Pub Date : 2024-02-01Epub Date: 2024-01-29DOI: 10.1007/s00101-023-01375-0
Sebastian Adamowicz, Erich Kilger, Raphael Klarwein
Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults, both in general and perioperatively and is associated with significant morbidity and mortality. The age of the patients is a major risk factor. The prevalence of AF in noncardiac surgery (NCS) varies widely from 0.4% to 30% and for cardiac surgery, especially major combined procedures, up to approximately 50%. Ectopic excitation centers and reentry mechanisms at the atrial level are favored as the main process of uncoordinated electrical atrial activity. The loss of atrial contraction can lead to a reduction in cardiac output of up to 20-25%. The increased risk of thromboembolism due to AF extends beyond the perioperative period. Medication-based prevention strategies have not yet gained widespread acceptance. Treatment strategies include frequency and rhythm control as well as the avoidance of thromboembolisms through anticoagulation.
{"title":"[Perioperative atrial fibrillation : Diagnosis with underestimated relevance].","authors":"Sebastian Adamowicz, Erich Kilger, Raphael Klarwein","doi":"10.1007/s00101-023-01375-0","DOIUrl":"10.1007/s00101-023-01375-0","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults, both in general and perioperatively and is associated with significant morbidity and mortality. The age of the patients is a major risk factor. The prevalence of AF in noncardiac surgery (NCS) varies widely from 0.4% to 30% and for cardiac surgery, especially major combined procedures, up to approximately 50%. Ectopic excitation centers and reentry mechanisms at the atrial level are favored as the main process of uncoordinated electrical atrial activity. The loss of atrial contraction can lead to a reduction in cardiac output of up to 20-25%. The increased risk of thromboembolism due to AF extends beyond the perioperative period. Medication-based prevention strategies have not yet gained widespread acceptance. Treatment strategies include frequency and rhythm control as well as the avoidance of thromboembolisms through anticoagulation.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139572531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01Epub Date: 2024-01-16DOI: 10.1007/s00101-023-01365-2
Mehmet F Cosgun, Emine A Salviz, Emre S Bingul, Mehmet Guzel, Emre Senturk, Merve O Dinc, Salih Aktas, Meltem Savran-Karadeniz
Background and aims: Costoclavicular brachial plexus block is gaining popularity due to its ease of application. Lateral and medial costoclavicular approaches have recently been defined. In the current study, we aimed to investigate the procedural execution of these approaches in the pediatric population.
Methods: In this study 55 children aged between 2 and 10 years were randomized to receive lateral (LC group) or medial (MC group) costoclavicular brachial plexus block after induction of general anesthesia for postoperative analgesia. All patients received bupivacaine (1 mg/kg, 0.25%) within the center of the cord cluster. The number of needle maneuvers was recorded as primary outcome. Block performing features (ideal ultrasound-guided brachial plexus cords visualization, needle pathway planning time, needle tip and shaft visualization difficulty, requirement of extra needle maneuver due to insufficient local anesthetic distribution, block performance time, total procedure difficulty) and postoperative pain-related data (block intensities, pain scores and analgesic requirements) were all compared as secondary outcomes.
Results: The LC group patients required less ultrasound visualization time (median 14 s, range 11-23 s vs. median 42 s, range 15-67 s, p < 0.001) and fewer needle maneuvers (median 1, range 1-2 vs. median 3, range 2-4, p < 0.001) compared to the MC group. Similarly, the median block performance duration was shorter (median 67 s, range 47-94 s vs. median 140s, 90-204 s, p < 0.01) and procedures were perceived as easier (median 4, range 4-5 vs. median 3, range 2-5, p = 0.04) in the LC group. All other parameters were comparable (p > 0.05).
Conclusion: The lateral approach required less needle maneuvers than the medial approach. Both techniques represented a good safety profile with favorable analgesic features.
{"title":"Comparison of ultrasonography-guided lateral versus medial costoclavicular brachial plexus block in pediatric patients : A randomized clinical trial.","authors":"Mehmet F Cosgun, Emine A Salviz, Emre S Bingul, Mehmet Guzel, Emre Senturk, Merve O Dinc, Salih Aktas, Meltem Savran-Karadeniz","doi":"10.1007/s00101-023-01365-2","DOIUrl":"10.1007/s00101-023-01365-2","url":null,"abstract":"<p><strong>Background and aims: </strong>Costoclavicular brachial plexus block is gaining popularity due to its ease of application. Lateral and medial costoclavicular approaches have recently been defined. In the current study, we aimed to investigate the procedural execution of these approaches in the pediatric population.</p><p><strong>Methods: </strong>In this study 55 children aged between 2 and 10 years were randomized to receive lateral (LC group) or medial (MC group) costoclavicular brachial plexus block after induction of general anesthesia for postoperative analgesia. All patients received bupivacaine (1 mg/kg, 0.25%) within the center of the cord cluster. The number of needle maneuvers was recorded as primary outcome. Block performing features (ideal ultrasound-guided brachial plexus cords visualization, needle pathway planning time, needle tip and shaft visualization difficulty, requirement of extra needle maneuver due to insufficient local anesthetic distribution, block performance time, total procedure difficulty) and postoperative pain-related data (block intensities, pain scores and analgesic requirements) were all compared as secondary outcomes.</p><p><strong>Results: </strong>The LC group patients required less ultrasound visualization time (median 14 s, range 11-23 s vs. median 42 s, range 15-67 s, p < 0.001) and fewer needle maneuvers (median 1, range 1-2 vs. median 3, range 2-4, p < 0.001) compared to the MC group. Similarly, the median block performance duration was shorter (median 67 s, range 47-94 s vs. median 140s, 90-204 s, p < 0.01) and procedures were perceived as easier (median 4, range 4-5 vs. median 3, range 2-5, p = 0.04) in the LC group. All other parameters were comparable (p > 0.05).</p><p><strong>Conclusion: </strong>The lateral approach required less needle maneuvers than the medial approach. Both techniques represented a good safety profile with favorable analgesic features.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139473144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01Epub Date: 2024-01-23DOI: 10.1007/s00101-023-01368-z
Felix C F Schmitt, Herbert Schöchl, Kathrin Brün, Sascha Kreuer, Sven Schneider, Stefan Hofer, Christian F Weber
Viscoelastic test (VET) procedures suitable for point-of-care (POC) testing are in widespread clinical use. Due to the expanded range of available devices and in particular due to the development of new test approaches and methods, the authors believe that an update of the current treatment algorithms is necessary. The aim of this article is to provide an overview of the currently available VET devices and the associated reagents. In addition, two treatment algorithms for the VET devices most commonly used in German-speaking countries are presented.
适用于护理点(POC)检测的粘弹性测试(VET)程序已广泛应用于临床。由于可用设备的范围不断扩大,特别是由于新检测方法和手段的发展,作者认为有必要对目前的治疗算法进行更新。本文旨在概述目前可用的 VET 设备和相关试剂。此外,还介绍了德语国家最常用的 VET 设备的两种治疗算法。
{"title":"[Update on point-of-care-based coagulation treatment : Systems, reagents, device-specific treatment algorithms].","authors":"Felix C F Schmitt, Herbert Schöchl, Kathrin Brün, Sascha Kreuer, Sven Schneider, Stefan Hofer, Christian F Weber","doi":"10.1007/s00101-023-01368-z","DOIUrl":"10.1007/s00101-023-01368-z","url":null,"abstract":"<p><p>Viscoelastic test (VET) procedures suitable for point-of-care (POC) testing are in widespread clinical use. Due to the expanded range of available devices and in particular due to the development of new test approaches and methods, the authors believe that an update of the current treatment algorithms is necessary. The aim of this article is to provide an overview of the currently available VET devices and the associated reagents. In addition, two treatment algorithms for the VET devices most commonly used in German-speaking countries are presented.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10850202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1007/s00101-024-01383-8
Nora Dehina, Björn-Erik Ole Jensen, Michael Bernhard, Lennert Böhm
Patients often present to emergency departments after potential or confirmed exposure to human immunodeficiency virus (HIV) asking for recommendations concerning the initiation of post-exposure prophylaxis (PEP). These presentations may occur after occupational as well as non-occupational exposure. PEP entails taking a triple antiretroviral therapy for 28-30 days. If taken early (ideally within 2 h, but no later than 72 h) and as indicated, HIV infection can be prevented with a high level of probability. Since these presentations occur around the clock, they require basic expertise on the part of the emergency department staff regarding its indication and its side effects as well as standardized procedures in the emergency department to not delay initiation. Patients should present to an infectious disease outpatient clinic or practice specialized in HIV in order to have the indication reviewed by a specialist and, if necessary, adapted to complex cases with the aim of making individual case decisions. This review article aims to summarize core statements of the 2022 German-Austrian guideline on HIV post-exposure prophylaxis and to give emergency department staff necessary knowledge to safely and correctly begin PEP.
{"title":"[Presentations for HIV post-exposure prophylaxis in emergency departments: guideline and recommendations].","authors":"Nora Dehina, Björn-Erik Ole Jensen, Michael Bernhard, Lennert Böhm","doi":"10.1007/s00101-024-01383-8","DOIUrl":"10.1007/s00101-024-01383-8","url":null,"abstract":"<p><p>Patients often present to emergency departments after potential or confirmed exposure to human immunodeficiency virus (HIV) asking for recommendations concerning the initiation of post-exposure prophylaxis (PEP). These presentations may occur after occupational as well as non-occupational exposure. PEP entails taking a triple antiretroviral therapy for 28-30 days. If taken early (ideally within 2 h, but no later than 72 h) and as indicated, HIV infection can be prevented with a high level of probability. Since these presentations occur around the clock, they require basic expertise on the part of the emergency department staff regarding its indication and its side effects as well as standardized procedures in the emergency department to not delay initiation. Patients should present to an infectious disease outpatient clinic or practice specialized in HIV in order to have the indication reviewed by a specialist and, if necessary, adapted to complex cases with the aim of making individual case decisions. This review article aims to summarize core statements of the 2022 German-Austrian guideline on HIV post-exposure prophylaxis and to give emergency department staff necessary knowledge to safely and correctly begin PEP.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139572433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01Epub Date: 2024-01-09DOI: 10.1007/s00101-023-01374-1
Duc Tri Dinh, Wera Seydel, Patrick Meybohm, Peter Kranke, Benedikt Schmid
{"title":"[Conventional vs. video-assisted laryngoscopy for perioperative endotracheal intubation-COVALENT trial].","authors":"Duc Tri Dinh, Wera Seydel, Patrick Meybohm, Peter Kranke, Benedikt Schmid","doi":"10.1007/s00101-023-01374-1","DOIUrl":"10.1007/s00101-023-01374-1","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01Epub Date: 2024-02-07DOI: 10.1007/s00101-024-01381-w
Patrick Meybohm
{"title":"[ICD, OPS and HL7 : Digital medicine in the clinical routine].","authors":"Patrick Meybohm","doi":"10.1007/s00101-024-01381-w","DOIUrl":"10.1007/s00101-024-01381-w","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139698953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-30DOI: 10.1007/s00101-024-01377-6
Lucas Guimarães Ferreira Fonseca, Gianluca Bertolizio, Thomas Engelhardt, Jacob Karlsson
{"title":"Pediatric point of care airway ultrasound (POCUS) : Current evidence and future practice.","authors":"Lucas Guimarães Ferreira Fonseca, Gianluca Bertolizio, Thomas Engelhardt, Jacob Karlsson","doi":"10.1007/s00101-024-01377-6","DOIUrl":"https://doi.org/10.1007/s00101-024-01377-6","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139577000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-01-12DOI: 10.1007/s00101-023-01370-5
Heribert Kirchner, Andreas Bohn, Nik Hulsmans, Patrick Brzoska, Frank-Gerald B Pajonk
Background: The coronavirus disease 2019 (COVID-19) pandemic represented a serious challenge for healthcare systems worldwide. Special psychiatric patients represent a vulnerable group and are particularly affected by lockdown interventions. Knowledge on the possible effects for this group of patients in an emergency physician setting is low.
Objective: The aim of this paper is to investigate the impact of the first lockdown during the COVID-19 pandemic in 2020 on emergency ambulance services for psychiatric patients in a large German city.
Material and methods: A retrospective analysis was conducted on all prehospital psychiatric emergencies in a large German city during the first pandemic-related lockdown from 22 March 2020 to 4 May 2020, with the same period in 2019 serving as a reference.
Results: During the first lockdown there was a significant increase in the number of emergency missions with respect to psychiatric cases. A substantial rise in substance-associated deployments was observed. Moreover, there was an increase in the proportion of psychiatric patients who did not meet emergency criteria. Suicidal tendencies and agitation status played a minor role during the lockdown.
Conclusion: The lockdown had a notable impact on the frequency and profile of emergency physician calls in the metropolitan area studied. The substantial increase in substance-associated callouts can be interpreted as both a deterioration in access to the healthcare system and an expression of the increased stress faced by the general population and vulnerable groups in particular.
{"title":"[Impact of the 2020 lockdown on prehospital psychiatric emergencies in a large city].","authors":"Heribert Kirchner, Andreas Bohn, Nik Hulsmans, Patrick Brzoska, Frank-Gerald B Pajonk","doi":"10.1007/s00101-023-01370-5","DOIUrl":"10.1007/s00101-023-01370-5","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic represented a serious challenge for healthcare systems worldwide. Special psychiatric patients represent a vulnerable group and are particularly affected by lockdown interventions. Knowledge on the possible effects for this group of patients in an emergency physician setting is low.</p><p><strong>Objective: </strong>The aim of this paper is to investigate the impact of the first lockdown during the COVID-19 pandemic in 2020 on emergency ambulance services for psychiatric patients in a large German city.</p><p><strong>Material and methods: </strong>A retrospective analysis was conducted on all prehospital psychiatric emergencies in a large German city during the first pandemic-related lockdown from 22 March 2020 to 4 May 2020, with the same period in 2019 serving as a reference.</p><p><strong>Results: </strong>During the first lockdown there was a significant increase in the number of emergency missions with respect to psychiatric cases. A substantial rise in substance-associated deployments was observed. Moreover, there was an increase in the proportion of psychiatric patients who did not meet emergency criteria. Suicidal tendencies and agitation status played a minor role during the lockdown.</p><p><strong>Conclusion: </strong>The lockdown had a notable impact on the frequency and profile of emergency physician calls in the metropolitan area studied. The substantial increase in substance-associated callouts can be interpreted as both a deterioration in access to the healthcare system and an expression of the increased stress faced by the general population and vulnerable groups in particular.</p>","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139426119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-12-05DOI: 10.1007/s00101-023-01360-7
Tobias Wöhrle, Erich Kilger
{"title":"[Pro: Levosimendan in Cardiac Surgery].","authors":"Tobias Wöhrle, Erich Kilger","doi":"10.1007/s00101-023-01360-7","DOIUrl":"10.1007/s00101-023-01360-7","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138489275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-01-04DOI: 10.1007/s00101-023-01372-3
Thomas Fuchs-Buder, Heidrun Lewald, Peter Kranke
{"title":"[ESAIC and ASA guidelines for the management of neuromuscular blockade].","authors":"Thomas Fuchs-Buder, Heidrun Lewald, Peter Kranke","doi":"10.1007/s00101-023-01372-3","DOIUrl":"10.1007/s00101-023-01372-3","url":null,"abstract":"","PeriodicalId":72805,"journal":{"name":"Die Anaesthesiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139089591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}