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Background and objective: In this study medical students of the generations Y and Z at the Georg-August University Göttingen were asked about their preferences in the workplace and the choice of an employer.

Material and methods: In 2016, the survey was sent to 2637 students at the University Medical Center Göttingen using an online questionnaire via EvaSys and was answered by 742 (response rate: 28.1%).

Results: Regardless of the generation, with 89.5% the respondents felt predominantly "well" and "not so well" prepared for the transition from university to professional life. The most common fears were a lot of work/little free time, lack of time in patient care, lack of experience, stress, excessive technical demands and poor familiarization. In both groups almost 60% obtained information about future employers via the hospital's website. It was important for the students to have a particularly good education and a structured induction/advanced training curriculum.

Conclusion: The further development of a structured induction concept for young professionals, a binding and structured further training curriculum, the establishment or further development of a mentoring program, the further development of leadership skills and the design of an appealing and updated website are essential prerequisites for future success in the highly competitive skilled labor market.

Transesophageal echocardiography (TEE) is firmly established in cardiac surgery for diagnostics, hemodynamic monitoring and as a guiding tool. Dynamic and (patho)physiological processes of the heart can be immediately depicted. Ideally, therapeutic changes can be derived. For this reason, TEE is increasingly used in high-risk non-cardiac surgery interventions and in the interventional setting. In the first part of this advanced training series, general aspects regarding TEE examinations as well as indications and contraindications are presented. Clinical fields of application, where TEE can play a role in hemodynamic monitoring are outlined. The second part focusses on an emergency examination pathway and differential diagnoses, which can be made in the event of intraoperative hemodynamic instability or unexplained hypoxemia using TEE. The article concludes with an outlook on the use of computer-aided evaluation of TEE images.

Although pain services have been established in many hospitals, there is considerable heterogeneity among them with respect to organization of service, staff and qualifications of staff, and treatment approaches.With this recommendation, the German Society for Anesthesiology and Intensive Care Medicine defines requirements for pain services in hospitals with respect to organizational standards and staff qualifications. The therapy offered by pain services supplements the treatment provided by the other departments involved, ensuring the high quality of specialized pain management in all areas of the hospital. Pain services shall oversee treatment with specialized analgesia techniques as well as the involvement of consultants, bringing together in-hospital pain medicine expertise in one service with availability 24 h and 7 days per week via a single contact. The medical head of the pain service shall be a qualified provider of pain medicine as defined by the German Medical Association and as a minimum should also have undergone additional training in basic psychosomatic medicine. Further members of the medical staff should possess the credentials of a medical specialist: non-medical staff should have completed continuing education in the treatment of pain. Minimal guidelines for personnel resources were defined: these included a specific time frame for first contacts (20 min) and follow-up (10 min) for specific analgesic techniques and for the involvement of consultants (first contact 45 min, follow-up 20 min), with additional time for travel, set-up, training and quality management. In addition to definition of the space and equipment needed, each service should draft its own budget, and this should be adequate and plannable. Written agreements between the disciplines and transparent documentation, including patient-reported outcomes, are recommended to ensure quality. The provision of specialized pain therapy should have high priority over all disciplines or departments.

Background: This study aimed to determine the current state of implementation of the recommendations for the classification of emergency surgery published in 2016 by the German societies of anesthesiology (BDA/DGAI), surgery (BDC/DGCH) and operating room management (VOPM).

Methods: Based on these societies' recommendations, various organizational issues were explored using an online questionnaire that was limited to German operating room (OR) managers and coordinators for hospitals that had surgical programs and at least 200 hospital beds.

Results: A total of 550 hospitals were contacted and 274 participated in the survey (49.8%). Of these 70.7% reported that they had implemented the recommendations, and 15.2% were aware of the recommendations but did not consistently apply them. Of the participating OR managers and coordinators that had either implemented or were aware of the recommendations, 78.2% agreed that the standardized definition of medical emergencies led to improvements in emergency treatment but 33.6% stated that the defined response intervals for emergency categories induced a certain degree of subjectivity in categorizing emergencies. Additional in-house guidelines specifically for the most frequent surgeries were or would be welcomed by 80.1% of the respondents and 39.1% of the surveyed hospitals had already implemented such guidelines. Of the OR managers and coordinators, 62.9% were informed about their emergency volumes and 47.3% stated that they regularly assessed them. There was no dedicated capacity for emergency care in 65.2% of hospitals. Of the respondents 3.9% stated that a separate emergency OR was reserved with a freely available team, which, during core operating hours, could be used for interdisciplinary emergency care and 26.2% of hospitals considered the capacity required for emergency procedures when planning the OR program or determining OR capacities.

Conclusion: The recommendations for classifying emergency operations are an essential and generally accepted control mechanism in OR coordination. They simplify interdisciplinary coordination and communication when dynamically incorporating emergency procedures into an OR program. Most OR managers and coordinators view the recommendations as improving the speed of action in emergency care. To support the adoption of emergency classifications within an organization it may be advisable to incorporate them into the OR statutes and integrate them within the hospital information systems. The majority of participants supported additional specifications based on medical indicators for classifying the most frequent emergency operations. Being cognizant of key metrics concerning in-house emergency volume represents a crucial basis for interdisciplinary OR management and emergency care integration. Contrary to common perception, blocking fixed OR capacities remains the exception. When esta

Background: There is a significant increase in number of obese pregnant women worldwide. Obese parturients undergoing cesarean section have a higher risk for hypotension and require higher doses of vasopressors following spinal anesthesia compared to nonobese parturients.

Objective: This study aimed to compare the maternal hemodynamic changes when combined spinal-epidural anesthesia (CSEA) is induced in the left lateral decubitus and sitting positions in obese pregnant women undergoing elective cesarean section.

Material and methods: In this study, pregnant women with full-term gestation diagnosed as obese undergoing elective cesarean section were included. Two groups were formed: the CSEA was performed in left lateral position in group I (n = 50) and in sitting position in group II (n = 50). At the end of the CSEA procedure, patients were placed in the supine position. When the sensory block reached at the upper level of T6 dermatome, surgery was initiated. Hemodynamic, anesthetic and neonatal parameters were recorded.

Results: In all patients, CSEA was successful and sufficient anesthesia was provided for surgery. Time to reach T6 dermatome sensory level in group II was found to be longer than group I (P = 0.011). At 20 min after spinal injection, the maximum sensory block level was similar in both groups. There were no significant differences between groups in terms of sensory block time and the time to requiring postoperative supplemental analgesics. There were no significant differences in terms of the volume of intravenous fluid administered, ephedrine and atropine requirements between groups. Both groups had similar systolic blood pressure, heart rate and oxygen saturation values during surgery and postoperatively. While both groups had similar diastolic blood pressure (DBP) values during surgery and at the 1st postoperative hour, group II had lower DBP values at the 2nd postoperative hour compared with group I (P = 0.04).

Conclusion: Left lateral decubitus and sitting positions during performance of CSEA lead to similar maternal hemodynamic changes in obese pregnant women undergoing cesarean section.

Background/objective: Congenital hip dysplasia (CHD) defines a spectrum of pathologies in which the acetabulum and proximal femur of babies and children abnormally develop. Open surgery in congenital hip dysplasia leads to severe postoperative pain. The aim of this study was to evaluate the effectiveness of ultrasound-guided quadratus lumborum block (QLB) in pediatric patients undergoing surgery for congenital hip dysplasia.

Material and methods: Following ethical board approval, 40 children aged between 1-5 years undergoing surgery for congenital hip dysplasia were randomized into two groups. Patients (n = 20) received ultrasound guided quadratus lumborum block (group QLB) using 0.5 mL/kg body weight 0.25% bupivacaine preoperatively. The same standard postoperative analgesia protocol was used in both groups. Pain scores, parental satisfaction, requirement for ibuprofen and opioids were recorded. Pain was measured using the face, legs, activity, crying, consolability (FLACC) scale.

Results: The FLACC scores were lower at 30min and 1h, 2h, 4h, 6h, 12h and 24h in the QLB group when compared to the control group (p < 0.05). The requirement for rescue opioid analgesia was statistically significantly higher in the control group when compared to the QLB group (15/20 vs. 3/20, p < 0.001). Rate of ibuprofen usage in the ward was higher in the control group when compared to the QLB group (14/20 vs. 4/20, p = 0.004). Parental satisfaction was higher in the QLB group (p < 0.001).

Conclusion: Ultrasound-guided quadratus lumborum block reduces pain scores and analgesic requirements following congenital hip dysplasia surgery.

Purpose: After laparoscopic cholecystectomy patients have moderate pain in the early postoperative period. According to several studies an erector spinae plane (ESP) block can be a valuable part of multimodal analgesia. Our intention was to evaluate how ESP block influences postoperative pain scores and opioid consumption after laparoscopic cholecystectomy.

Methods: This single-blinded, prospective, randomized study included 60 patients undergoing laparoscopic cholecystectomy to receive either bilateral ESP block at the Th 7 level (n = 30) with 20 ml of 0.25% levobupivacaine plus dexamethasone 2 mg per side, or standard multimodal analgesia (n = 30). Patients from the standard multimodal analgesia group received tramadol 100 mg at the end of the procedure. Postoperative analgesia for both groups was acetaminophen 1 g/8 h i.v. and ketorolac 30 mg/8 h. Tramadol 1 mg/kg was a rescue treatment for pain breakthrough (numeric rating scale/NRS ≥ 6) in both groups. Pain at rest was recorded at 10 min, 30 min, 2 h, 4 h, 8 h, 12 h and 24 h after surgery using NRS (0-10).

Results: An ESP block significantly reduced postoperative pain scores compared to standard multimodal analgesia after 10 min (p = 0.011), 30 min (p = 0.004), 2 h (p = 0.011), 4 h (p = 0.003), 8 h (p = 0.013), 12 h (p = 0.004) and 24 h (p = 0.005). Tramadol consumption was significantly lower in the ESP group 25.02 ± 56.8g than in the standard analgesia group 208.3 ± 88.1g (p < 0.001).

Conclusion: An ESP block can provide superior postoperative analgesia and reduction in opioid requirement after laparoscopic cholecystectomy.