Die Anaesthesiologie最新文献

{"title":"[WAKWiN minireview: intraoperative ventilation and postoperative pulmonary complications-Current evidence and concepts for lung protection].","authors":"Katharina Hellenthal, Martin Scharffenberg","doi":"10.1007/s00101-026-01687-x","DOIUrl":"10.1007/s00101-026-01687-x","url":null,"abstract":"<p><p>Approximately 5% of patients undergoing surgery under general anesthesia suffer from postoperative pulmonary complications. In 20% of these cases, the patients die within the first 30 days after surgery. While ensuring pulmonary gas exchange under general anesthesia, intraoperative mechanical ventilation itself may substantially contribute to the development of ventilator-induced lung injury. Based on approaches used in the treatment of acute respiratory distress syndrome, various intraoperative ventilation strategies have been developed to prevent postoperative pulmonary complications. While neither a high positive end-expiratory pressure nor an individualization of the driving pressure has so far been shown to consistently reduce postoperative pulmonary complications in either one-lung or two-lung ventilation, a beneficial effect appears to emerge in selected surgical procedures and high-risk patients. Newer pathophysiological concepts such as mechanical power (or intensity) may help to optimize ventilation and reduce complications in the future. This review article provides a concise summary of the pathogenesis of ventilator-induced lung injury and discusses the most recently available evidence as well as the potential of current ventilation strategies for lung protection.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"573-578"},"PeriodicalIF":1.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790837","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":"[(Failed) Intubation during emergency coniotomy by the emergency physician].","authors":"L Schlattmann, B Hartung, P Markwerth","doi":"10.1007/s00101-026-01692-0","DOIUrl":"10.1007/s00101-026-01692-0","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"557-560"},"PeriodicalIF":1.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977600","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 mindset of anesthesiologists while performing surgical airway management].","authors":"Jan Carlo Del Tedesco, Lion Sieg, Markus Flentje, Vera Hagemann, Kai Johanning, Lars Friedrich, Hendrik Eismann","doi":"10.1007/s00101-026-01696-w","DOIUrl":"10.1007/s00101-026-01696-w","url":null,"abstract":"<p><strong>Background: </strong>The surgical establishment of a secure airway in a cannot intubate-cannot oxygenate situation represents a feared and multidimensionally challenging situation in anesthesiology and emergency medicine teams. Numerous factors can influence the performance of a cricothyroidotomy. In addition to experience, knowledge and practical skills, the materials used and the mindset of the personnel also appear to play a significant role.</p><p><strong>Aim of the study: </strong>This study aimed to provide a comprehensive picture of experiences, attitudes and knowledge on surgical airway management of medical personnel at a department of anesthesiology and intensive care medicine. This study builds on data collected on cricothyroidotomy in 2017, which changed the internal training concept adaptation of the hospital.</p><p><strong>Methodology: </strong>This study used a mixed qualitative and quantitative approach. We conducted a survey using questionnaires sent to all physicians of the department of anesthesiology, followed by expert interviews with doctors in training, specialists and senior physicians.</p><p><strong>Results: </strong>We could evaluate 59 questionnaires from the medical personnel. Additionally, we conducted 4 group interviews, each with 6-8 participants. We could demonstrate the significant influence of skill and simulation teaching programs on coniotomy; however, in the total collective the safety of decisions and performance remains low. Interviews covered a wide range of anesthesiological topics that indirectly affect and influence the topic of surgical airway management. The role of the anesthesia identification card was explained and the further education in the field of awake fiberoptic intubation was examined.</p><p><strong>Conclusion: </strong>Cricothyroidotomy in the context of failed airway management is and remains one of the most challenging scenarios for anesthesiology teams. Regular continuing education in the form of skills training, followed by integration into simulation scenarios, can significantly increase the subjective competence; however, the well-known uncertainty about an objectively measurable or detectable point that unequivocally indicates a cricothyroidotomy remains an inhibiting factor that needs to be addressed in the further development of training programs.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"579-588"},"PeriodicalIF":1.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152435","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":"[Feedback conversations in postgraduate medical education : Structured feedback in anesthesiological postgraduate education at the University Medical Center Hamburg-Eppendorf -A pre-post analysis].","authors":"Nicolas Hoffmann, Martin Klasen, Katharina Röher, Saša Sopka","doi":"10.1007/s00101-026-01700-3","DOIUrl":"10.1007/s00101-026-01700-3","url":null,"abstract":"<p><strong>Background: </strong>Feedback is one of the most powerful influences on learning and achievement. Nevertheless, residents receive too little of it during postgraduate clinical education. Currently mandatory annual professional development reviews are perceived as inadequate by residents.</p><p><strong>Objective: </strong>In order to make clinical feedback more frequently available, structured clinical feedback conversations were introduced in 2018 in the Department of Anesthesiology at the University Medical Center Hamburg-Eppendorf (UKE) in postgraduate education to accompany clinical workplace rotations.</p><p><strong>Methods: </strong>The effect of the introduction of these feedback conversations was evaluated by conducting a survey among residents before (time t₀) and after (time t₁) the introduction regarding general perceptions of received feedback, any desire for more clinical feedback and general job satisfaction. The research question was if the introduction of feedback conversations could improve satisfaction of received feedback on job performance and overall job satisfaction among the residents.</p><p><strong>Results: </strong>Approximately half of the residents (t₀ 51%; t₁ 44%) participated in the surveys. At t₀ 64% initially judged the annual professional development reviews to be inadequate as a feedback tool. At t₁ on average, 3.4 feedback conversations (mean 2) took place per resident, each lasting 10.4 min (mean 10 min). After the introduction of the feedback conversations, however, 84% viewed it as a more useful tool and 78% felt that the feedback conversations took place in an appreciative and respectful atmosphere. In comparison before and after the introduction of the feedback conversations the residents increasingly felt they knew how their supervisors assessed their practical skills (p = 0.017), were treated by their supervisors as they desired (p = 0.039) and were more likely to be able to easily present their own criticisms and suggestions for improvement (p = 0.033); however, no improvement could be observed in general job satisfaction.</p><p><strong>Conclusion: </strong>In contrast to the mandatory annual professional development reviews, multiple feedback conversations per year are generally welcomed by the residents and recognized as a teaching tool for providing feedback. These feedback conversations also create a forum in which residents can more easily provide feedback to superiors. Thus, feedback conversations appear to contribute to a feedback culture and an appreciative and respectful working environment.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"549-556"},"PeriodicalIF":1.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310575","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":"Relevance of blood gas analysis in emergency medical services: an emergency physician's assessment.","authors":"Steffen Grautoff, Niclas Knappen, Luca Hennig, Christian Engelen, Tobias Hübner","doi":"10.1007/s00101-026-01678-y","DOIUrl":"10.1007/s00101-026-01678-y","url":null,"abstract":"<p><strong>Objective: </strong>Blood gas analyses form part of routine testing in emergency medicine and intensive care in hospitals in the western world; however, this method has not yet become established in prehospital management, despite the fact that patients are comparable in terms of severity of the illnesses. This study aimed to assess whether the use of prehospital blood gas analysis has medical and/or organizational consequences for patient care.</p><p><strong>Methods: </strong>In two regions in Germany, seven emergency physician-staffed response units were equipped with portable blood gas analysis devices. After each use, providers were required to complete a 6-item questionnaire evaluating potential medical and organizational consequences for the patient.</p><p><strong>Results: </strong>A total of 184 patients underwent prehospital blood gas analysis. In 85% of cases, providers reported consequences for patient management, including medical and/or organizational effects.</p><p><strong>Conclusion: </strong>In the majority of cases, prehospital blood gas analysis influenced the care of critically ill patients. Further research is needed to determine whether its use translates into improved clinical outcomes, such as reduced mortality.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"487-494"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147701157","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":"Unklarer Einfluss des hormonellen Status auf das Auftreten von postoperativer Übelkeit und Erbrechen sowie fehlende Prä-Post-Analyse in der vorliegenden Forschungsarbeit.","authors":"Maike Stegen, Celine Nowak, Thorsten Brenner, Stefanie Klenke","doi":"10.1007/s00101-026-01697-9","DOIUrl":"10.1007/s00101-026-01697-9","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"513-514"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139930","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":"[Electrical impedance tomography-guided PEEP individualization during laparoscopic fundoplication and lymphangioleiomyomatosis].","authors":"Stefan Rederlechner, Patrick Friederich","doi":"10.1007/s00101-026-01688-w","DOIUrl":"10.1007/s00101-026-01688-w","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"495-497"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846917","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":"[RSI in pediatric anesthesia: an online survey of actual clinical practice].","authors":"Melanie Fieler, Marcus Nemeth, Vanessa Rigterink, Christiane E Beck","doi":"10.1007/s00101-026-01671-5","DOIUrl":"10.1007/s00101-026-01671-5","url":null,"abstract":"<p><strong>Background: </strong>For many years, controlled rapid sequence induction (cRSI) has been recommended in children at risk of aspiration to reduce the risk of hypoxia; however, no fixed age limit has been defined for the transition to classical RSI. This study examines the current practices of RSI in children as well as controversies regarding existing approvals, recommendations and clinical guidelines.</p><p><strong>Methods: </strong>An anonymous online survey was carried out among the members of the Scientific Working Group on Pedíatric Anesthesia (WAKKA) of the German Society of Anesthesiology and Intensive Care Medicine (DGAI).</p><p><strong>Results: </strong>A total of 244 questionnaires could be evaluated. Of the respondents 218 were specialists and 191 respondents performed pediatric anesthesia at least once a week. For 73.4%, there was no fixed age limit for cRSI. Despite off-label-use propofol is the most frequently used hypnotic agent also in the group of premature and newborn infants and rocuronium was the most used muscle relaxant in all age groups. Pressure-controlled ventilation until intubation is performed by 80% of the respondents. The standard use of a video laryngoscope for cRSI is confirmed by 34.8% of the respondents and relaxometry is used routinely by 59.8%.</p><p><strong>Conclusion: </strong>Controversial practices include the use of propofol in premature and newborn infants and the inconsistent use of video laryngoscopy, relaxometry, neuromuscular blocking agents, neuromuscular monitoring and mechanical pressure-controlled intermediate ventilation. The transition to classical RSI is based on individual patient circumstances regarding the risk of hypoxia. No fixed age limit could be identified.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"467-472"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679018","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":"Hormonelle Heterogenität und fehlende Prä-Post-Kontrolle als methodische Limitationen einer standardisierten Prophylaxe-Studie zu postoperativer Übelkeit und Erbrechen (PONV).","authors":"Muhammed Nezih Koç, Ömer Keklicek","doi":"10.1007/s00101-026-01698-8","DOIUrl":"10.1007/s00101-026-01698-8","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"511-512"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139990","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":"Das Häufige ist häufig und das Seltene häufig komplex.","authors":"Ehrenfried Schindler","doi":"10.1007/s00101-026-01701-2","DOIUrl":"10.1007/s00101-026-01701-2","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"453-454"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206928","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}