Die Anaesthesiologie最新文献

{"title":"[Successful resuscitation after energy drink consumption in a patient with unknown right ventricular dysplasia].","authors":"A Molitor, S Bitaraf, S G Sakka","doi":"10.1007/s00101-024-01473-7","DOIUrl":"10.1007/s00101-024-01473-7","url":null,"abstract":"<p><p>This case report describes a 28-year-old man who successfully underwent cardiopulmonary resuscitation (CPR) for ventricular fibrillation after consuming an energy drink containing a nonlethal dose of caffeine. The caffeine-naive patient, without previously known diseases, had rapidly drunk 3 cans of an energy drink (480 mg caffeine, i.e., an amount he had never consumed before according to his own statement) after a football training before he collapsed lifelessly and required resuscitation. After successful CPR, the patient was admitted to the intensive care unit and extubation was carried out on the following day. In parallel, differential diagnostic cardiological procedures were carried out. These revealed a previously unknown right ventricular dysplasia, so that after exclusion of an accessory atrioventricular conduction pathway in the electrophysiological examination, a single chamber implantable cardioverter defibrillator (ICD) for secondary prevention was implanted. The patient was discharged home without neurological deficits on day 14 after hospital admission. This case presentation is intended to show that the consumption of caffeine-containing energy drinks, even in a nonlethal dose, can be potentially dangerous in the presence of an unknown cardiac disease, even if physical performance is not impaired.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"837-842"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649559","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":"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":"810-818"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482267","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":"[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":"https://doi.org/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":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-29","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":"[Palliative neurology].","authors":"K Amadori, T Steiner","doi":"10.1007/s00101-024-01476-4","DOIUrl":"10.1007/s00101-024-01476-4","url":null,"abstract":"<p><p>Palliative medicine represents the holistic multiprofessional treatment of severely and incurably ill people and their relatives, addressing their complex physical, psychological, social and spiritual needs. The central therapeutic goals are the quality of life and alleviation of suffering. In the course of many neurological diseases, high symptom burden, long and variable trajectories and unfavorable prognosis at times create a need for palliative care even at an early stage, which is currently still inadequately met. This can be countered by qualified neuropalliative care. In addition to intensifying interdisciplinary collaboration, this requires neurologists to have core competencies in palliative care. These include a team-oriented attitude, communication skills, expertise in symptom control and knowledge of biomedical ethics including palliative options at the end of life.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"781-790"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514052","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":"[Prehospital blood transfusion : Opportunities and challenges for the German emergency medical services].","authors":"Jens Schwietring, Dirk Wähnert, Lucas Sebastian Scholl, Karl-Christian Thies","doi":"10.1007/s00101-024-01463-9","DOIUrl":"10.1007/s00101-024-01463-9","url":null,"abstract":"<p><strong>Background: </strong>Exsanguination is the leading cause of preventable death in severe trauma. Immediate hemorrhage control and transfusion of blood products are critical to maintain oxygen delivery and address trauma-induced coagulopathy. While prehospital blood product transfusion (PHBT) is established in neighboring countries, the fragmented configuration of Germany's emergency medical service (EMS) infrastructure has delayed the adoption of widespread PHBT programmes. This review aims to provide an updated perspective on the evolution, international practices and research needs of PHBT within the German context.</p><p><strong>Methods: </strong>This narrative review is based on a PubMed search using the search terms \"prehospital\" and \"blood*\". From an initial 4738 articles, 333 were directly related to PHBT and were subjected to further detailed examination. The literature, including referenced studies, was categorized into areas such as history, rationale, international practices, and evidence, and analyzed for quality.</p><p><strong>Results: </strong>The benefit of early blood transfusion in major trauma has been established since WW1, explaining the efforts to initiate this lifesaving intervention as early as possible in the care pathway, including the prehospital field. Recent randomized trials have faced design and recruitment challenges, reflecting the complexity of the research question. These trials have yielded inconclusive results regarding the survival benefits of PHBT in civilian settings. This scenario raises doubts about the capability of randomized trials to resolve questions concerning survival advantages. Despite these difficulties, there is a discernible trend indicating potential improvements in patient outcomes. In Germany, the incidence of trauma-associated shock stands at 38 per 100,000 individuals per year. It is estimated that between 300 and 1800 patients annually possibly benefit from PHBT.</p><p><strong>Conclusion: </strong>Prehospital Blood Transfusion appears to be promising but identifying patient groups most likely to benefit as well as the most suitable blood products remain unresolved issues. In Germany PHBT programs are not yet widely established. Paradoxically, this situation, paired with the extensive German Trauma Registry, provides a prime opportunity for comprehensive prospective cohort studies, addressing the balance between PHBT benefits, logistical feasibility, and implementation strategies. Such studies are essential for establishing guidelines and integrating PHBT efficiently into German trauma care protocols.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"760-770"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360714","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":"Inferior vena cava collapsibility index for predicting hypotension after spinal anesthesia in patients undergoing total knee arthroplasty.","authors":"Yang Liu, Ziyu Han, Jianhua Wang, Qiujun Wang, Xiaojuan Qie","doi":"10.1007/s00101-024-01468-4","DOIUrl":"10.1007/s00101-024-01468-4","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify risk factors associated with hypotension in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia.</p><p><strong>Method: </strong>A total of 200 patients (50-75 years of age) who underwent elective TKA under spinal anesthesia between October 2023 and January 2024 were enrolled. Patients were divided into two groups (hypotensive and nonhypotensive) depending on the occurrence of postspinal anesthesia hypotension (PSAH). Patient characteristics (age, sex, body mass index, and medical history), blood pressure, heart rate, and ultrasound data before anesthesia were documented. Multivariate logistic regression models were used to determine risk factors for hypotension after spinal anesthesia. Furthermore, a nomogram was constructed according to independent predictive factors. The area under the curve (AUC) and calibration curves were employed to assess the performance of the nomogram.</p><p><strong>Results: </strong>In total, 175 patients were analyzed and 79 (45.1%) developed PSAH. Logistic regression analysis revealed that variability of the inferior vena cava (odds ratio, OR, 1.147; 95% confidence interval, CI: 1.090-1.207; p < 0.001) and systolic arterial blood pressure (SABP, OR 1.078; 95% CI: 1.043-1.115; p < 0.001) were independent risk factors for PSAH. Receiver operating characteristic (ROC) curve analysis showed that the AUC of the inferior vena cava collapsibility index (IVCCI) and SABP alone were 0.806 and 0.701, respectively, while the AUC of both combined was 0.841. Specifically, an IVCCI of > 37.5% and systolic arterial blood pressure of > 157 mm Hg were considered threshold values. Furthermore, we found that the combination had a better predictive value with higher AUC value, sensitivity, and specificity than the index alone. The nomogram model and calibration curves demonstrated the satisfactory predictive performance of the model.</p><p><strong>Conclusion: </strong>Elevated preoperative systolic arterial blood pressure and a higher IVCCI were identified as independent risk factors for hypotension in patients receiving spinal anesthesia, which may help guide personalized treatment.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"735-742"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395715","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":"[\"I know that I know nothing\"-Intraoperative blood pressure management in pediatric anesthesiology].","authors":"Katharina Röher, Bernd Saugel","doi":"10.1007/s00101-024-01470-w","DOIUrl":"10.1007/s00101-024-01470-w","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":"73 11","pages":"721-723"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549304","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 emergency medicine 2023/2024-Summary of selected studies in emergency medicine].","authors":"S Katzenschlager, M Obermaier, N Kaltschmidt, J Bechtold, W Spöttl, M Dietrich, M A Weigand, F Weilbacher, E Popp","doi":"10.1007/s00101-024-01465-7","DOIUrl":"10.1007/s00101-024-01465-7","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"746-759"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333693","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 neurosurgical intensive care medicine 2022-2024 : Summary of selected studies in intensive care medicine].","authors":"Christopher Beynon, Michael Bernhard, Thorsten Brenner, Maximilian Dietrich, Mascha O Fiedler-Kalenka, Christian Nusshag, Markus A Weigand, Christopher J Reuß, Dominik Michalski, Christine Jungk","doi":"10.1007/s00101-024-01471-9","DOIUrl":"10.1007/s00101-024-01471-9","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"771-780"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333694","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":"[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}