree or a high school diploma. There was no correlation between the number of correct answers given and the participants' level of education. The majority of the patients (71.4%; n = 140/195) expressed interest in learning more about anemia.</p><p><strong>Conclusion: </strong>We identified a significant knowledge deficit, particularly regarding the causes and symptoms of anemia. It is likely that knowledge gaps persist and that anemia does not receive sufficient attention in everyday clinical practice. Educating and training patients about anemia is essential to further reduce its prevalence.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"81-88"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070012","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":"[The updated S3 guidelines: sedation in gastrointestinal endoscopy : Innovations and relevant aspects for the routine].","authors":"Peter H Tonner, Till Wehrmann, Andrea Riphaus","doi":"10.1007/s00101-025-01501-0","DOIUrl":"10.1007/s00101-025-01501-0","url":null,"abstract":"<p><p>In 2023 the third revision of the S3 guidelines on sedation in gastrointestinal endoscopy was presented. As with the two previous versions of the guidelines, the relevant and current literature was reviewed and evaluated by a group of experts from various specialist societies under the guidance of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS). In addition to confirming some of the older recommendations, a number of recommendations were revised or newly added. A brief overview of the current version of the S3 guidelines is provided with a focus on relevant changes.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"103-108"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411947","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}