Die Anaesthesiologie最新文献

{"title":"[Failure of critical infrastructures in German hospitals : Online survey on crisis management structures and exercises in hospitals].","authors":"Manuel Geiger, Steffen Neuner, Muhammed Enes Bodur, Alexander Fekete","doi":"10.1007/s00101-026-01664-4","DOIUrl":"10.1007/s00101-026-01664-4","url":null,"abstract":"<p><strong>Background: </strong>Hospitals are critical infrastructures and essential for healthcare provision, yet they heavily depend on the continuous availability of other parts of the critical infrastructure, such as electricity and water supply. In emergencies, organizational aspects often play a crucial role as hospitals need to shift from routine organizational structures to specialized crisis management frameworks. This survey investigates the organizational structures used by German hospitals in crisis management, focusing on the frequency and types of exercises related to critical infrastructure failures, particularly water and power supply as well as sewage disposal.</p><p><strong>Objective: </strong>While organizational preparations for mass casualty incidents are common in German hospitals, insufficient structures are implemented for critical infrastructure failures as well as how often these scenarios are practiced. This study aims to address these gaps by examining hospital crisis management structures, the frequency of related exercises and the interplay among hospital size, ownership and regional factors. The research is part of the NOWATER project, funded by the Federal Ministry of Education and Research (BMBF, 13N15281), which investigates these aspects.</p><p><strong>Methods: </strong>The survey conducted from November 2022 to April 2023 and targeting hospitals across Germany, gathered 72 fully completed responses, representing 3.8% of Germany's total hospitals.</p><p><strong>Results: </strong>The findings reveal a diverse range of crisis management structures employed across hospitals, with 47% adhering to the federal recommendation for the Feuerwehr-Dienstvorschrift 100 (Fire Department service regulations 100) framework; however, many hospitals, especially those with fewer than 200 beds, opt for regular organizational structures or hybrid models. The survey also highlights a significant variation in the frequency of exercises across hospitals. While annual exercises for power failure scenarios are common, training related to water and wastewater disruptions is rarely conducted. Additionally, hospitals with fewer than 200 beds tend to conduct fewer exercises than larger hospitals, with significant disparities in resources influencing exercise frequency and type.</p><p><strong>Conclusion: </strong>The results suggest that while larger hospitals are more likely to follow recommended crisis management structures and conduct regular exercises, smaller hospitals often lack the personnel and financial resources necessary for such preparations. This disparity underlines the need for tailored crisis management strategies that account for hospital size and available resources. In conclusion, the study underlines the importance of regular crisis management exercises to improve resilience and preparedness for infrastructure failures. It also calls for increased focus on water and wastewater contingency planning, which currently lags be","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"391-398"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13226423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147534577","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":"[Peripheral regional anesthesia and analgesia: \"the magnificent seven\" for training].","authors":"M H Huppertz-Thyssen, A H Andres, T Komanek, N Nikolić, T Volk, A U Steinbicker, U H Frey, T P Weber","doi":"10.1007/s00101-026-01667-1","DOIUrl":"10.1007/s00101-026-01667-1","url":null,"abstract":"<p><p>Recent technological advances in ultrasound imaging have expanded the access routes for nerve and fascia blocks, opening up new perspectives. This has led to a significant increase in the number of published block techniques in regional anesthesia. Which specific regional anesthesiology techniques should be taught is currently not defined, even though the focus of the new postgraduate training regulations prior to admission to the anesthesia board examination now focuses on the acquisition of practical skills and ability to act rather than defined training time and numbers. The aim of this article is to propose frequent and established techniques for postgraduate training. The foundations for the recommendations were the establishment of interfascial blocks and the necessity of \"motor sparing\", which is increasingly considered to be an integral part of modern regional anesthesia concepts. These techniques are characterized by their ease of learning and an optimal risk-benefit profile. Proposals for regional anesthesia procedures in individual body regions are presented. A total of seven regional anesthesia procedures are proposed: axillary brachial plexus block (BPB), distal sciatic nerve block (DIB), interscalene BPB, femoral nerve block (NFB) together with the motor-sparing femoral triangle block (TFB), pericapsular nerve group block (PENG), transversus abdominis plane block (TAPB) with its variations and serratus anterior plane block (SAPB).</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"426-436"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13226434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583102","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":"[Anesthesiology-The invisible backbone of hospital resilience].","authors":"Martin Kulla","doi":"10.1007/s00101-026-01691-1","DOIUrl":"10.1007/s00101-026-01691-1","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"377-378"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038328","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":"[Pediatric anesthesia services at German university hospitals : A descriptive analysis (2022-2024)].","authors":"Armin Sablewski, Clemens Miller, Christiane E Beck, Katharina Röher, Ehrenfried Schindler, Nina Zech","doi":"10.1007/s00101-026-01666-2","DOIUrl":"10.1007/s00101-026-01666-2","url":null,"abstract":"<p><strong>Background: </strong>University hospitals play a key role in research, clinical care and medical education; however, the number of pediatric anesthetic procedures performed at German university hospitals, including complex cases requiring specialized expertise and those relevant for training remains unknown.</p><p><strong>Methods: </strong>All chairs of anesthesiology at German university hospitals were invited via email to participate in a survey. For the years 2022-2024, the number of anesthetic procedures, patient age groups (< 1, 1-4, 5-11, 12-17, ≥ 18 years) and the American Society of Anesthesiologists (ASA) classification of pediatric cases were collected. The primary endpoint was the percentage of pediatric anesthetic procedures relative to the total number of anesthetic procedures. Secondary variables included age distribution, relative proportion, ASA classification and case volume-dependent structure of pediatric anesthesia services.</p><p><strong>Results: </strong>In this study 23 university hospitals participated (response rate: 43.6%). On average, 24,910 ± 9325 anesthetic procedures were performed per hospital and year. The proportion of children was 13.6% (of whom 11.6% were < 1 year and 31.8% aged 1-4 years). The relationship between total case volume and the pediatric proportion was positive and linear (y = 0.0017x + 7.0785; R² = 0.69). The ASA classification of children was distributed as follows: 47.9% ASA I, 28.5% ASA II, 20.0% ASA III, 3.3% ASA IV and 0.2% ASA V. Hospitals with the largest total caseloads had the highest pediatric proportion (16.5%), including the largest share of children aged 0-5 years (52.2%) and the highest proportions of ASA IV-V cases (27.6%).</p><p><strong>Discussion: </strong>There were marked differences in case volume among university hospitals; however, a clear correlation was observed between total anesthetic case volume and the pediatric proportion. The findings suggest that pediatric anesthesia services are increasingly concentrated in large centers.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"413-421"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13226350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446153","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":"[Good outcome after out of hospital cardiac arrest despite unfavorable prognosis and without using eCPR].","authors":"Susanne Waitz, Christine Kleindorfer, Liudmila Belevskaia, Alexander Leibold, Peter Paul Ellmauer, Jan Dembianny, Dirk Lunz, Bernhard Graf, Dominic Barthelmes","doi":"10.1007/s00101-026-01672-4","DOIUrl":"10.1007/s00101-026-01672-4","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"422-425"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13226369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596427","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 during cesarean section in women with congenital heart disease : Experience from a certified university hospital for adults with congenital heart disease in Germany-Retrospective analysis from 2013-2023.","authors":"Susanne Greve, Nathalie Weigt, Christiane E Beck, Anna Fischbach, Tim Heusinger von Waldegg, Sebastian Heiderich, Vanessa Rigterink, Steffen B Wiegand","doi":"10.1007/s00101-026-01670-6","DOIUrl":"10.1007/s00101-026-01670-6","url":null,"abstract":"<p><strong>Background: </strong>Women with congenital heart disease (CHD) often reach childbearing age and may become pregnant. In this study we examine the anesthetic management of cesarean section (C-section) in a university hospital certified for CHD.</p><p><strong>Methods: </strong>The anesthesiological care for women with CHD who presented at our certified university hospital between January 2013 and December 2023 was descriptively analyzed. We restricted analysis to women who underwent C‑section (n = 38) and the women were classified according to the complexity of the CHD based on the WHO classification of CHD into I mild (A; n = 6), II moderate (B; n = 13) or III severe (C; n = 19). This study is mainly descriptive and serves as a preliminary study for a larger prospective multicenter study.</p><p><strong>Results: </strong>Most of the C‑sections were planned and scheduled (A: n = 3; 50%; B: n = 11; 85% and C: n = 16; 84%) for the dayshift. Anesthesia was performed in more than two thirds of cases by two anesthesiologists. Neuraxial anesthesia was most often performed to achieve adequate surgical tolerance. The frequency of arterial catheter and central venous catheter placements were similar among the groups. Although sometimes introducer sheaths were placed to enable faster introduction of a cannula for extracorporeal membrane oxygenation (ECMO), no use of ECMO was necessary. Postpartum women with severe CHD were more likely to be admitted to the ICU. None of the mothers or newborns died.</p><p><strong>Conclusion: </strong>This study aimed to describe the anesthesiological management in women with different severity of CHD undergoing C‑section. This management requires a multidisciplinary approach within a pregnancy heart team. Due to the overall low frequencies and heterogeneity of the CHDs larger multicenter studies are necessary to develop recommendations for obstetric anesthesia in pregnant women with CHD.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"399-412"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13226378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639802","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":"Perioperative blood management in Jehovah's Witnesses.","authors":"Florian Piekarski, Jan Menzenbach, Tobias Hilbert, Jürgen Hersch, Ehrenfried Schindler, Mark Coburn, Josefin Grabert","doi":"10.1007/s00101-026-01683-1","DOIUrl":"10.1007/s00101-026-01683-1","url":null,"abstract":"<p><strong>Background: </strong>Jehova's Witnesses refuse the administration of allogenic blood products for religious reasons. This stance represents a special challenge for the perioperative management and requires individualized ethically sensitive and medically founded strategies. In this respect patient blood management (PBM) provides a structured and evidence-based approach for optimization of the preoperative, intraoperative and postoperative care.</p><p><strong>Objective: </strong>Description of the current medical, ethical and legal procedure for the management of patients who refuse blood transfusions exemplified by Jehova's Witnesses and presentation of a standardized clarification model.</p><p><strong>Material and methods: </strong>Narrative overview of current recommendations and guidelines on preoperative treatment of anemia, intraoperative coagulation treatment, autotransfusion and the legal framework of action. In addition, a questionnaire on differentiated clarification developed at the University of Bonn is presented.</p><p><strong>Results: </strong>A timely structured management of anemia, the application of viscoelastic point of care diagnostics and the differentiated use of autologous procedures, such as mechanical autotransfusion, enable a safe perioperative treatment even in cases of refusal of allogenic blood transfusion. Legal aspects underline the binding to patient advance directives, particularly in adults able to provide informed consent. For children, the child's welfare is prioritized in emergency cases. The clarification form presented reduces uncertainties and strengthens the interdisciplinary decision making.</p><p><strong>Conclusion: </strong>An individualized PBM concept represents an effective and ethically tenable strategy for the perioperative treatment of patients who refuse blood transfusions. It combines medical safety with respecting patient autonomy.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824266","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: Update zum perioperativen Umgang mit kardial implantierten elektronischen Geräten.","authors":"Fiona Uhor, Andreas Haeberlin, Jürgen Knapp","doi":"10.1007/s00101-026-01677-z","DOIUrl":"10.1007/s00101-026-01677-z","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"376"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517221","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":"[Sepsis care in Germany: quality indicators on diagnostics and treatment of sepsis].","authors":"Christian S Scheer, Evgeny A Idelevich, Simon Oelsner, Jacob Packmohr, Konrad Reinhart, Matthias Gründling","doi":"10.1007/s00101-026-01663-5","DOIUrl":"10.1007/s00101-026-01663-5","url":null,"abstract":"<p><strong>Background: </strong>In Germany quality indicators from the Institute for Quality Assurance and Transparency in the Healthcare System (IQTIG) on the diagnostics and treatment of sepsis in hospitals will be compulsorily introduced in 2026. Currently, there are few data on the extent to which quality indicators in the form of measures to recognize and treat sepsis are already established.</p><p><strong>Methods: </strong>This was a secondary analysis of the European Sepsis Care Survey, an international, cross-sectional study of the organization of sepsis care in acute care hospitals. Head physicians from hospitals in all federal states and at all levels of care in Germany were systematically invited to participate. The analysis investigated seven quality indicators of the IQTIG on the diagnostics and treatment of sepsis.</p><p><strong>Results: </strong>In Germany 253 hospitals (20% of all acute care hospitals in Germany) were analyzed. Standardized screening for early detection of sepsis existed in 34.8% (95% confidence interval, CI 27.9-42.3%) of hospitals and standardized measures for sepsis management in 36.6% (95% CI 29.2-44.5%) of hospitals. There were differences between emergency departments, general wards and intensive care units (p < 0.05) but no significant differences between university and non-university hospitals. Regular training of medical and nursing staff in all departments existed in 4.7% (95% CI 2.3-8.5%) of hospitals.</p><p><strong>Conclusion: </strong>In Germany only a few hospitals had hospital-wide standardized measures for the early detection and treatment of sepsis. Regular training of medical and nursing staff to improve quality was rarely implemented. Against this background, the establishment of quality improvement programs is urgently needed but at the same time requires clear structures and sufficient resources.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":" ","pages":"333-343"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488613","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":"[Packed red blood cells-Avoidable risks and complications].","authors":"Thomas Frietsch, Dania Fischer","doi":"10.1007/s00101-026-01669-z","DOIUrl":"10.1007/s00101-026-01669-z","url":null,"abstract":"<p><p>Packed red blood cells (PRBC) are indispensable but high-risk therapeutic agents with a high quality of preparation but the safety of administration is compromised by avoidable errors. The physician's decision for a transfusion must consider both the inherent risk profile of the high-quality product and the safety of administration. Key problem areas in the clinical use of PRBCs include confusion of products and hemolytic transfusion reactions due to process or identification errors, undertransfusion resulting from logistical bottlenecks or misjudgement and overtransfusion due to the overreliance on hemoglobin concentrations as transfusion trigger and a lack of adherence to guidelines. The risk of PRBC overdosing, in particular, is currently underestimated. As a large proportion of adverse events are application-related and therefore potentially preventable, technical safeguards, digitalization, structured processes and consistent patient blood management are essential measures for increasing patient safety.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":"75 5","pages":"359-375"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790824","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}