Scheffel D, Wirkner J, Adler S
… +6 more, Wassilew G, Dragowsky K, Seemann R, Fröhlich S, AG-Lehre der DGOU, Kasch R
Anaesthesist
· 2022 May · PMID 35507045
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BACKGROUND: Practical experiences in clinical traineeships can shape the later specialty choice of medical students. KEY QUESTION: The following study aimed to find factors in anesthesiological clinical traineeship that...BACKGROUND: Practical experiences in clinical traineeships can shape the later specialty choice of medical students. KEY QUESTION: The following study aimed to find factors in anesthesiological clinical traineeship that encourage students to specialize in the field. MATERIAL AND METHODS: As part of a nationwide online survey conducted by the working group for education of the German Association for Orthopedics and Trauma Surgery (Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, DGOU), study participants (n = 479) answered questions about their minimum 4‑week traineeship in anesthesiology. The information on items was analyzed in six content categories: 1) integration into the team, 2) acquisition of skills, 3) teachers, 4) quality of teaching, 5) structure of teaching and 6) satisfaction with the clinical internship. The respondents were subdivided into 4 groups by answering the question "Could you imagine an elective in anesthesiology during the final year (PJ)" with "Yes, I have made this decision after the clinical traineeship" (JdF, n = 212, 44%), "No I have decided against an elective during the final year after the traineeship" (NdF, n = 56, 12%), "Yes I have decided for an elective in anesthesiology before the internship" (JvF Yes: n = 144, 30%) and "No, I have decided against an elective in anesthesiology before the internship" (NvF: n = 67, 14%). Answers of the participants regarding the six content categories were compared between the four groups. RESULTS: The survey reached all medical faculties in Germany and included participants with an average age of 25.8 years and a balanced gender ratio. There were significant differences between satisfied and dissatisfied students in all four subgroups. Of the 479 respondents, 211 (44%) were already set regarding their decision of choosing anesthesiology as an elective during the final year before the clinical traineeship. Of the respondents 268 (56%) were influenced by the internship, 212 (44%) of them positively. In total, 81% of the trainees rated the internship as "satisfying". Students who were satisfied with the overall internship and who spoke in favor of the PJ elective in anesthesiology differed significantly from the other groups in the categories of team integration, skills acquisition, structure and quality of teaching. The teaching of practical skills and specialist knowledge as well as the integration into diagnostics and treatment planning promoted the recruitment of young people. DISCUSSION: The positively evaluated anesthesiology internship promotes later specialty choice, with quality and structure of the teaching affecting student satisfaction. Trainees who were attracted by anesthesiology gave better overall ratings and acquired more skills during the course of the internship. In order to win aspiring doctors for anesthesiology, the medical team has to integrate trainees well and support the acquisition of practical skills and specialist knowledge. In addition, didactics and practical relevance should be given high priority.
Anaesthesist
· 2022 May · PMID 35397669
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The controversy surrounding ventilation in coronavirus disease 2019 (COVID-19) continues. Early in the pandemic it was postulated that the high intensive care unit (ICU) mortality may have been due to too early intubatio...The controversy surrounding ventilation in coronavirus disease 2019 (COVID-19) continues. Early in the pandemic it was postulated that the high intensive care unit (ICU) mortality may have been due to too early intubation. As the pandemic progressed recommendations changed and the use of noninvasive respiratory support (NIRS) increased; however, this did not result in a clear reduction in ICU mortality. Furthermore, large studies on optimal ventilation in COVID-19 are lacking. This review article summarizes the pathophysiological basis, the current state of the science and the impact of different treatment modalities on the outcome. Potential factors that could undermine the benefits of noninvasive respiratory support are discussed. The authors attempt to provide guidance in answering the difficult question of when is the right time to intubate?
Anaesthesist
· 2022 May · PMID 35357555
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Acute decompensation in patients with liver cirrhosis is characterized by the development of ascites, gastrointestinal bleeding, hepatic encephalopathy, or bacterial infection and is often accompanied by further extrahep...Acute decompensation in patients with liver cirrhosis is characterized by the development of ascites, gastrointestinal bleeding, hepatic encephalopathy, or bacterial infection and is often accompanied by further extrahepatic organ dysfunction. Since critically ill patients with decompensated cirrhosis have a high mortality risk, rapid identification and treatment of the triggering event of decompensation (e.g., infection, hemorrhage, drugs) as well as specific measures for the treatment of concomitant extrahepatic organ dysfunctions are essential in order to improve the patient's prognosis and to prevent the development of acute-on-chronic liver failure (ACLF).
Porphyrias are a group of rare, mostly inherited metabolic disorders of heme biosynthesis. Each type of porphyria results from a specific deficiency of one of the pathway enzymes, causing a characteristic accumulation an...Porphyrias are a group of rare, mostly inherited metabolic disorders of heme biosynthesis. Each type of porphyria results from a specific deficiency of one of the pathway enzymes, causing a characteristic accumulation and excretion of heme precursors. Diagnosis is confirmed by the biochemical detection of these porphyrins and the precursors in urine, feces and blood. Porphyrias can be classified into acute and non-acute forms. The clinical presentation is unspecific and includes acute neurovisceral and/or cutaneous symptoms. The latent phase can evolve into a potentially life-threatening acute crisis, which is often misdiagnosed. The four acute hepatic porphyrias are relevant for anesthesiologists as precipitating factors are commonly found in the perioperative setting. Safe anesthetic management in cases of known porphyria is possible by adherence to current recommendations. The immediate administration of heme arginate as specific treatment for acute attacks is decisive for the outcome.
In 1989 the United Nations passed the "United Nations Convention on the Rights of the Child" (UNCRC) and, among others, demanded the highest attainable standard of health for children. Safe Anesthesia for Every Tot (SAFE...In 1989 the United Nations passed the "United Nations Convention on the Rights of the Child" (UNCRC) and, among others, demanded the highest attainable standard of health for children. Safe Anesthesia for Every Tot (SAFETOTS, www.safetots.org ), an association of internationally active pediatric anesthetists, has derived 10 rights, the 10 R's, which are of essential importance for the pediatric anesthetic practice. The first right (R1) postulates: "Children have the right to enjoy the highest possible standard of health. Children below the age of three years in particular should be treated by experienced anesthesiologists with profound and continuous training and regular activity in pediatric anesthesia. Children with significant comorbidities and those who need highly specialized or major interventions benefit from specialized pediatric anesthesia in pediatric centers". The current situation in pediatric anesthesia care in Germany, Austria and Switzerland does not always meet the requirements demanded by the UNCRC. Anesthesia-related complications are approximately 10 times more frequent in children than in adults. In contrast to adults, children who are injured during anesthesia are often healthy. Severe complications in pediatric anesthesia have a mortality that is several times higher than in adult anesthesia. There are hardly any statistics on this for German-speaking countries but corresponding cases frequently occur in the context of expert opinions in liability litigation and in the press. Anesthesiologists are often charged with the anesthetic care of newborns, infants and small children without having sufficient child-specific expertise, which results in morbidity and mortality. In some places, only a few babies per year undergo general anesthesia in clinics without a specialized pediatric anesthesia team or a small number of infant anesthesia cases are divided among a large number of anesthesiologists. These case numbers are not even sufficient to maintain a single pediatric anesthesiologist in training in this age group.Changes are needed to guarantee children the right to enjoy the highest attainable standard of health. We need decision-makers, politicians and professional representatives who rethink and who are willing to implement the UNCRC. This includes changing the current financing of hospitals in order that the quality actually provided is financed. The "pay for performance" must change to "pay for quality". In addition to broad basic pediatric care, all complex forms of pediatric treatment must be carried out in specialized pediatric centers, particularly for small and severely ill children.Significant improvement can be achieved at the local level by reorganization, bundling of pediatric surgical interventions within a clinical unit together with the concentration on a dedicated team.
Helmer P, Schlesinger T, Hottenrott S
… +13 more, Papsdorf M, Wöckel A, Sitter M, Skazel T, Wurmb T, Türkmeneli I, Härtel C, Hofer S, Alkatout I, Messroghli L, Girard T, Meybohm P, Kranke P
Anaesthesist
· 2022 Mar · PMID 35244736
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Postpartum hemorrhage (PPH) nowadays still represents a severe complication of both a vaginal delivery and a cesarean section. In German-speaking areas a new definition of the term has recently become established and the...Postpartum hemorrhage (PPH) nowadays still represents a severe complication of both a vaginal delivery and a cesarean section. In German-speaking areas a new definition of the term has recently become established and the nomenclature with respect to the severe form of PPH was dropped. The handling of misoprostol as a uterotonic during treatment of PPH is also new, which is available in Germany only as a medical direct import. For adequate diagnostics and targeted treatment interdisciplinary and standardized algorithms should be established and the specialist disciplines involved should be sensitized to this problem. In addition to an adequate hemostasis, a developing coagulopathy must be recognized at an early stage and treated with targeted coagulation management. Through implementation concepts, particularly the second pillar (minimization of blood loss) and the third pillar (rational use of blood transfusions) of patient blood management, various aspects for improvement of treatment of a PPH can be identified.
Helmer P, Schlesinger T, Hottenrott S
… +13 more, Papsdorf M, Wöckel A, Diessner J, Stumpner J, Sitter M, Skazel T, Wurmb T, Härtel C, Hofer S, Alkatout I, Girard T, Meybohm P, Kranke P
Anaesthesist
· 2022 Mar · PMID 35234987
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The implementation of patient blood management (PBM) is increasingly becoming standard in operative medicine. Recently, interest has also been shown for the vulnerable collective of pregnant women and neonates. As the in...The implementation of patient blood management (PBM) is increasingly becoming standard in operative medicine. Recently, interest has also been shown for the vulnerable collective of pregnant women and neonates. As the information regarding anesthesiological procedures for pregnant women and the peripartum period including an informed consent process should be carried out long before childbirth, this provides a good possibility in this connection to incorporate PBM. An anesthesiological risk estimation as well as the diagnostic workup and treatment of potential anemia should be carried out during the pregnancy. Furthermore, loss of blood in anticipation of bleeding complications should be reduced by interdisciplinary preventive measures and an individually coordinated postpartum care should be organized. This results in an early diagnosis of anemia or iron deficiency with subsequent treatment also postpartum, analogous to the prepartum period.
Anaesthesist
· 2022 May · PMID 35147751
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The current S2k guidelines on treatment of thermal injuries in adults are summarized in this article from the perspective of anesthesiology, emergency medicine and intensive care medicine. The guidelines were prepared un...The current S2k guidelines on treatment of thermal injuries in adults are summarized in this article from the perspective of anesthesiology, emergency medicine and intensive care medicine. The guidelines were prepared under the auspices of the German Society for Burn Medicine with the participation of other professional societies and interest groups and were published last year in revised form by the AWMF.
Anaesthesist
· 2022 Mar · PMID 35084510
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The revised and redefined "International Guidelines for Management of Sepsis and Septic Shock 2021" of the Surviving Sepsis Campaign were published on 4 October 2021. As in the previous version from 2016, the focus of th...The revised and redefined "International Guidelines for Management of Sepsis and Septic Shock 2021" of the Surviving Sepsis Campaign were published on 4 October 2021. As in the previous version from 2016, the focus of these international guidelines is on the diagnosis and acute treatment measures in sepsis. The topics long-term outcome and treatment targets for rehabilitation are extensively discussed and accompanied by specific recommendations. These recommendations and the underlying studies reflect the increasing awareness about the long-term consequences of severe diseases requiring intensive medical care. This article summarizes the updates in a clearly comprehensible form.
Anaesthesist
· 2022 Feb · PMID 35050390
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The current guidelines of the European Resuscitation Council recommend targeted temperature management to improve functional neurological outcome in comatose survivors after cardiac arrest. With the pathophysiological ba...The current guidelines of the European Resuscitation Council recommend targeted temperature management to improve functional neurological outcome in comatose survivors after cardiac arrest. With the pathophysiological background of hypothermia-induced neuroprotection for prevention of hypoxic-ischemic encephalopathy, targeted temperature management is a key measure and represents a central aspect in postresuscitation care.In the 2021 guidelines the application of targeted temperature management in postresuscitation care has been recommended for all rhythms and irrespective of the location of cardiac arrest. Targeted temperature management is advocated for adult patients who remain unresponsive following return of spontaneous circulation (ROSC) after either out-of-hospital cardiac arrest or in-hospital cardiac arrest. The body temperature should be maintained at a constant value between 32 °C and 36 °C for at least 24 h. To avoid rebound hyperthermia, fever following targeted temperature management, defined as a temperature above 37.7 °C, should be prevented and treated for at least 72 h after ROSC in persistently comatose patients. The routine use of prehospital cooling by rapid infusion of large volumes of cold i.v. fluid immediately after ROSC is not recommended.Based on a systematic review of the current literature, this article summarizes the results of randomized trials and new findings on targeted temperature management in comatose adult patients after cardiac arrest. The review has a particular focus on the most recent evidence regarding the optimum range of target temperatures. Furthermore, recent data on preclinical management, different patient populations, the duration of targeted temperature management, cooling methods and rebound hyperthermia are discussed.The impact of targeted temperature management on neurological outcome after cardiac arrest has been a matter of controversy. Despite contradictory results and heterogeneity of study designs, the current evidence supports the relevance and the necessity of strict temperature control in postresuscitation care for neuroprotection and improvement in functional neurological outcomes.
Michels G, Bauersachs J, Böttiger BW
… +8 more, Busch HJ, Dirks B, Frey N, Lott C, Rott N, Schöls W, Schulze PC, Thiele H
Anaesthesist
· 2022 Feb · PMID 34984492
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The European guidelines on cardiopulmonary resuscitation, which are divided into 12 chapters, have recently been published. In addition to the already known chapters, the topics "epidemiology" and "life-saving systems" h...The European guidelines on cardiopulmonary resuscitation, which are divided into 12 chapters, have recently been published. In addition to the already known chapters, the topics "epidemiology" and "life-saving systems" have been integrated for the first time. For each chapter five practical key statements were formulated. In the present article the revised recommendations on basic measures and advanced resuscitation measures in adults as well as on postresuscitation treatment are summarized and commented on.