Anaesthesist最新文献

Background: The evaluation of German postanesthesia questionnaires is often restricted to inpatient medical care. The anesthesiological questionnaire for patients (ANP) has previously been validated only after medical care of inpatients. Therefore, the aim of the present study was to evaluate the validity of the ANP in the context of outpatient surgery and anesthesia.

Methods: Data from 4547 patients (mean age 18-89 years, sex: m/f, 55%/45%), scheduled for ambulatory orthopedic and trauma surgery, were analyzed. All patients received a standard induction of anesthesia with propofol, sufentanil and 4 mg dexamethasone. Maintenance of anesthesia was achieved with a balanced technique comprising volatile anesthesia (either sevoflurane or desflurane) and sufentanil. In addition, patients undergoing operations on the anterior cruciate ligament received a femoral nerve block with 12-15 ml 0.5% ropivacaine. Of the patients 13% remained in hospital overnight as a result of complex operations (combined anterior and posterior cruciate ligament repair, hip arthroscopy and 10% of those undergoing shoulder operations). Before discharge from the recovery room, patients were asked to answer questions with respect to postoperative symptoms 1h after anesthesia (ESNA 19 items), at the time of interview (ABZ 17 items) and about overall patient satisfaction (10 items). These results were matched with the type of procedure and time data from the patient administration system. All data were analyzed descriptively using parametrical tests.

Results: At both time points, pain in the area of the operation was the predominant symptom (ESNA: 77,1%; ABZ: 74,3%). Pain after shoulder arthroscopy was more severe compared to knee arthroscopy, both with and without repair of the anterior cruciate ligament. Most of the adverse symptoms decreased significantly (p ≤ 0.001) with time, demonstrating progressive recovery of the patient. Patient discomfort was more likely to occur in female than in male patients, and female patients were more likely to be dissatisfied with the progress of recovery. The risk of experiencing adverse symptoms after anesthesia was higher for female than for male patients; this was most apparent for feeling cold (odds ratio, OR 4.08) and nausea and vomiting (OR 3.45). Younger patients (18-40 years) were more likely to express discomfort than both groups of older patients (41-60 years and 61-89 years). Accordingly, younger patients had lower satisfaction levels with respect to both anesthesia and overall perioperative care, and the progress of recovery. Postoperative nausea and vomiting (PONV) were linked to younger age, female sex, and longer procedure times (>40 min).

Conclusion: The individual analyses delivered plausible results, which support the validity of the ANP. The ANP may also be used for assessment of postoperative discomfort and patient satisfaction in the se

Purpose: Only few studies have analyzed the global distribution of anesthesia research. This study was designed to reveal the current global research status of anesthesiology.

Methods: Articles published between 1999 and 2018 in international journals in the field of anesthesiology were retrieved from the PubMed database. The top 20 ranked countries were identified. The gross domestic product (GDP) of each country was also retrieved to reveal the correlation between research outputs and the economy. The total outputs and outputs per 10 million inhabitants in each country were calculated and compared. To analyze the quality of publications among the top 10 ranked countries, the impact factor (IF), article influence score (AIS), and immediacy index (ImI) were calculated and analyzed. In addition, the keywords of publications were retrieved to conduct co-occurrence analysis in order to determine the research focus in anesthesiology.

Results: A total of 112,918 articles were published in 30 selected journals from 1999 to 2018. There was a positive correlation between research outputs and GDP of 10 countries (p < 0.001, r = 0.825). The USA ranked 1st with 21,703 articles, followed by the UK (8393 articles) and Germany (6504 articles). Canada had the highest number of publications per 10 million inhabitants in 2018. The UK had the highest average IF (4.70), average AIS (1.16), and average ImI (1.64) among the 10 countries. The research highlights in the field of anesthesiology included "mechanism and management of pain", "cardiac anesthesia", "pediatric anesthesia and airway management", "analgesia" and "anesthetic agents".

Conclusion: Regarding quantity trend, the output of global production in anesthesiology increased continuously as the number of articles from the high-output countries showed an increasing trend; however, there was still a gap between developing and developed countries in research quality. High-quality research should be encouraged in developing countries.

The first public demonstration of ether anesthesia took place 175 years ago. Since that time, insensitivity to pain during surgical operations has been possible. The "Ether Day" has been portrayed in many ways. News of the event soon reached Europe and the rest of the world. The development of suitable apparatuses and anesthetics pathed the way for acceptance of the new method. Since the end of the nineteenth century, quality management has become more and more important. In the first half of the twentieth century the use of anesthetic apparatuses prevailed. In Germany, the medical discipline of anesthesiology was established only after 1945. This happened with support from Anglo-American countries. Further methods, such as intubation and muscle relaxation were introduced. The development of atraumatic cannulas made of plastic greatly facilitated the application of drugs. Consideration of workplace safety as a problem was a long time coming. The first concepts were not developed until the late 1970s. By the 1980s the essential elements of modern anesthesia had finally been implemented. In the beginning of the twenty-first century, the focus was initially on procedures that saved allogeneic blood. New topics emerged, ranging from the effects of anesthesia on tumors up to climate change. Anesthesiology must continue to face new challenges in the future.

In developed countries, peripartum hemorrhage, thromboembolic events and hypertensive pregnancy disorders are the most frequent complications in pregnancy. They pose a significant challenge for the interdisciplinary team of gynecology and anesthesiology. Untreated, these pregnancy-related complications result in a fulminant course. Close consultation between the specialist departments and knowledge of the area of responsibility are essential. In the case of acute bleeding the anesthesiologist is responsible for maintaining adequate circulatory conditions and management of hemostasis. Thromboembolic events require immediate anticoagulation and focused diagnostics. Thereby, both the fetal and the maternal risks must be weighed up. The hypertensive diseases in pregnancy have a very high risk of complications. In addition to symptomatic treatment in the intensive care unit, the optimal time of delivery must be determined by an interdisciplinary consensus. This is the only causal treatment option possible.

Focused treatment of epileptic emergencies, and in particular status epilepticus (SE), require a reliable differentiation of epileptic syndromes. In these cases, and especially in cases with predominant non-motor symptoms, clinical and electroencephalographic expertise is necessary. In 2020 the German guidelines for the management of SE were updated, which adhere to a strict stage-based treatment algorithm. The staged approach includes the administration of benzodiazepines, antiepileptic drugs and anesthetic agents. So far, efforts failed to determine the most effective and safest antiepileptic drug without interaction potential. Therefore, for the differentiated treatment of SE, individual pre-existing medical conditions and concomitant circumstances must be considered, added by the experience of the medical team. Therapeutic interventions especially for refractory forms of SE have been shown to be complex with relevant implications concerning intensive care aspects. Consequently, the modern treatment strategy of SE is characterized by an interdisciplinary approach. Future research is needed to define the optimal treatment of non-convulsive SE, in particular regarding the time point and degree of treatment escalation with associated ethical considerations.

The Ether Day, a key moment in the history of mankind, commemorates its 175th anniversary on 16 October 2021. On that day the dentist William T. G. Morton successfully gave the first public ether anesthesia in Boston. From then on it was possible to save people from pain with justifiable risk and at the same time to protect them from psychological damage by inducing unconsciousness. The German philosopher Peter Sloterdijk, one of the most renowned and effective philosophers of our times, deduced that from then on humans, to some extent, had a right to unconsciousness when in psychophysical distress. This postulate unfolded from his concept of "anthropotechnics" developed around 1997, meaning the idea of treating human nature as an object of possible improvements. According to Sloterdijk, in favorable cases a synthesis of man and technology can result in a significant improvement of human capabilities in the sense of "enhancement", i.e. an increase, an improvement or even an expansion of intellectual, physical or psychological possibilities, as it were in a transgression of the human (so-called transhumanism). Man should go into vertical tension, i.e. strive for higher aims and exploit his inherent potential, he should not dwell in the horizontal. This is not meant as an appeal but as an imperative: "You must change your life!". In this context modern anesthesia may prove helpful: be operated on by others in order to undergo an enhancement. Or, in its most extreme form, the operation in the "auto-operational curved space", a person can even operate on himself as has been dramatically demonstrated by Rogozov, a young Russian physician and trainee surgeon who successfully performed a self-appendectomy under local anesthesia at the Novolazarevskaya Antarctic Station in 1961; however, the implementation of this idea is a long way off. On the one hand, many countries lack qualified personnel in sufficiently large numbers to perform even vital operations with patients under anesthesia. On the other hand, over the decades it has become clear that anesthesia is obviously beneficial for mankind in that it offers relief from pain and psychological stress but that it can also often show its dark side: substance abuse, use of anesthetics in torture and in executions. In addition, the role of anesthetics in resuscitation, palliative care, and allaying executions is unclear or controversial. Finally, the necessary formal legal steps to acknowledge a "human right to unconsciousness" have not yet been implemented.