Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie最新文献

International guidelines recommend encouraging patients to drink up to two hours before induction of anaesthesia. But why are patients still fasting for up to a median of 12 hours? Are liberal clear liquid fasting regimens harmful to patients or considered "best clinical practice"? Gastric emptying of clear liquids is very fast, exponential and proportional to the current filling of the stomach. There is no evidence of a link between drinking clear liquids and the risk of aspiration. As a result, more and more hospitals are allowing their patients to drink clear liquids until they are called for surgery. Since 2021, "SipTilSend" has become best practice in the UK and the concept of fasting cards has been awarded by patient safety organisations in 2024.

Modern patient simulation and CRM (crisis resource management) are very often mentioned in the same context. In this article, we will classify the parallel developments of the last 60 years and the introduction of CRM in healthcare concept over 30 years ago and to examine them from different perspectives. CRM has more dimensions than most people realize. This toolbox deals with the description and optimization of human factors in the context of the healthcare system. Since the human factors and the effects on the quality of treatment can be addressed very well in the context of simulation training, they play a natural role in many simulation training courses.

Modern oncological treatment options are significantly extending patient survival. As a result, anaesthetists are increasingly faced with patients who have been pre-treated with immunotherapy or chemotherapy, are currently undergoing a cycle of therapy, or even need to receive chemotherapy intraoperatively. As the anaesthetic agents and perioperative analgesics may interfere with the oncological drugs, it is of interest for the anaesthetist to be aware of the spectrum of side effects and incompatibilities and to adapt the anaesthetic and perioperative treatment regimens accordingly. The aim of this review article is to present the relevant information and provide the clinician with recommendations on where problems may occur and how they can be avoided.

Simulations have become an integral part of modern teaching. They provide a safe environment to learn and refine complex clinical skills without putting patients at risk. This article highlights the current possibilities and advantages of simulation in anesthesiology, intensive care medicine, emergency medicine and pain medicine and shows how these technologies can revolutionize medical training.Safe learning environment: Simulations provide a risk-free environment to develop and refine clinical skills, which increases patient safety and improves efficiency in clinical practice.Fostering collaboration: Interprofessional and interdisciplinary simulations strengthen collaboration and communication between different medical professions and specialties, leading to better team dynamics and decision-making.Diversity of simulation methods: High-fidelity simulations, virtual reality (VR), augmented reality (AR) and task trainers are essential tools in medical education that support different learning objectives.Complementing reality: Although simulations cannot completely replace reality, they are a valuable addition to traditional teaching methods and allow students to make mistakes and learn from them in a controlled environment.Optimizing the quality of training: A clear definition of the terminology used for simulation and structured simulation programs could improve the quality of training and alleviate bottlenecks in training, especially in specialized areas of anesthesia.

The Section Metabolism and Nutrition of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) recently published two position papers specifying some aspects of the guideline on clinical nutrition for critically ill patients published by the German Society for Nutritional Medicine in 2018. This article provides a condensed overview for clinical practice; some key aspects of these position papers are presented focussing on the monitoring of energy expenditure and macronutrient administration.

Medical Nutrition Therapy (MNT) is a key component of treatment in intensive care units (ICU) and plays a crucial role in the prognosis of critically ill patients. An individualized nutrition strategy is essential to meet the specific needs of critically ill patients and to minimize potential complications.Recommendations for MNT differ between the guidelines of the German Society for Nutritional Medicine (DGEM), the European Society for Clinical Nutrition and Metabolism (ESPEN), and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), making its implementation in clinical practice challenging. Therefore, the first part of this article provides a pragmatic summary of the current recommendations for everyday clinical practice. The second part focuses on recent data and how these might influence current paradigms of MNT for critically ill patients, with particular emphasis on phase-appropriate macronutrient delivery and combinations of nutrition with other interventions.

The market offers a wide range of medical nutrition formulations for oral, enteral and parenteral nutrition of critically ill patients. In addition to so-called "standard" nutrition formulations, which are available in different variants and already cover a wide range of products, there are also specialized nutrition formulations that have been developed specifically for certain diseases.According to current evidence, normocaloric "standard" nutrition formulations are the first choice. However, in certain cases, depending on the clinical picture, phase of illness and individual tolerance, energy-dense or protein-rich variants as well as fiber-containing or fiber-free options may also be useful. These products enable individualized disease- and phase-specific nutrition therapy in clinical practice.However, the evidence for the benefits of specialized nutrition formulations that are tailored to specific metabolic changes and particular needs of individual clinical pictures is currently limited. Such specialized products should therefore only be used in individual cases and under consideration of medical and therapeutic conditions: Special nutrition formulations for patients with diabetes mellitus and kidney disease can simplify metabolic control and the practice of nutritional therapy. By carrying out close metabolic monitoring, special nutrition formulations can be used individually in these patients. However, specialized nutrition formulations for patients with liver or lung disease are not recommended based on current evidence and guidelines.While the evidence for the use of special substrates in pharmacological doses is still limited, they are an integral part of clinical nutrition products in physiological doses.Particular attention should be paid to complete protein/amino acid patterns (dispensable, indispensable and conditionally indispensable amino acids) and mixed lipid emulsions (soy, olive, fish oil, medium-chain triglycerides) in parenteral nutrition products.

The use of ultrasound in regional anaesthesia is increasingly establishing itself as the gold standard, as supported by the 2021 PERSEUS guideline on the perioperative use of ultrasound in regional anaesthesia. This guideline reviews the effectiveness, safety, and training requirements for ultrasound-guided anaesthesia techniques and provides recommendations for various block techniques as well as educational approaches for sonography-based methods. Studies show that the use of ultrasound generally increases success rates and reduces complications, particularly in performing upper and lower extremity blocks. However, there remains significant heterogeneity in the data, and clear recommendations are still lacking for many techniques, especially for truncal and neuraxial blocks. The guideline specifies quality indicators, though the data supporting these is occasionally unclear. For training and education, a structured model combining practical and theoretical knowledge is recommended. The authors of the guideline regard ultrasound as the standard in regional anaesthesia due to its visual safety advantages, although the application for some procedures is not yet fully evidence-based.