Die Anaesthesiologie最新文献

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.

Background: Medical societies around the world are exploring strategies to reduce their carbon footprint. In this context, organizational readiness can serve as an important facilitator for the success of change. In this study we assessed whether a series of educational interventions improved anesthesia departments' organizational readiness for climate change mitigation.

Methods: Anesthesiologists at three German university hospitals were asked to complete a survey on their departments' organizational readiness for climate change mitigation before and after an educational intervention bundle featuring lectures, posters and stickers was conducted. The second survey included additional questions about the use of climate-friendly low-flow and minimal-flow techniques.

Results: A total of 422 questionnaires were completed, 256 of them prior to the interventions. Most participants noticed the interventions and mostly rated them as "good" or "rather good". We found high overall levels of organizational readiness. Agreement to statements in the subcategories of cultural and staff readiness increased from a low baseline level. Participants reported an increased use of minimal-flow techniques (51.6% vs. 66.3% endotracheal tube) and of low-flow techniques (41.0% vs. 57.8% laryngeal mask) during inhalational anesthesia.

Conclusion: Following our educational intervention bundle, organizational readiness at the participating institutions increased and a reduction in consumption of volatile anesthetics was reported. Pending proof of causality, these results encourage further exploration and the application of educational interventions on climate change mitigation in anesthesiology.

Background: The 2025 revision of the donor identification guidelines by the German Medical Association reaffirms the importance of organ-protective intensive care or the application of intensive medical measures to maintain organ function in cases of imminent or established irreversible loss of brain function (brain death). These measures aim to preserve the possibility of organ donation in patients who have declared a willingness to donate or in whom the donation status remains uncertain. Currently, no evidence-based guidelines exist in Germany regarding the intensive care management in this context. This review aims to provide practical guidance on organ-protective intensive care and organ function-preserving strategies in adult patients with severe brain injury and imminent or confirmed brain death.

Material and methods: This review is based on relevant English and German language publications retrieved from databases (PubMed/Medline) as well as international guidelines and expert recommendations for action.

Results: Across the continuum from imminent to confirmed brain death and the subsequent phase, various pathophysiological changes occur that have implications for organ-protective intensive care and the maintenance of organ function. These include disturbances in hemodynamics, lung function, the endocrine system and infectious complications. Additionally, some measures focus on organ protection after retrieval. Based on cohort and registry studies and few randomized trials, interventions such as intravenous administration of vasopressin and glucocorticoids as well as consistent lung-protective ventilation including recruitment maneuvers, appear to improve hemodynamics and lung function in certain situations; however, the overall evidence remains limited and key aspects, such as the optimal timing for vasopressin or glucocorticoid administration, remain unresolved. Other interventions, such as thyroid hormone substitution, low-threshold insulin administration, and the use of dopamine, continue to be controversially discussed.

Discussion: From the current literature recommendations can be derived regarding the use of organ-protective intensive care or organ function-preserving strategies in the context of brain death, mainly under specific conditions such as hemodynamic instability. In the clinical practice, general standards of intensive care should therefore be applied. Further research initiatives are urgently needed to address both specific medical interventions and healthcare supply aspects. This could be achieved through randomized trials and the further development of the German National Transplantation Registry, which would provide a foundation for generating robust clinical insights.

Transoral robot-assisted surgery (TORS) enables minimally invasive procedures in the areas of the mouth, palate, pharynx, larynx and tonsils. It offers numerous advantages such as enhanced precision, improved access and reduced surgical trauma compared to traditional, more invasive techniques; however, TORS also presents new anesthesiological challenges, particularly concerning airway management, anesthesia management and perioperative care. These aspects are the focus of this review. A key issue in TORS is airway management as many patients present with risk factors for a difficult airway, while at the same time it is essential to minimize obstruction of the surgical field and access. Several options are available for securing the airway during TORS. This article outlines and discusses the advantages and disadvantages of the various techniques. Special attention is paid to a novel ultra-thin endotracheal tube known as the Tritube©, which thanks to its slim design opens up new surgical and anesthesiological possibilities. The associated technique of flow-controlled ventilation (FCV) is discussed and compared to more established ventilation methods such as volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). This article aims to provide an overview of anesthesia management in TORS, highlight potential risks and outline strategies to mitigate them.

Background: Since the introduction of three-dimensional transesophageal echocardiography (3D-TEE) in 2007, the technique has been incorporated into the guidelines of both national and international societies for intraoperative and peri-interventional TEE examinations. It is recommended for most cardiac surgical procedures and interventional transcatheter interventions but the actual use in the clinical routine has not been investigated.

Objective: Despite its growing adoption, data on the clinical application of 3D-TEE remains limited. To address this gap, the research group, in collaboration with the German Society of Anesthesiology and Intensive Care Medicine (DGAI), conducted a survey of all German departments performing cardiac surgery. The survey aimed to assess the intraoperative and peri-interventional use of 3D-TEE, structural conditions, equipment availability, imaging modalities and potential limitations encountered in daily clinical practice.

Material and methods: A representative individual for echocardiography from each of the 81 German departments offering cardiac surgery was invited via email to participate in a 25-item online survey. The survey was created using LimeSurvey software, and the results were subsequently analyzed. Subanalyses were performed for two subgroups: 1) proportion of certified anesthesiologists in the department (high vs. low certification rate) and 2) presence of a standardized image acquisition protocol (available vs. not available). Responses to the remaining questions were analyzed for these subgroups.

Results: Of the 81 German departments, 54 (67%) completed the questionnaire. More than half of the respondents reported a low TEE certification rate and 82% of departments lacked a formal 3D-TEE training program. Of the departments 4% did not have 3D-capable TEE devices, while 68% of departments had 1 device available per operating room. The 3D-TEE was frequently used in 91% of cases for transcatheter edge-to-edge repair (TEER) of the mitral and tricuspid valves, in 74% of cases for surgical valve procedures and in 57% of cases for coronary artery bypass graft (CABG) surgery. The presence of a standardized 3D image acquisition protocol was associated with more frequent TEE examinations and a greater perceived impact of 3D-TEE on daily cardiac surgical practice. A higher certification rate was linked to more frequent use of 3D modalities, increased use of 3D measurements and greater utilization of 3D-TEE for anatomical understanding and educational purposes. In Germany, intraoperative TEE for common procedures, such as heart valve surgery and bypass surgery is almost exclusively performed by cardiothoracic anesthesiologists. The most significant limitations in daily clinical practice were insufficiently trained personnel (61%) and insufficient time (57%).

Conclusion: The survey reveals that the impl