[Preclinical emergency medicine-thinking outside the box is worth it!]
PMID: 29352363 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - January 19, 2018 Category: Anesthesiology Authors: Bernhard M, Gries A Tags: Anaesthesist Source Type: research

[Accidental central venous administation of 0.1  % chlorhexidine mouthwash].
We describe a case of central venous administration of 0.1% CHX mouthwash, its potential complications and possibilities of treatment. In contrast to another case report our patient had no detectable adverse side effects. The immediate hemofiltration and cleansing of the i. v. line may have contributed to this favorable outcome. PMID: 29352364 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - January 19, 2018 Category: Anesthesiology Authors: Ploner M, Löffel LM, Schüpfer G, Besmer I, Konrad CJ Tags: Anaesthesist Source Type: research

[Anesthesia problem cards-indispensable yet problematic : Nationwide survey on experiences from clinical practice].
CONCLUSION: Anesthesia problem cards are considered a useful tool to increase patient safety and are frequently issued in clinical practice; however, in the document's current form its full potential for risk minimization cannot be exploited. Structural changes are required to increase documentation quality and reproducibility. Concerning its informational content, the spectrum of included complications and their individual solutions need to be expanded to meet the requirements of modern anesthetic practice. PMID: 29352365 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - January 19, 2018 Category: Anesthesiology Authors: Schieren M, Böhmer A, Golbeck W, Defosse J, Wappler F, Marcus HE Tags: Anaesthesist Source Type: research

[Drugs for intravenous induction of anesthesia: propofol].
Abstract In a series of articles dealing with hypnotics for induction of anesthesia, this article describes the development and current value of propofol. Its significance far exceeds that of a pure induction hypnotic (sedation in diagnostic and therapeutic procedures and on the intensive care unit). Propofol is also used for sedation in diagnostic and therapeutic procedures and on the intensive care unit. In the field of induction of anesthesia, the alternatives are barely used. Some contraindications are still controversial whereas others are no longer sufficiently anchored in the users' awareness (wid...
Source: Der Anaesthesist - January 15, 2018 Category: Anesthesiology Authors: Bolkenius D, Dumps C, Halbeck E Tags: Anaesthesist Source Type: research

[Antibiotic stewardship : Measures for optimizing prescription of anti-infective agents].
Abstract Antibiotic stewardship (ABS) comprises a bundle of different interventions to improve anti-infective treatment in a hospital setting. An important component of ABS interventions is the interdisciplinary approach to infection management. Besides improving infrastructural aspects on a hospital level, including surveillance of the use of anti-infective agents and nosocomial infections, collation and interpretation of statistics on resistance and formulation of local treatment guidelines, ABS teams go to the wards and advise treating physicians on antibiotic therapy. Frequent approaches for opt...
Source: Der Anaesthesist - January 8, 2018 Category: Anesthesiology Authors: Lanckohr C, Bracht H Tags: Anaesthesist Source Type: research

Out-of-hospital airway management during manual compression or automated chest compression devices : A  registry-based analysis.
Out-of-hospital airway management during manual compression or automated chest compression devices : A registry-based analysis. Anaesthesist. 2018 Jan 04;: Authors: Bernhard M, Behrens NH, Wnent J, Seewald S, Brenner S, Jantzen T, Bohn A, Gräsner JT, Fischer M Abstract BACKGROUND: Airway management during resuscitation is pivotal for treating hypoxia and inducing reoxygenation. This German Resuscitation Registry (GRR) analysis investigated the influence of the type of airway used in patients treated with manual chest compression (mCC) and automated chest compression devices (ACCD) after out-...
Source: Der Anaesthesist - January 4, 2018 Category: Anesthesiology Authors: Bernhard M, Behrens NH, Wnent J, Seewald S, Brenner S, Jantzen T, Bohn A, Gräsner JT, Fischer M Tags: Anaesthesist Source Type: research

[Perioperative bleeding in a  Jehovah's Witness].
We report the case of a 45-year-old man, who refused to accept red blood cell concentrates by a patient directive. A postoperative bleeding occurred after removal of a transplanted kidney. Despite critically low hemoglobin (3.1 g/dl) and hematocrit (9.5%) levels, the case was managed without red blood cell transfusions. The patient showed an amazingly quick recovery and was discharged from hospital after 24 days without any sequelae. PMID: 29294161 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - January 2, 2018 Category: Anesthesiology Authors: Heschl S, Schörghuber M, Kröll W Tags: Anaesthesist Source Type: research

[Antibiotic stewardship in a basic care hospital : A retrospective observational study].
Abstract BACKGROUND: In response to the global increase in antibiotic resistance, the concept of antibiotic stewardship (ABS) has become increasingly important in recent years. Several publications have demonstrated the effectiveness of ABS, mainly in university facilities. This retrospective observational study describes the implementation of ABS in a basic care hospital. MATERIAL AND METHODS: Following existing national guidelines, an ABS team was set up and measures were launched. These included: hospital guidelines, teaching, weekly antibiotic ward rounds and the restriction of definite substances. T...
Source: Der Anaesthesist - January 2, 2018 Category: Anesthesiology Authors: Bonsignore M, Balamitsa E, Nobis C, Tafelski S, Geffers C, Nachtigall I Tags: Anaesthesist Source Type: research

[Intramedullary injection with tethered cord : Case report of a rare complication during spinal anesthesia].
This report describes and analyses a case of spinal injury due to an undiagnosed tethered cord (TC) during spinal anesthesia for a cesarean section of a 31-year-old woman expecting twins. As a consequence of spinal dysraphism during embryogenesis, an atypically low conus level can occur and increase the risk of injury during neuraxial anesthesia, especially in the absence of symptoms. Injuries can be caused by mechanical trauma from direct needle injury, hematoma or neurotoxicity from local anesthetics. Special attention should therefore be paid to frequent symptoms, such as a hairy nevus on the back, deformities...
Source: Der Anaesthesist - December 21, 2017 Category: Anesthesiology Authors: Vogt L, Rodermond B, Post P, Iborra S, Stickeler E, Schiefer J, Alt JP, Rossaint R, Röhl A Tags: Anaesthesist Source Type: research

[Acute perioperative right heart insufficiency : Diagnostics and treatment].
CA Abstract Acute right heart failure is often overlooked as a cause of cardiopulmonary insufficiency. The various pathologies underlying right heart failure at the level of afterload, preload and contractility, make rapid, targeted diagnostics necessary. In addition to clinical symptoms and laboratory chemical parameters, echocardiography in particular is relevant for making a diagnosis. Symptomatic treatment of the endangered patient is essential. The focus is on a reduction of right ventricular pressure and afterload, a correction of systemic hypotension and positive inotropic support of the right ve...
Source: Der Anaesthesist - December 21, 2017 Category: Anesthesiology Authors: Schäfer B, Greim CA Tags: Anaesthesist Source Type: research

[Comments on: Daytime variation of perioperative myocardial injury in cardiac surgery].
e C PMID: 29234824 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - December 12, 2017 Category: Anesthesiology Authors: Schälte G, Stoppe C Tags: Anaesthesist Source Type: research

[Fulminant sepsis after Capnocytophaga canimorsus infection].
Abstract Capnocytophaga canimorsus is a Gram-negative bacterium present in the oral cavities of cats and dogs. It is known for its capability to cause life-threatening sepsis following a dog bite, especially in immunocompromised patients. We report the case of a 67-year-old man who suffered from septic shock and multiorgan failure presumably following contamination of a pre-existing minor skin lesion by canine saliva. The purpose of this report is to raise awareness of Capnocytophaga canimorsus among physicians when faced with a patient presenting with fulminant septic shock and Gram-negat...
Source: Der Anaesthesist - December 11, 2017 Category: Anesthesiology Authors: Feige K, Hartmann P, Lutz JT Tags: Anaesthesist Source Type: research

[Analysis and options for optimization of preoperative assessment for anesthesia at a  university hospital].
CONCLUSION: The analysis of processes and problems in the context of preoperative assessment for anesthesia revealed several options for optimization. Major efforts should be the implementation of an appointment system for the preoperative assessment clinic in order to generate a homogeneous distribution of patients during the course of a day. Furthermore, surgeons and case managers should be requested to refer patients to the preoperative assessment clinic only with complete records and test results according to the in-house standard. PMID: 29230500 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - December 11, 2017 Category: Anesthesiology Authors: Kieninger M, Eissnert C, Seitz M, Judemann K, Seyfried T, Graf B, Sinner B Tags: Anaesthesist Source Type: research

[Development of ground-based physician-staffed emergency missions in the city of Leipzig from 2003 to 2013].
r A Abstract BACKGROUND: The annual number of physician-based emergency missions reported is continuously increasing. Data from large cities concerning this development over long periods is sparse. MATERIAL AND METHODS: In this retrospective study the charts of all ground-based physician-staffed emergency missions in the city of Leipzig for the first quarters of 2003 and 2013 were analyzed. Patient characteristics, injury and illness severities, mission location, hospital admission rate, as well as emergency interventions were collated. The emergency mission rate was calculated as rescue missions per 1000 inh...
Source: Der Anaesthesist - December 11, 2017 Category: Anesthesiology Authors: Bader K, Bernhard M, Gries A, Kaul M, Schröder R, Ramshorn-Zimmer A Tags: Anaesthesist Source Type: research

[Acceptance of post-mortem organ donation in Germany : Representative cross-sectional study].
CONCLUSION: Education on organ donation can be a means to increase organ donation rates. The effects of the change in legislation and the establishment of the transplant register need to be evaluated. Further research regarding the influence of religion, especially among religious minorities, on organ donation rates in Germany needs to be conducted to identify possible obstacles. Moreover, the use of social networks to address potential organ donors has proven to increase registration numbers and could easily be implemented in Germany. PMID: 29230502 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - December 11, 2017 Category: Anesthesiology Authors: Tackmann E, Dettmer S Tags: Anaesthesist Source Type: research

[Different levels of experience with anesthetic agents of German emergency physicians : Results of an online survey].
CONCLUSION: The results of this survey demonstrate that clinical practice of emergency physicians is in high accordance with the recommendations named in the guidelines for prehospital emergency anesthesia in adults (except for cardiac patients and time of preoxygenation). With respect to the lower levels of experience of non-anesthetists in the use of anesthetic drugs, specific training concepts may help to further improve the quality of preclinical emergency care. PMID: 29209787 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - December 5, 2017 Category: Anesthesiology Authors: Luckscheiter A, Fischer M, Zink W Tags: Anaesthesist Source Type: research

[Reform of emergency physician training in Austria : Finally up to date?]
Abstract During the last 20 years Austrian prehospital emergency medical services (EMS) have significantly improved. The structure and organization of Austrian EMS comply with European standards but training requirements for prehospital EMS physicians are insufficient when compared with other countries. Although some EMS systems follow the German or Swiss postgraduate training concepts, the legal requirements in Austria defining the scope of mandatory training for physicians in the prehospital setting are only minimal. Thus, besides board certification as a general practitioner or specialist of any discipline...
Source: Der Anaesthesist - December 5, 2017 Category: Anesthesiology Authors: Trimmel H, Baubin M, Kreutziger J, Frank G, Prause G Tags: Anaesthesist Source Type: research

[Novel aspects of the guidelines for hemotherapy 2017 : Implications for anesthesiology].
e P Abstract Based on the German Transfusion Law, the periodically updated guidelines "Richtlinien zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten" ("Hämotherapierichtlinien") are intended to provide the current knowledge and state of the art of blood transfusion practice in Germany. The novel update 2017 contains relevant changes for blood donation, especially the extension of the exclusion period of persons at risk for sexually transmitted HBV, HCV and HIV diseases to 12 months. Moreover, the guidelines provide several changes relevant to blood trans...
Source: Der Anaesthesist - December 5, 2017 Category: Anesthesiology Authors: Pekrul I, Wittmann G, Möhnle P Tags: Anaesthesist Source Type: research

[Delegation of medical activities in acute pain therapy].
Abstract Acute pain management is an interprofessional and interdisciplinary task and requires a good and trustful cooperation between stakeholders. Despite provisions in Germany according to which medical treatment can only be rendered by a formally qualified physician ("Arztvorbehalt"), a physician does not have to carry out every medical activity in person. Under certain conditions, some medical activities can be delegated to medical auxiliary personnel but they need to be (1) instructed, (2) supervised and (3) checked by the physician himself; however, medical history, d...
Source: Der Anaesthesist - December 5, 2017 Category: Anesthesiology Authors: Erlenwein J, Moroder A, Biermann E, Petzke F, Ehlers APF, Bitter H, Pogatzki-Zahn E Tags: Anaesthesist Source Type: research

[Prewarming according to the AWMF S3 guidelines on preventing inadvertant perioperative hypothermia 2014 : Retrospective analysis of 7786 patients].
l M Abstract BACKGROUND: Inadvertent perioperative hypothermia, which is defined as a core body temperature of less than 36.0 °C, can have serious consequences in surgery patients. These include cardiac complications, increased blood loss, wound infections and postoperative shivering; therefore, the scientific evidence that inadvertent perioperative hypothermia should be avoided is undisputed and several national guidelines have been published summarizing the scientific evidence and recommending specific procedures. The German AWMF guidelines were the first to emphasize the importance of prewarming for ...
Source: Der Anaesthesist - November 20, 2017 Category: Anesthesiology Authors: Grote R, Wetz AJ, Bräuer A, Menzel M Tags: Anaesthesist Source Type: research

[Algorithm for securing an unexpected difficult airway : User analysis on a simulator].
CONCLUSION: The conformity to the algorithm of over 90% indicates a good training level of the participants concerning the difficult airway algorithm. In the observed sample flexible intubation endoscopy tended to be of high significance even in the unanticipated difficult airway. Cricothyrotomy was performed faster surgically than by the use of the transtracheal puncture approach, while no differences between junior and senior anesthetists were observed. For the successful management of an unexpected difficult airway, specific training of these special and rare events is crucial. A standardized provision of spec...
Source: Der Anaesthesist - November 20, 2017 Category: Anesthesiology Authors: Ott T, Truschinski K, Kriege M, Naß M, Herrmann S, Ott V, Sellin S Tags: Anaesthesist Source Type: research

[Etomidate for intravenous induction of anaesthesia].
Abstract The pharmacological and historical knowledge about the currently available intravenous induction hypnotics form the basis for the daily work of anesthetists. Side effects of using hypnotic induction agents must be anticipated and adequately treated. Decades of experience with using intravenous induction hypnotics have led to theoretical requirements for an ideal narcotic agent with a best possible side effect profile. In the absence of this optimal hypnotic induction agent, a careful selection of one or a combination of narcotic drugs is necessary to meet the needs of the respective risk co...
Source: Der Anaesthesist - November 16, 2017 Category: Anesthesiology Authors: Dumps C, Bolkenius D, Halbeck E Tags: Anaesthesist Source Type: research

[Additional emergency medical measures in trauma-associated cardiac arrest].
DISCUSSION: The percentage of patients who might benefit from additive treatment implemented in tCPR efforts was shown to be equal between the local situations in Leipzig and Chemnitz compared to previous reports in Berlin. A need for optimizing the professional resuscitation process still remains as not all reversible causes were appropriately addressed. Further training and education should intensively address the mentioned deficits and continuous awareness of necessary additional medical procedures in the preclinical setting in cases of traumatic cardiac arrest is inevitable. Cooperation with forensic institutes ca...
Source: Der Anaesthesist - November 15, 2017 Category: Anesthesiology Authors: Ondruschka B, Baier C, Dreßler J, Höch A, Bernhard M, Kleber C, Buschmann C Tags: Anaesthesist Source Type: research

[Regional anesthesia: tradition and innovation].
PMID: 29134257 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - November 13, 2017 Category: Anesthesiology Authors: Schwemmer U Tags: Anaesthesist Source Type: research

Anesthesia in a  child with suspected peroxisomal disorder.
We present the case of an 8‑year-old female child with suspected peroxisomal disorder requiring general anesthesia for adenotomy, paracentesis and brainstem-evoked response audiometry. Peroxisomes are small intracellular organelles that catalyse key metabolic reactions. Peroxisomal disorders are a heterogeneous group of rare genetic diseases. Anesthesia can be challenging as adrenal insufficiency, mental retardation, muscle weakness, risk of pulmonary aspiration, airway complications, seizure disorders and altered pharmacokinetics and pharmacodynamics can occur in these patients but guidelines for anesthesia do not ...
Source: Der Anaesthesist - November 8, 2017 Category: Anesthesiology Authors: Englbrecht JS, Maas M Tags: Anaesthesist Source Type: research

Preoperative evaluation of adult patients before elective, noncardiothoracic surgery : Joint recommendation of the German Society of Anesthesiology and Intensive Care Medicine, the German Society of Surgery, and the German Society of Internal Medicine.
CH), Zwissler B Abstract Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery, and may help to optimize the patient's preoperative medical condition and guide perioperative management. Whether performance of additional technical tests (e. g., blood chemistry, electrocardiography, spirometry, chest x‑ray) can contribute to reduction of the perioperative risk is often not well known or controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists, and surgeons with respect to perioperat...
Source: Der Anaesthesist - November 2, 2017 Category: Anesthesiology Authors: Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Deutsche Gesellschaft für Innere Medizin (DGIM), Deutsche Gesellschaft für Chirurgie (DGCH), Zwissler B Tags: Anaesthesist Source Type: research

[Role-specific targets and teamwork in the operating room].
CONCLUSION: The results show that considering the main categories no dimension is equally important for the participating professional groups. This can result in goal conflicts. Additionally, the ad hoc teams make it impossible for team building to occur, making it difficult for the professional groups to adapt to each other and the individual goals. This presents a high potential for conflict. The difference in the perception of the importance of employee satisfaction is a crucial factor for emerging conflicts in the OR, as employee satisfaction correlates with productivity and patient satisfaction. Knowing and ...
Source: Der Anaesthesist - October 30, 2017 Category: Anesthesiology Authors: Hoeper K, Kriependorf M, Felix C, Nyhuis P, Tecklenburg A Tags: Anaesthesist Source Type: research

Determination of the median effective dose (ED50) of bupivacaine and ropivacaine unilateral spinal anesthesia : Prospective, double blinded, randomized dose-response trial.
CONCLUSION: We find the ED50 were lower, and the ED50 of 0.5% hypobaric bupivacaine and ropivacaine was 4.66 mg (95% CI 4.69-4.63 mg) and 6.43 mg (95% CI 6.47-6.39 mg), respectively, for USpA in geriatric patients (age ≥ 70 years) undergoing elective hip replacement surgery. PMID: 29071370 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - October 25, 2017 Category: Anesthesiology Authors: Wang W, Li Y, Sun A, Yu H, Dong J, Xu H Tags: Anaesthesist Source Type: research

[Regional anesthesia - are the standards changing?]
Abstract Regional anesthesia has undergone many changes over the years and the increasing use of ultrasound has certainly played an important role in this. Apart from individual case reports in the literature of very different blocking options, some new procedures seem to have become established and can be broadly applied. Among these are blockades, by which ultrasound-guided injection of local anesthetics is carried out in fascial or muscular layers rather than around target nerves (e.g. cervical plexus blocks and truncal blocks). In addition, the precision with which ultrasound can be used to identify nerve stru...
Source: Der Anaesthesist - October 18, 2017 Category: Anesthesiology Authors: Volk T, Kubulus C Tags: Anaesthesist Source Type: research

[Knowledge of the population about leading symptoms of cardiovascular emergencies and the responsibility and accessibility of medical facilities in emergencies : Results of the KZEN study in Western Palatinate].
Abstract BACKGROUND: The Westpfalz is a mainly rural region in the southwestern part of the German state of Rhineland-Palatinate with 527,000 inhabitants and demonstrates a higher than average cardiovascular mortality compared to the rest of Germany. The reasons are not known. Our study attempted to investigate whether significant deficits in knowledge of the population on cardiovascular emergencies, the accessibility of emergency medical services (EMS) or the different responsibilities and abilities of the medical facilities could be held responsible for this. These factors are of the utmost importance for t...
Source: Der Anaesthesist - October 18, 2017 Category: Anesthesiology Authors: Luiz T, Dittrich S, Pollach G, Madler C Tags: Anaesthesist Source Type: research

[Interprofessional symptom management at the end of life].
er J Abstract At the end of life patients often show distressful symptoms which significantly reduce their quality of life. The goal of all healthcare professionals should be to recognize the beginning of this end of life period in order to provide good symptom management. For this purpose, existing symptoms have to be recorded, suitable therapeutic goals have to be defined for the current situation and potential therapeutic strategies have to be individually formulated. Besides the identification of underlying causes with the possibility of causal treatment, a symptom-based therapy is often necessary. Therap...
Source: Der Anaesthesist - October 13, 2017 Category: Anesthesiology Authors: Frankenhauser S, Geist MJP, Weigand MA, Bardenheuer HJ, Keßler J Tags: Anaesthesist Source Type: research

[Pacemaker, defibrillator and co : Perioperative handling of cardiac implantable electronic devices].
Abstract The number of patients treated with cardiac implantable electronic devices (CIED) is continously increasing. Knowledge of the medical indications and technical mode of functioning of these devices is a basic prerequisite for the safe perioperative care of this patient cohort. The CIEDs are subjected to a multitude of disturbing influences in the perioperative setting. This can result in potentially dangerous complications, such as exit block and oversensing. The safe performance of interventions is possible as long as some basic rules are followed. An interdisciplinary approach involving all participating...
Source: Der Anaesthesist - October 10, 2017 Category: Anesthesiology Authors: Ott K, Pressl H, Schramm M, Wutzl A Tags: Anaesthesist Source Type: research

[The right opioid for my patient].
r M PMID: 28993842 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - October 9, 2017 Category: Anesthesiology Authors: Schäfer M Tags: Anaesthesist Source Type: research

[Bacterial sepsis : Diagnostics and calculated antibiotic therapy].
stern C Abstract The mortality of patients with sepsis and septic shock is still unacceptably high. An effective antibiotic treatment within 1 h of recognition of sepsis is an important target of sepsis treatment. Delays lead to an increase in mortality; therefore, structured treatment concepts form a rational foundation, taking relevant diagnostic and treatment steps into consideration. In addition to the assumed focus and individual risks of each patient, local resistance patterns and specific problem pathogens must be taken into account for selection of anti-infection treatment. Many pathophysiological a...
Source: Der Anaesthesist - October 4, 2017 Category: Anesthesiology Authors: Richter DC, Heininger A, Brenner T, Hochreiter M, Bernhard M, Briegel J, Dubler S, Grabein B, Hecker A, Krüger WA, Mayer K, Pletz MW, Störzinger D, Pinder N, Hoppe-Tichy T, Weiterer S, Zimmermann S, Brinkmann A, Weigand MA, Lichtenstern C Tags: Anaesthesist Source Type: research

[Use of near-infrared spectroscopy for control of limb perfusion during venoarterial ECMO treatment : Application and limitations].
YA Abstract Patients undergoing peripheral venoarterial extracorporeal membrane oxygenation have a high risk of lower limb ischemia. In general, regular controls are carried out based on clinical and laboratory parameters in order to quickly detect and treat complications. These controls are challenging due to states of shock, nonpulsatile flow and vasopressor therapy. As additional monitoring the use of near-infrared spectroscopy (NIRS) is described in the literature as being very successful in detecting ischemia. The present article describes the use and possible limitations of NIRS for the diagnostics of perip...
Source: Der Anaesthesist - October 4, 2017 Category: Anesthesiology Authors: Werner T, Lunz D, Philipp A, Flörchinger B, Graf BM, Zausig YA Tags: Anaesthesist Source Type: research

[Differential indications of opioids in pain therapy].
Abstract Due to their strong analgesic potency opioids are highly effective in the therapy of acute and particularly cancer-induced chronic pain; however, the individual opioids differ considerably with respect to their pharmacokinetic and physicochemical properties and may therefore not be equally applicable for every patient. Caution should be taken especially in patients with impaired organ function. Furthermore, the metabolism of opioids leads to active or inactive metabolites. This process can be substantially influenced by genetic polymorphisms or drug interactions. Knowledge of all these factors for individ...
Source: Der Anaesthesist - October 2, 2017 Category: Anesthesiology Authors: Heyn J, Azad SC Tags: Anaesthesist Source Type: research

[Does annual simulation training influence the safety climate of a university hospital? : Prospective 5 ‑year investigation using dimensions of the safety attitude questionnaire].
[Does annual simulation training influence the safety climate of a university hospital? : Prospective 5‑year investigation using dimensions of the safety attitude questionnaire]. Anaesthesist. 2017 Oct 02;: Authors: St Pierre M, Gall C, Breuer G, Schüttler J Abstract BACKGROUND: Simulation-based training with a focus on non-technical skills can have a positive influence on safety relevant attitudes of participants. If an organization succeeds in training sufficient staff, it may experience a positive change in the safety climate. As the effects of a single training are of a ...
Source: Der Anaesthesist - October 2, 2017 Category: Anesthesiology Authors: St Pierre M, Gall C, Breuer G, Schüttler J Tags: Anaesthesist Source Type: research

[One size does not fit all].
PMID: 28956072 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - September 27, 2017 Category: Anesthesiology Authors: Bercker S, Laudi S, Stehr SN Tags: Anaesthesist Source Type: research

[Polytrauma following a truck accident : How to save lives by guideline-oriented emergency care].
DISCUSSION: In modern emergency medical services, treatment based on defined algorithms is recommended and also increasingly established in dealing with critical patients. The guideline-oriented emergency care of patients with polytrauma requires invasive measures, such as intubation and thoracic decompression in the preclinical setting. The foundation for this procedure includes training in theory and practice both of the non-medical and medical rescue service personnel. PMID: 28956075 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - September 27, 2017 Category: Anesthesiology Authors: Kippnich M, Jelting Y, Markus C, Kredel M, Wurmb T, Kranke P Tags: Anaesthesist Source Type: research

[Cave: interscalene catheters].
This article describes seven  cases of misplaced catheters. The etiology and symptoms are discussed as well as recommendations regarding the prevention of catastrophic complications. As a result, internal practice guidelines are recommended for anesthesia departments in order to enhance the safety and quality of regional anesthesia. PMID: 28936539 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - September 21, 2017 Category: Anesthesiology Authors: Gaus P, Kutz P, Bachtler JA, Lindner R, Saur P Tags: Anaesthesist Source Type: research

Repeated 2% sevoflurane administration in 7 ‑ and 60-day-old rats : Neurotoxicity and neurocognitive dysfunction.
CONCLUSION: Our findings suggested that sevoflurane can induce neuroapoptosis and cognitive dysfunction in adolescent rats that received repeated sevoflurane (2% for 1 h) during the postnatal period. These findings will promote further studies to investigate the effects of repeated sevoflurane exposure on the development of the central nervous system and function of learning and memory, as well as the underlying mechanisms in vitro and in vivo. PMID: 28914327 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - September 15, 2017 Category: Anesthesiology Authors: Huang H, Liu CM, Sun J, Jin WJ, Wu YQ, Chen J Tags: Anaesthesist Source Type: research

[The IDEALE-handover].
t H PMID: 28914331 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - September 15, 2017 Category: Anesthesiology Authors: Hölz W, Zinsmeister T, Forst H Tags: Anaesthesist Source Type: research

[Comment on: ketamine for prevention of postoperative delirium and pain].
PMID: 28914332 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - September 15, 2017 Category: Anesthesiology Authors: Ziemann S, Coburn M Tags: Anaesthesist Source Type: research

[Sepsis masquerading as delirium].
Abstract A previously healthy 60-year-old patient presented to the emergency department with severe headache, altered personality and fever. He was treated for bacterial meningitis with delirium of unknown cause but presumed to be due to alcohol withdrawal. Despite receiving the antibiotic therapy regimen recommended for bacterial meningitis the patient's condition rapidly deteriorated with profound delirium and tachypnea. The intensivist who was consulted immediately suspected sepsis-associated organ failure and admitted the patient to the intensive care unit (ICU). The blood culture was positive for Listeri...
Source: Der Anaesthesist - September 8, 2017 Category: Anesthesiology Authors: Seifert A, Hartog CS, Zweigner J, Schummer W, Reinhart K Tags: Anaesthesist Source Type: research

Erratum to: Ultrasound-guided interscalene brachial plexus block in a  child with acute upper respiratory infection.
Erratum to: Ultrasound-guided interscalene brachial plexus block in a child with acute upper respiratory infection. Anaesthesist. 2017 Sep 04;: Authors: Ergönenç T, Can H, Beyaz SG PMID: 28871309 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - September 4, 2017 Category: Anesthesiology Authors: Ergönenç T, Can H, Beyaz SG Tags: Anaesthesist Source Type: research

[Neurophysiological monitoring during surgical procedures].
l;hle M Abstract The application of intraoperative neurophysiological monitoring (IONM) is gaining more and more importance in daily clinical practice. The use of IONM allows the localization of neural structures and to control functioning of the peripheral and central nervous systems in anesthetized patients. This enables surgeons to identify and to protect neural structures and cerebral areas. The use of IONM also enables anesthesiologists to adjust anesthesia and cardiopulmonary therapy to the individual needs of the patient. Thereby, it may be possible to reduce the incidence of postoperative delirium and the ...
Source: Der Anaesthesist - August 24, 2017 Category: Anesthesiology Authors: Michels P, Bräuer A, Bauer M, Söhle M Tags: Anaesthesist Source Type: research

[The central nervous system as the target organ of general anesthesia].
e T PMID: 28831498 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - August 22, 2017 Category: Anesthesiology Authors: Kreuer S, Hüppe T Tags: Anaesthesist Source Type: research

[Migration of an axillary plexus catheter fragment : A severed catheter tip unnoticed on removal wandered into the central nervous system].
Abstract MIGRATION OF AN AXILLARY PLEXUS CATHETER FRAGMENT INTO THE INTRACEREBRAL COMPARTMENT: During removal of an axillary plexus catheter used for pain therapy, the catheter was probably inadvertently and unnoticed severed together with the suture fixation. The error went unnoticed and an approximately 14 cm long catheter fragment remained in the patient. The patient complained of neck pain, nausea and vomiting 2.5 years later. A computed tomography scan of the cranium and neck region revealed a tubular foreign body with a diameter of ca. 1 mm and a length of ca. 14&thi...
Source: Der Anaesthesist - August 22, 2017 Category: Anesthesiology Authors: Brandt L, Artmeier-Brandt U Tags: Anaesthesist Source Type: research

[Airway anatomy : Relevant structures in emergency medicine].
Abstract The subject of this article is the anatomy of the respiratory tract with an emphasis on the larynx. A differentiation is made between the upper and lower airways according to topographical and functional aspects, the limits of which are marked by the lower section of the larynx. The focus is on the anatomy of the structures involved, which are relevant for emergency medicine. PMID: 28808821 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - August 14, 2017 Category: Anesthesiology Authors: Schulze M, Wree A Tags: Anaesthesist Source Type: research

Diagnostic precision of triage algorithms for mass casualty incidents. English version.
CONCLUSION: Triage procedures with acceptable diagnostic quality exist to identify the most severely injured. Due to its high rate of false positive results (over-triage) the recently developed PRIOR algorithm will cause overload of available resources for the severely injured within mass casualty incident missions. Non-surgical patients still are poorly identified by the available algorithms. PMID: 28798972 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
Source: Der Anaesthesist - August 10, 2017 Category: Anesthesiology Authors: Heller AR, Salvador N, Frank M, Schiffner J, Kipke R, Kleber C Tags: Anaesthesist Source Type: research