Die Anaesthesiologie最新文献

{"title":"[Monocentric cohort analysis of anaesthesiological management of pregnant women with congenital heart disease].","authors":"Emmanuel Schneck, Melanie Markmann, Annahita Bahadori, Emmanuella Iyoha, Frank Oehmke, Roland Axt-Fliedner, Aline Wolter, Monika Lüdemann, Thomas S Zajonz, Matthias Müller","doi":"10.1007/s00101-026-01690-2","DOIUrl":"10.1007/s00101-026-01690-2","url":null,"abstract":"<p><strong>Introduction: </strong>The number of pregnant women with adult congenital heart disease (ACHD) is increasing, posing growing challenges for obstetric anaesthesia. This study analysed anaesthetic strategies and postoperative care in ACHD patients treated at a tertiary care centre.</p><p><strong>Methods: </strong>This retrospective single-centre study included ACHD patients who received anaesthesia for delivery, caesarean section or obstetric surgery between 2004 and 2023. A comparison group of obstetric patients without congenital heart disease was selected based on baseline characteristics.</p><p><strong>Results: </strong>A total of 391 cases were included (131 ACHD, 260 comparison group). Most patients were classified as mWHO I (44.2%) or II (23.8%), with 20.5% mWHO II-III and 11.5% mWHO III and IV. Spinal and epidural anaesthesia were used more frequently in lower mWHO classes (p = 0.017). All mWHO IV patients required general anaesthesia provided by ACHD-experienced anaesthetists. ACHD patients more frequently required postoperative ICU or IMCU care (6.6% vs. 1.6%, p = 0.02; 13.9% vs. 3.7%, p < 0.001). Anaesthesiologic complication rates were low in both groups.</p><p><strong>Conclusion: </strong>Obstetric anaesthesia was feasible with low complication rates, even in severe ACHD, when management was individualised and interdisciplinary. All anaesthetic procedures proved to be feasible when adapted to the risk profile.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"473-486"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13323292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846932","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":"[Muscle relaxation 2026-50 years of searching for the ideal relaxant].","authors":"Thomas Krönauer, Felix Girrbach, Philipp Simon, Axel R Heller","doi":"10.1007/s00101-026-01707-w","DOIUrl":"10.1007/s00101-026-01707-w","url":null,"abstract":"<p><p>Since its clinical introduction, muscle relaxation has been one of the most specific topics in anesthesiology, due to the clear interaction between physiology and pharmacology and the immediately apparent effects.Beyond the classical indications in anesthesia for securing the airway, many modern surgical procedures and interventions would not be possible without the development of muscle relaxation; however, warnings about the associated risks and complications have also been issued for decades.Following the expiration of the patent protection of sugammadex in summer 2023, its specific effects and favorable side-effect profile have made a significant contribution to the simplification of muscle relaxation management; however, nearly 2 years later it is important to acknowledge that this advantageous development does not guarantee complete safety and that clinical risks continue to exist in connection with muscle relaxation.Therefore, in this field profound physiological and pharmacological knowledge stay just as important as a consistent and thorough work ethic in accordance with the current guidelines of the anesthesia professional associations.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"502-510"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13323612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280219","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 in neonates and preterm infants : Current knowledge on ventilation, circulation and transfusion].","authors":"Stefanie Reimer, Christian A Maiwald, Karin Becke-Jakob, Frank Fideler","doi":"10.1007/s00101-026-01693-z","DOIUrl":"10.1007/s00101-026-01693-z","url":null,"abstract":"<p><p>The survival rate of extremely preterm infants (< 28 weeks of gestation) has substantially improved over the past decades. The earlier an infant is born, the more likely anesthesiological care becomes necessary (62% < 28 weeks gestation vs. 6% in term infants). Anesthesiologists are therefore increasingly involved in the management of this highly vulnerable population of neonates and preterm infants. Intraoperative events requiring intervention, such as hypotension, hypoxemia and anemia, are frequently found, occurring in up to 70% of infants younger than 32 weeks postmenstrual age and markedly increase morbidity and mortality, particularly when they occur in combination. This article reviews the current literature on three outcome-relevant domains in the anesthesiological management of neonates and preterm infants: hemodynamic management, ventilation strategies and transfusion of cellular blood products and outlines approaches by which clinical outcomes can be improved.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"455-466"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977622","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":"[Chameleon/Lemierre syndrome?]","authors":"Oliver Sommerfeld, Sebastian Reinartz, Michael Bauer, Petra Dickmann","doi":"10.1007/s00101-026-01689-9","DOIUrl":"10.1007/s00101-026-01689-9","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"498-501"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13323268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846848","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":"[Muscle relaxation and neuromuscular monitoring : Current findings and recommendations for the clinical practice].","authors":"Thomas Krönauer, Felix Girrbach, Philipp Simon, Axel R Heller","doi":"10.1007/s00101-026-01705-y","DOIUrl":"10.1007/s00101-026-01705-y","url":null,"abstract":"<p><p>Muscle relaxation is one of the most specific domains of anaesthesiology. Both the interaction between the physiology of the motor end plate and the pharmacology of the substances used as well as the impressive effects immediately following injection explain the fascination of this core competence of anaesthesiological work. A profound pharmacological understanding particularly of the pharmacodynamics and pharmacokinetics of the drugs used and the expertise with respect to the monitoring procedures employed are essential prerequisites for the safe use of muscle relaxants and their antagonists. The aim of this continuing education article is therefore to summarise the basic knowledge of muscle relaxation and neuromuscular monitoring from a clinical perspective. Based on research findings published in recent years and guideline recommendations from various professional associations, a possible approach to clinical practice is outlined.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"515-526"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304123","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":"Patent foramen ovale, bone cement implantation syndrome and paradoxical embolism : Case study and pathophysiological aspects.","authors":"Ludwig Brandt, Ulrike Artmeier-Brandt, Klara Luisa Brandt","doi":"10.1007/s00101-026-01706-x","DOIUrl":"https://doi.org/10.1007/s00101-026-01706-x","url":null,"abstract":"<p><p>Patients with a patent foramen ovale (PFO) have an increased risk of perioperative cerebral stroke due to the potential for paradoxical embolism. It is pathophysiologically plausible that this risk is further increased when bone cement implantation syndrome (BCIS) occurs during endoprosthetic joint surgery; however, despite double-digit prevalence rates for both PFO and BCIS, the perioperative concurrence of these conditions with subsequent paradoxical embolism has not previously been reported.We describe an 81-year-old woman with a known PFO who developed intraoperative BCIS during cemented hip arthroplasty and subsequently sustained a paradoxical embolic stroke involving a large cerebral vessel. The potential pathophysiological links between PFO and BCIS are discussed, and anesthesiological implications and practical recommendations are derived from the current literature.Published estimates of paradoxical embolism risk during endoprosthetic joint replacement are highly inconsistent, ranging from no increased risk to a 29-fold increase. This variability may partly reflect that many embolic events remain clinically silent.For paradoxical embolism two conditions are required: (1) gaseous or particulate emboli must enter the venous circulation and (2) the physiological left-to-right interatrial shunt must reverse to a right-to-left shunt through the PFO. Both mechanisms can be promoted by BCIS by generating embolic load from the surgical field and increasing pulmonary vascular resistance, thereby favoring right-to-left shunting. Because specific anesthesiological preventive and therapeutic options are limited, close postoperative monitoring is essential and any new neurological or hemodynamic abnormalities should prompt immediate comprehensive diagnostic evaluation.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280131","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: Der Einsatz von Tourniquets im Rahmen der Luftrettung.","authors":"M Lautenschläger, D Braun, H Wrigge, B Hossfeld, F Streibert, P Hilbert-Carius","doi":"10.1007/s00101-026-01681-3","DOIUrl":"10.1007/s00101-026-01681-3","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"452"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640165","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":"[The pulmonary artery catheter-Not a niche tool but often a must].","authors":"Matthias Heringlake, Lennart H Muras, Simon Schemke","doi":"10.1007/s00101-026-01676-0","DOIUrl":"10.1007/s00101-026-01676-0","url":null,"abstract":"<p><p>The pulmonary artery catheter (PAC) is the only hemodynamic monitoring tool that continuously integrates systemic blood flow, global oxygen balance, cardiopulmonary interactions and right ventricular function. Meta-analyses show that PAC-guided treatment reduces morbidity and mortality in high-risk surgical patients. Additionally, multiple observational and register data suggest a survival benefit in cardiogenic shock. Despite this evidence the use of PAC has declined in Germany in contrast to the rest of the world, with a concomitant loss of clinical expertise in the use of this monitoring modality. Current data clearly indicate that PAC use and correct data interpretation are not optional skills but core competencies in anesthesiology and intensive care medicine.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"439-451"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790829","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":"[Toxic working environment-A widespread frequently repressed problem].","authors":"Melanie Meersch-Dini","doi":"10.1007/s00101-026-01661-7","DOIUrl":"10.1007/s00101-026-01661-7","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"437-438"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313073","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":"[Anesthesiology as an integrative cross-sectional discipline of clinical resilience-What hospitals must anticipate now for high-load operations].","authors":"Axel R Heller, Amelie Oberst, Dennis M Ritter","doi":"10.1007/s00101-026-01686-y","DOIUrl":"10.1007/s00101-026-01686-y","url":null,"abstract":"<p><p>The increasing complexity of modern threats, from pandemics and cyberattacks to hybrid and conventional forms of warfare, requires a paradigm shift in disaster preparedness at medical facilities. Building on experiences from the war in Ukraine, business continuity management and a consistent all-hazards approach, a multilevel, practical resilience model for hospitals is presented. In the context of alliance and national defense, civilian hospitals assume the role of military level 4 facilities. They must be able to cold start and receive and stabilize wounded patients while maintaining regular care and transfer them onward in a scalable manner. To this end, military medical evacuation and distribution systems must be integrated in an interoperable manner.The approach integrates a legally robust procedural framework (disaster declaration, general administrative orders, medical management, hospital coordination) with operational capacity (resource-independent triage at entry, damage control resuscitation/surgery, chemical, biological, radiological, nuclear (CBRN) minimum protection standard) as well as hybrid documentation and communication (paper-based mode, digital coordination instruments, bed occupancy, wave plan/tickets, defined fallbacks). Resources are allocated without discrimination according to urgency and clinical prospects of success, supported by re-evaluation and the multiple assessor principle.In clinical operations, interdisciplinary anesthesiological and intensive care cross-sectional services make an essential contribution to maintaining overall system functionality. This includes, in particular, the management of intensive care capacity. These functions act in a complementary and cooperative manner alongside core surgical services, embedded within a multiprofessional and multidisciplinary framework.A staged resilience roadmap prioritizes upgrades to existing facilities (emergency power/water, protected operating room/ICU cores), network and cooperation structures and staff training; large-scale new construction is a lower priority. In addition, supplementary curricular qualifications (e.g. nursing assistant and emergency medical services modules for students) and binding funding commitments for training, infrastructure, supplies and cyber/IT resilience are required. The resulting synthesis of operational, ethical, legal and infrastructural elements anchors a highly resilient, interoperable care architecture that reliably preserves clinical functionality, decision-making ability and moral integrity even under extremely challenging conditions.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"379-390"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13226363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846799","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}