Die Anaesthesiologie最新文献

In 2023 the third revision of the S3 guidelines on sedation in gastrointestinal endoscopy was presented. As with the two previous versions of the guidelines, the relevant and current literature was reviewed and evaluated by a group of experts from various specialist societies under the guidance of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS). In addition to confirming some of the older recommendations, a number of recommendations were revised or newly added. A brief overview of the current version of the S3 guidelines is provided with a focus on relevant changes.

Background: Fixation plasters are nowadays an important part of clinical care and the product range is adapted to the needs of patient care. A multifaceted selection is available.

Aim of the study: To increase vigilance towards the supposedly low-threshold use of fixation plasters in patient care.

Material and method: This review is dedicated to the use of fixation plasters, mostly outside of their intended use on patients.

Results: There are countless examples of how fixation plasters are used outside of their intended purpose and patient safety is often neglected. This can lead to an occult latex contamination. Devices repaired with makeshift fixation plasters also put patients at risk. From a hygienic point of view, adhesive residues from fixation plasters promote surface contamination of various materials or work surfaces.

Discussion: The intended use of medical products is meaningful and prescribed by law. This serves to ensure patient and user safety. Further training is extremely important so that vigilant players in the healthcare sector can counteract sources of danger. This special attention can be trained in the "room of error", for example, and is one of the most important preventative measures to avoid errors occurring in the first place. Checking the use of fixation plasters in one's own working environment helps to minimize risks.

Hemodynamic treatment is a core task in the intensive medical care of cardiac surgery patients. The patient's underlying disease, the type of surgical procedure and the patient's individual characteristics play key roles in the selection of the treatment regimen. The basis of any targeted hemodynamic treatment is the differential diagnosis of the underlying pathological disorder. The established basic monitoring can be expanded if necessary. Postoperative circulatory dysfunction can occur as low cardiac output syndrome (LCOS) predominantly with left or right heart failure or as vasoplegic syndrome (VS). In addition to catecholamines in the narrow sense, various vasoactive and inotropic substances are available for treatment. Knowledge of the recommended target parameters and indication-appropriate monitoring are essential. This article summarizes the current guideline recommendations for the treatment of postoperative circulatory dysfunction.

On 23 April 1895, the Berlin ENT medical specialist Alfred Kirstein performed the first direct examination of the larynx using a Casper esophagoscope equipped with electric lighting, which he called an "autoscope". The examination of the larynx, which had previously only been possible indirectly using mirror systems, was named by him "autoscopy". The development of the device enabled a more precise observation than before and laryngeal or tracheal foreign bodies could be removed better and more easily. The new instrumental development and examination technique he described met with rapid approval and great interest in specialist circles. Shortly afterwards the first publications on orotracheal intubation for anesthesia appeared in scientific journals, that should also be possible with the aid of Kirstein's autoscope. Although he never propagated this himself, it was also possible to perform these under visualization using a tongue depressor equipped with a light, which he had developed a short time later. Both developments are already very close to today's laryngoscopes. Kirstein's contribution in this respect has so far hardly been appreciated, especially in German-speaking countries.

With a decrease in mortality of critically ill patients in recent years, intensive care medicine research has shifted its focus on functional impairments of intensive care units (ICU) survivors. ICU survivorship is characterized by long-term impairments of cognition, mental health, and physical health. Since 2012, these impairments have been summarized with the umbrella term Post-Intensive Care Syndrome (PICS). Mental health impairments frequently entail new are aggravated symptoms of depression, anxiety, and posttraumatic stress disorder. Beyond impairments in the three PICS domains, critical illness survivors frequently suffer from chronic pain, dysphagia, and nutritional deficiencies. Furthermore, they have a higher risk for osteoporosis, bone fractures, and diabetes mellitus. Taken together, these sequelae reduce their health-related quality of life. Additionally, ICU survivors are challenged by social problems such as isolation, economic problems such as treatment costs and lost earnings, and return to previous employment. Yet, patients and caregivers have described post-ICU care as inadequate and fragmented. ICU follow-up clinics could improve post-ICU care, but there is insufficient evidence for their effectiveness. Thus far, large high-quality trials with multicomponent and interdisciplinary post-ICU interventions have mostly failed to improve patient outcomes. Hence, preventing PICS and minimizing risk factors by optimizing ICU care is crucial, e.g. by implementing the ABCDE bundle. Future studies need to identify effective components of post-ICU recovery interventions and determine which patient populations may benefit most from ICU recovery services.