Die Anaesthesiologie最新文献

Life in an intensive care unit (ICU) involves the successful use of life-sustaining treatment and patients dying. In intensive care medicine, allowing a patient to die often means discontinuing life-sustaining measures. Together with the severity of the illness, this has a significant impact on the course of the dying process. End of life treatment and support focus on alleviating symptoms. The interprofessional team's task in the ICU is to anticipate, plan and implement palliative measures. A family-centered approach to palliative care requires providing human resources for psychosocial support and spiritual care for those affected. Implementing internal recommendations for action improves the quality of care. Training in the necessary skills to support people at the end of life is an integral component of education and ongoing professional development. This training includes basic knowledge of palliative care as well as specific knowledge about terminating life-sustaining measures.

Sodium-glucose Cotransporter 2 (SGLT-2) inhibitors are oral antidiabetic drugs that were developed for the treatment of patients with diabetes mellitus and are now also approved for treating chronic heart failure and chronic kidney disease. By inhibiting SGLT‑2 in the proximal renal tubule, urinary excretion of glucose is increased. Large randomized trials have demonstrated improved glycemic control, reduced cardiovascular events and lower mortality but also an increased risk of urogenital infections and dehydration. Of particular concern is an increasing number of reports describing postoperative (euglycemic) ketoacidosis in patients on treatment with SGLT-2 inhibitors, which is a rare but potentially life-threatening side effect which is difficult to detect. The extremely limited data situation is reflected in the heterogeneous recommendations, surgical stress, prolonged fasting and metabolic changes are considered key triggers. International guidelines recommend withholding SGLT-2 inhibitors 3-4 days before elective surgery, whereas an increase in undesired events has been described when discontinuing the medication in patients with heart failure. This indicates that a one-size-fits-all approach is unsuitable and an individualized, risk-stratified strategy that considers the risk of surgery, fasting duration and ketone monitoring appears to be more appropriate. The lack of evidence for the approach in emergency situations, limited availability of blood ketone testing and unclear guidance on when to restart treatment further complicate perioperative management. This review outlines the effects and side effects of SGLT-2 inhibitors and summarizes the current recommendations for perioperative management.

Antimicrobial stewardship (AMS) is a relatively new movement in Germany that aims to rationalize the use of antibiotics. The primary aim is to halt the global rise of bacterial resistance which of course also affects Germany. Perioperative antibiotic prophylaxis is an important topic for AMS. In December 2024 the new S3 guideline on perioperative prophylaxis was published by the Association of the Scientific Medical Societies in Germany (AWMF), which are also presented here.Surgical site infections (SSI) have greatly increased in Germany in recent years. These should be prevented with perioperative antibiotic prophylaxis. Nevertheless, for AMS reasons, the antibiotic prescription of perioperative prophylaxis should be judicious. As many studies have shown, the optimal time for administering antibiotics is 30-60 min before the surgical incision. This interval ensures an adequate antibiotic concentration in skin and subcutaneous tissue. A history of penicillin allergy should be preoperatively questioned as only a small proportion of patients who report a penicillin allergy actually have one; however, beta-lactams are the most important substances for perioperative prophylaxis, alternative substances such as clindamycin are less effective and resistance rates have greatly increased. Multidrug-resistant pathogens (MRE) are now given special consideration: the new guideline lists surgical procedures where MRE should be considered as well as the recommended screening and adjustment of substance selection in this situation. The most important point from the perspective of infectious diseases, however, is the duration of the perioperative antibiotic prophylaxis: it is specified also in the new guidelines (with a few exceptions) as a single dose (plus intraoperative re-dosing in the event of a long duration of surgery or high intraoperative blood loss).The new guidelines excellently summarize the existing data and based on these provide clear recommendations. It thus supports AMS efforts in this area in an exemplary manner.

Background: The coronavirus disease 2019 (COVID-19) pandemic was marked by increased patient surge in hospitals around the world as well as significant staff shortages due to illness and isolation. Hospital preparedness plans in Germany should plan for staff surge capacity in the event of a future pandemic or disaster.

Objective: We assessed whether non-medical helpers could be incorporated as surge capacity workforce in German hospitals.

Methods: For this scoping review we performed an initial pilot search using GoogleScholar, followed by a systematic query of the Embase and Medline databases. The identified literature and the results of the pilot search were summarized in a narrative-descriptive way.

Results: We identified 64 relevant articles for the scoping review (4 reports, 5 reviews, 1 book section, 13 interventional and 4 observational studies, 8 cross-sectional surveys, 12 expert articles, 13 case reports, 4 training materials). Previous preparedness plans have included volunteers from nongovernmental-organizations, students from medical and public health faculties and spontaneous volunteers. Training this surge capacity workforce is usually a requirement and can take place pre-emptively or at short notice (just in time).

Conclusion: An increasing body of evidence describes including volunteers in preparedness plans within the clinical setting. Especially medical students seem to be a well-established surge capacity workforce that could be systematically planned into preparedness plans in the event of another pandemic or significant disaster in Germany.