Die Anaesthesiologie最新文献

{"title":"Effect of electroencephalography-guided general anesthesia on postoperative delirium : A meta-analysis of randomized controlled trials.","authors":"Ji-Hyeon Lee, Hyo-Seok Na, Ji-Na Kim, Jung-Won Hwang, Hyun-Jung Shin","doi":"10.1007/s00101-026-01721-y","DOIUrl":"https://doi.org/10.1007/s00101-026-01721-y","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a common and serious complication. Electroencephalography (EEG)-guided anesthesia has been proposed as a method to minimize excessive depth of anesthesia and potentially reduce the incidence of POD.</p><p><strong>Objective: </strong>This study was conducted to evaluate the effect of EEG-guided anesthesia on POD incidence.</p><p><strong>Methods: </strong>To identify relevant trials a comprehensive search across several electronic databases was performed. The primary outcome was the incidence of POD, while secondary outcomes included duration of EEG suppression and postoperative cognitive dysfunction (POCD) at 1 week and between 1 and 3 months postoperatively. Pooled relative risk (RR) and standardized mean difference (SMD) were calculated.</p><p><strong>Results: </strong>A total of 18 studies were included in the analysis. The results showed that EEG-guided anesthesia significantly lowered the incidence of POD (RR: 0.77, 95% confidence interval, CI: 0.64-0.92; p = 0.0046), demonstrating a protective effect. Additionally, EEG-guided anesthesia resulted in a significant reduction in the duration of EEG suppression (SMD: -0.57, 95% CI: -0.90 to -0.25; p = 0.0005). For POCD, no significant effects were observed at 1 week (RR: 0.54, 95% CI: 0.19-1.51) or at 1-3 months postoperatively (RR: 0.49, 95% CI: 0.20-1.18).</p><p><strong>Conclusion: </strong>The use of EEG-guided anesthesia was associated with a decrease in the incidence of POD and a significant reduction in the duration of EEG suppression; however, its impact on preventing POCD was limited. These findings suggest that although EEG-guided anesthesia can help minimize excessive depth of anesthesia, further research is necessary to identify additional strategies for reducing POD and improving long-term cognitive outcomes.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852044","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":"Severe burns from a hairdryer during labor under epidural anesthesia.","authors":"Florian Marti, Christian Tschumi","doi":"10.1007/s00101-026-01722-x","DOIUrl":"10.1007/s00101-026-01722-x","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726961","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":"[Life-threatening cardiovascular decompensation following elective hernia surgery in a female patient with a low risk profile].","authors":"Maike Henkel, Sven Förster, Catharina Neßelmann, Sebastian Haas, Daniel A Reuter, Thomas Mencke","doi":"10.1007/s00101-026-01720-z","DOIUrl":"https://doi.org/10.1007/s00101-026-01720-z","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708649","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":"Determination of brain death in potential donors on ECMO support : A retrospective analysis highlights the need for evidence-based recommendations.","authors":"Jan Sönke Englbrecht, Jan Sackarnd, Felix Dinkel, Markus Holling","doi":"10.1007/s00101-026-01695-x","DOIUrl":"10.1007/s00101-026-01695-x","url":null,"abstract":"<p><strong>Background: </strong>A recent update of the German directive on determining brain death introduced changes regarding the diagnostics in potential donors on extracorporeal membrane oxygenation (ECMO). Physicians familiar with ECMO must accompany apnea testing and cerebral blood flow-based methods are no longer permitted as ancillary tests in potential donors on venoarterial (VA) ECMO because they are considered insufficiently validated.</p><p><strong>Objective: </strong>The aim was to identify challenges in determining brain death under VA-ECMO in the context of the updated directive.</p><p><strong>Methods: </strong>We analyzed and compared the complete process of brain death (BD) determination before and after the directive update in all potential donors on VA-ECMO between 2021 and 2024 at the University Hospital Münster.</p><p><strong>Results: </strong>A total of 8 potential organ donors on VA-ECMO were identified, BD was determined in seven donors and four donations were utilized (15% of all donors during the observation period). Apnea testing was performed safely in all cases, although PaCO₂ varied depending on the sampling site. In three cases before the update, cerebral circulatory arrest was demonstrated. After the update, a flat-line EEG was obtained in four cases. In one case, EEG was inconclusive due to artefacts.</p><p><strong>Conclusion: </strong>Both apnea tests and cerebral blood flow-based methods were safely performed in donors on VA-ECMO. Electroencephalography (EEG) was only used after the directive update. Future revisions of the directive should provide precise protocols for apnea testing. Further evidence is desirable to reauthorize cerebral blood flow-based methods as ancillary tests. This could support higher organ donation rates in potential donors on VA-ECMO.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"539-548"},"PeriodicalIF":1.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165827","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":"Vergessene Substanzen, verlorenes Wissen: ein Weckruf für die Anästhesiologie.","authors":"Helmuth Forst","doi":"10.1007/s00101-026-01699-7","DOIUrl":"10.1007/s00101-026-01699-7","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"561-562"},"PeriodicalIF":1.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139970","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":"[Ketamine or etomidate for emergency intubation of critically ill patients: no mortality benefit with ketamine, but increased hemodynamic instability].","authors":"Philipp Pütz, Mark Coburn, Florian Piekarski","doi":"10.1007/s00101-026-01715-w","DOIUrl":"10.1007/s00101-026-01715-w","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"589-591"},"PeriodicalIF":1.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431708","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":"[Hydrocortisone for septic shock: with or without fludrocortisone?]","authors":"Josef Briegel","doi":"10.1007/s00101-026-01711-0","DOIUrl":"10.1007/s00101-026-01711-0","url":null,"abstract":"<p><p>The authors of both national and international sepsis guidelines leave it up to clinician discretion whether hydrocortisone should be supplemented with fludrocortisone in cases of septic shock. The aim of this review is to present and discuss the available evidence and the rationale behind the combination of hydrocortisone and fludrocortisone as compared to hydrocortisone alone or standard care for septic shock. In addition to presenting new results from clinical trials and meta-analyses, arguments for and against the additive use of fludrocortisone are discussed and the underlying pathophysiological mechanisms are elucidated. Finally, clinically relevant guidance regarding the practical application of steroids in sepsis is provided.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"530-538"},"PeriodicalIF":1.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551650","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":"[Hereditary disorders of hemostasis in obstetrics 1/2-Anesthesiological aspects of primary hemostasis].","authors":"F Roll, F Fette, P Kranke, J Koscielny, K Zacharowski, Christian F Weber, M-L Lindner","doi":"10.1007/s00101-026-01710-1","DOIUrl":"10.1007/s00101-026-01710-1","url":null,"abstract":"<p><p>Disorders of primary hemostasis affect platelet adhesion and aggregation and include von Willebrand disease (vWD), Glanzmann thrombasthenia (GT) and Bernhard-Soulier syndrome (BSS). The safe administration of epidural anesthesia procedures, such as peridural or spinal anesthesia (PDA/SpA) in patients with coagulation disorders requires a thorough weighing-up of the risk of bleeding, especially the risk of spinal epidural hematoma. The adequate management of postpartum hemorrhage (PPH) also requires exact knowledge of the underlying pathophysiology and the available hemostatic treatment options. This article provides an overview of selected hereditary coagulation disorders of primary hemostasis during pregnancy and elucidates the pathophysiological principles, clinical symptoms, diagnostic procedures and treatment strategies.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"592-604"},"PeriodicalIF":1.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563932","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":"[International multidisciplinary consensus statement on perioperative fasting in adults].","authors":"Anne Rüggeberg, Peter Kranke, Ehrenfried Schindler","doi":"10.1007/s00101-026-01702-1","DOIUrl":"10.1007/s00101-026-01702-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The aim of this consensus statement was to develop evidence-based recommendations on perioperative fasting, taking the growing global awareness of the negative effects of prolonged fasting before surgery into account, particularly with respect to clear liquids.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic literature search was conducted, including assessments of the risk of bias and the overall level of evidence using GRADE methodology to develop 13 preliminary recommendations on perioperative fasting. This was followed by a 3-stage Delphi process involving an international, multidisciplinary panel of 68 experts and nonexperts. Experts on perioperative fasting were selected via a focused literature search, while nonexperts were selected via relevant organizations. The panel comprised anesthetists, surgeons, nurses, cardiologists, gastroenterologists, other physicians, patient representatives and members of international organizations related to the topic, including patient safety organizations and enhanced recovery after surgery (ERAS) societies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The panel of 68 stakeholders subsequently agreed on 8 recommendations. These recommendations are intended for all healthcare professionals as guidance for perioperative fasting in adults undergoing sedation or anesthesia. The consensus statement supports current preoperative fasting practices for solid food and non-clear liquids, reflecting the lack of meaningful new evidence. Patients should fast for 6h with respect to non-clear liquids, including milk, milk products, meal replacement drinks and enteral feeding formulas. They should fast for at least 6h with respect to solid food; for large fatty meals fasting for 8h or longer may be necessary; however, with respect to clear liquids it reflects a fundamental shift towards more liberal liquid regimens. It is recommended that institutional protocols should be implemented to reduce liquid fasting times. These protocols can either encourage patients to drink clear liquids until 2 h before the start of anesthesia or sedation or permit the intake of clear liquids less than 2 h before the start of anesthesia or sedation within institutional protocols. Clear liquids include water, tea or coffee with sugar or honey (including a small amount of milk, up to one fifth of the total volume), clear juices, lemonade and clear carbohydrate drinks. The consensus statement further recommends that oral intake should be resumed as soon as clinically feasible and that preprocedural gastric ultrasound performed by a trained provider can be used to guide clinical decisions when additional information is required.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;These consensus-based recommendations are not an official guideline issued by any national or international professional society. Nevertheless, they are currently regarded as the most comprehensive and up-to-date review of the available evidence, based on robust method","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"563-572"},"PeriodicalIF":1.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310599","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":"Fludrokortison im septischen Schock : Vom Mut, sich festzulegen.","authors":"Thomas Schmoch, Thorsten Brenner","doi":"10.1007/s00101-026-01712-z","DOIUrl":"10.1007/s00101-026-01712-z","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"527-529"},"PeriodicalIF":1.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521440","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}