Die Anaesthesiologie最新文献

The update of the S3 guidelines "Sepsis-Prevention, diagnosis, treatment and follow-up care" was published on 25 July 2025. The new guidelines address 29 new and 16 revised recommendations, with 43 recommendations remaining unchanged from the previous version. The 2025 update is a targeted adaptation of the internationally recognized recommendations of the Surviving Sepsis Campaign from 2021. The focus is on early individualized and evidence-based treatment, the integration of structured follow-up care after hospital discharge and a stronger focus on patient-centered comprehensive care beyond acute treatment. Despite advances in early detection, antibiotic treatment and intensive medical care of patients, sepsis and septic shock remain potentially life-threatening conditions, underlining the necessity for early diagnosis and the initiation of appropriate treatment.

Background: This study explores a new approach for managing high-risk diabetic patients undergoing diabetic-foot surgery, where traditional practices like preoperative fasting and medication changes are bypassed. We aimed to assess the safety and complications of using a popliteal-sciatic nerve block in this unique scenario, while also evaluating the impact on blood glucose levels and surgeon satisfaction.

Methods: The study included high-risk patients classified in the American Society of Anesthesiologists (ASA) III group, where general anesthesia was avoided due to elevated risk factors. Crucially, patients maintained their regular daily routines, with no changes to their medication regimen and they were not required to fast. After enjoying a light breakfast, patients were prepped with standard monitoring and an ultrasound-guided popliteal-sciatic block was performed with the patient in the prone position. Data on patient outcomes and surgeon satisfaction were recorded and analyzed.

Results: A total of 320 blocks were performed as some of the 142 patients required multiple surgical interventions. All of these patients successfully underwent surgery without the need for general anesthesia. Surgeon satisfaction was remarkable high, with a mean score of 4.6 ± 0.8 on a 5-point Likert scale (1 = very poor, 5 = very good), and only 1 patient (0.3%) developed a postoperative hematoma. Patients who did not require sedatives (midazolam) and additional analgesics (fentanyl) had higher surgeon satisfaction scores.

Conclusion: Our findings reveal that for high-risk patients with chronic conditions, a popliteal-sciatic nerve block offers a safe and effective alternative for diabetic foot surgery, eliminating the need for fasting or medication adjustments. This method not only ensures patient safety but also potentially setting a new standard in perioperative care.

Background and objective: During bleeding the prolongation of the clotting time (CT_INTEM) measured by rotational thromboelastometry (ROTEM) can detect alterations in the intrinsic pathway; however, the significance of a prolonged CT_INTEM for risk stratification in patients with bleeding and the treatment with fresh frozen plasma remains unclear.

Material and methods: A total of 2197 consecutive patients between 2014 and 2020 were retrospectively investigated. All patients were tested by ROTEM during bleeding at the Saarland University Hospital. The CT_INTEM values were compared to mortality at 30 days. Discrimination was assessed with C statistic. Adjusted hazard ratios (adjHR, 95% confidence interval, CI) were calculated with multivariable Cox models.

Results: The results of the C‑statistic showed that CT_INTEM (C statistic 0.62, optimal threshold > 226 s) had a predictive power for 30-day mortality. The determined threshold value of CT_INTEM > 226 s remained an independent risk predictor for 30-day mortality even after adjustment for confounding factors (adjHR 2.6, 95% CI 2.1-3.2, p < 0.001). The 30-day mortality rate was significantly increased in the group with CT_INTEM > 226 s (29% versus 15%, p < 0.001). A multivariable analysis showed that treatment with fresh frozen plasma was not associated with increased 30-day mortality in patients with CT_INTEM > 226 s, in contrast to all patients.

Conclusion: Our results indicate that CT_INTEM > 226s detected alterations in the intrinsic pathway might be an independent predictor for 30-day mortality in patients with bleeding and could be useful for decision making regarding treatment with fresh frozen plasma.

Background: In high-risk areas of medicine, such as anesthesiology, intensive care, emergency medicine and pain management, existing organizational and team cultures can significantly impede the delivery of effective and safe care. A predominantly numbers-driven management approach, structural overload and sometimes insufficient leadership competency contribute to overburdening, demotivation and the departure of key personnel. This in turn exacerbates the already critical shortage of healthcare professionals.

Aim of the study: This study explores the extent to which a targeted transformation toward a Just Culture, a culture of fairness and trust, can enhance patient safety, improve staff well-being and sustainably support the performance and economic resilience of medical organizations.

Material and methods: The study is based on a narrative review of the current literature on the topic of Just Culture, leadership, error and learning culture and team development. In addition, selected practical examples from the German and international healthcare sectors were analyzed. The review also incorporated studies on the effectiveness of (simulation) training and incident reporting and learning systems.

Results: The introduction of a Just Culture promotes a climate of trust, fairness and continuous learning in the workplace. It facilitates open communication about adverse events, supports systematic root cause analysis and reduces individual blame. Staff report increased psychological safety, reduced work-related stress and higher job satisfaction. Modern leadership approaches, such as transformational, shared and humble leadership, can further enhance teamwork and care quality. Evidence also suggests positive effects on employee retention and organizational performance, although causal relationships remain underexplored.

Discussion: An organizational culture shaped by Just Culture principles constitutes a key success factor for healthcare institutions. It fosters psychological safety, strengthens a sense of responsibility and enables collective learning; however, successful implementation requires a targeted evolution of leadership structures, continuous training and the development of supportive frameworks, such as reporting systems and interprofessional reflection formats. When effectively implemented, Just Culture can help secure care quality, retain skilled professionals and create a strategic advantage in an increasingly complex and economically pressured healthcare environment.

Background: Noncompressible torso hemorrhage (NCTH) poses a considerable problem in prehospital care as bleeding control is not possible in this situation. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive endovascular procedure that could be an option for temporary bleeding control or reduction. The aim of this study was to review and classify the available literature on the prehospital use of REBOA in the context of traumatic hemorrhagic shock.

Methods: A literature search was carried out in various databases (PubMed, Embase, Web of Sciences, Google Scholar) using the search terms "prehospital and REBOA" or "prehospital and resuscitative endovascular balloon occlusion of the aorta" to identify relevant studies. Only studies, case series or case reports of prehospital REBOA use were included in the review.

Results: A total of 15 studies (7 case reports, 8 case series) with a total of 80 patients (45 male, 15 female, 20 without gender information) with a mean age of 41.4 years (range 16-75 years) who underwent prehospital REBOA for hemorrhage control were included in the review and analyzed. Of these, 34 patients were treated in a military context and 46 patients in a civilian context. The average Injury Severity Score (ISS) was 41.4 (min. 9/max. 75) points. The use of REBOA was feasible in the prehospital setting with an overall success rate of > 85% ranging from 72% to 100%. The prehospital application leads to a hemodynamic stabilization with a mean systolic blood pressure increase of 50 mm Hg. Of the treated patients 89% could be transported alive to hospital and 45% survived to hospital discharge. Complications were reported in 29%, not all of which were specific to REBOA. Publication bias must be considered and therefore the results have to be interpreted with caution.

Conclusion: The application of REBOA in the prehospital setting in the context of traumatic hemorrhagic shock is feasible with a high success rate. The majority of patients can be hospitalized but only slightly less than 50% survive to hospital discharge. The currently available evidence relates exclusively to case reports and case series and is therefore still weak. A not insignificant publication bias must be considered.

The transfusion of platelet concentrates is an established treatment for thrombocytopenia or platelet dysfunction. The new international guideline from the Association for the Advancement of Blood and Biotherapies in collaboration with the International Collaboration for Transfusion Medicine Guidelines is based on 21 randomized and 13 observational studies comparing restrictive and liberal transfusion strategies. The evidence shows that restrictive strategies do not significantly increase 30-day mortality or the risk of severe bleeding (WHO grade 3-4), but are associated with a lower rate of transfusion-associated adverse events, improved resource availability, and lower costs. The guideline supports restrictive transfusion strategies, but emphasizes the need for individual clinical decisions taking into account symptoms, comorbidities, and patient preferences.

Heart failure is a significant risk factor for perioperative complications and postoperative mortality. A detailed medical history and physical examination during the preoperative consultation should guide decisions regarding further measures, such as the assessment of cardiac biomarkers, iron supplementation or echocardiography. Particularly in acutely decompensated patients, an interdisciplinary discussion should take place regarding the possibility of compensating the condition before an elective procedure. Preoperative cardiac medication should be adjusted or paused as needed. Adequate monitoring should enable a differentiated anesthesia induction, anesthesia management and postoperative monitoring to improve patient outcome. Intraoperative anesthesia management should include maintaining normotensive blood pressure, volume management, and a differentiated catecholamine treatment.