Gaisendrees C, Walter S, Sabashnikov A
… +2 more, Adler C, Wahlers T
Anaesthesist
· 2022 May · PMID 34694422
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BACKGROUND: Out-of-hospital cardiac arrest (OHCA) affects ca. 75,000 people each year in Germany and is associated with a limited prognosis and a high mortality. Extracorporeal cardiopulmonary resuscitation (eCPR) using...BACKGROUND: Out-of-hospital cardiac arrest (OHCA) affects ca. 75,000 people each year in Germany and is associated with a limited prognosis and a high mortality. Extracorporeal cardiopulmonary resuscitation (eCPR) using arteriovenous extracorporeal membrane oxygenation (av-ECMO) systems is an additional option for treatment, which is increasingly more widespread and since 2020 anchored in the guideline algorithm. METHODS: A selective search of the literature was carried out in PubMed and Embase focusing on studies that investigated eCPR for OHCA. Furthermore, clinical studies on this topic that are currently recruiting and running are summarized. RESULTS: The available data on the benefits of eCPR for OHCA are mostly based on retrospective cohort studies. A survival advantage and an advantage in the neurological outcome could be derived from these data for selected patients treated with eCPR vs. conventionally resuscitated patients (CPR). This effect could be confirmed by two current randomized controlled studies. Studies which are currently running are investigating if out-of-hospital ECMO cannulation at the earliest time possible at the site of OHCA of patients could be associated with a better survival. CONCLUSION: Despite a current scarcity of data, a survival advantage for eCPR treatment in selected OHCA patients must be assumed. If this can be substantiated by other high-quality studies, it seems to be indicated to evaluate if and to what extent resource-intensive eCPR programs can be comprehensively established.
Anaesthesist
· 2021 Dec · PMID 34676422
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Neuropathic pain is pain caused by a lesion or disease of the somatosensory nervous system. Scientific studies have shown that neuropathic pain is the result of complex altered signalling processes in the peripheral and...Neuropathic pain is pain caused by a lesion or disease of the somatosensory nervous system. Scientific studies have shown that neuropathic pain is the result of complex altered signalling processes in the peripheral and central nervous system. Current forms of treatment of neuropathic pain are causally oriented but also aim at symptomatic analgesia by pharmacological and nonpharmacological methods. Furthermore, psychological pain management techniques are used in a supportive role. This review summarizes the contemporary diagnostics of neuropathic pain using frequent diseases as examples and presents the evidence from randomized controlled trials on the treatment of neuropathic pain. Treatment guidelines for pharmacological management of neuropathic pain include evidence-based use of antidepressants, anticonvulsants, opioids, capsaicin and lidocaine.
Boeken U, Ensminger S, Assmann A
… +41 more, Schmid C, Werdan K, Michels G, Miera O, Schmidt F, Klotz S, Starck C, Pilarczyk K, Rastan A, Burckhardt M, Nothacker M, Muellenbach R, Zausig Y, Haake N, Groesdonk H, Ferrari M, Buerke M, Hennersdorf M, Rosenberg M, Schaible T, Köditz H, Kluge S, Janssens U, Lubnow M, Flemmer A, Herber-Jonat S, Wessel L, Buchwald D, Maier S, Krüger L, Fründ A, Jaksties R, Fischer S, Wiebe K, Hartog C, Dzemali O, Zimpfer D, Ruttmann-Ulmer E, Schlensak C, Kelm M, Beckmann A
Anaesthesist
· 2021 Nov · PMID 34665266
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In Germany, a remarkable increase regarding the usage of extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) systems has been observed in recent years with approximately 3000 ECLS/ECMO impla...In Germany, a remarkable increase regarding the usage of extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) systems has been observed in recent years with approximately 3000 ECLS/ECMO implantations annually since 2015. Despite the widespread use of ECLS/ECMO, evidence-based recommendations or guidelines are still lacking regarding indications, contraindications, limitations and management of ECMO/ECLS patients. Therefore in 2015, the German Society of Thoracic and Cardiovascular Surgery (GSTCVS) registered the multidisciplinary S3 guideline "Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure" to develop evidence-based recommendations for ECMO/ECLS systems according to the requirements of the Association of the Scientific Medical Societies in Germany (AWMF). Although the clinical application of ECMO/ECLS represents the main focus, the presented guideline also addresses structural and economic issues. Experts from 17 German, Austrian and Swiss scientific societies and a patients' organization, guided by the GSTCVS, completed the project in February 2021. In this report, we present a summary of the methodological concept and tables displaying the recommendations for each chapter of the guideline.
Trimmel H, Egger A, Doppler R
… +3 more, Beywinkler C, Voelckel WG, Kreutziger J
Anaesthesist
· 2022 Mar · PMID 34664081
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Treatment of acute pain is a central task in emergency medicine. Yet, prehospital pain relief is often insufficient or delayed since the administration of potent intravenous analgesic drugs (such as opioids) is mostly li...Treatment of acute pain is a central task in emergency medicine. Yet, prehospital pain relief is often insufficient or delayed since the administration of potent intravenous analgesic drugs (such as opioids) is mostly limited to physicians due to legal restrictions or training deficiencies in Germany and Austria. Frequently, prehospitally operating emergency physicians have to be demanded later for anguished patients limiting disposability of physicians for patients who are in a potentially life-threatening condition. Thus, inhaled analgesics could represent an interesting alternative.A mixture of 50% nitrous oxide and 50% oxygen (NO, Livopan®) has been available in Germany and Austria for several years; however, prehospital use of Livopan has been merely realized and only one trial has been published. In addition, methoxyflurane (Penthrop®), a volatile anesthetic from the group of the dialkyl esters (2-dichloro-1:1-difluoroethyl-methyl-ester) was approved for the treatment of moderate to severe pain following trauma in adults in many European countries in recent years and was brought onto the market in Austria in 2018. Several in-hospital trials demonstrated high effectiveness in this setting.This article discusses the effects and prehospital areas of application of both substances in the light of the existing literature. We provide a narrative overview of the current study situation and report on a recently performed prehospital application study of methoxyflurane (Penthrop®) from Austria.The need for pressurized gas cylinders for the use of NO represents a certain limitation in prehospital use. Furthermore, in certain injuries such as of the inner ear or a pneumothorax NO should not be used and the risk of diffusion hypoxemia has to be addressed. Users should be particularly careful and limit the use in alcohol addicts and vegans. The advances of NO are that it is odorless, has a fast onset of action, the usability in patients over 1 month old and has stabilizing effects on the circulation. Plenty of literature regarding prehospital as well as in-hospital use of nitrous oxide in emergency, obstetric and pediatric settings show its effectiveness as a single drug as well as in combination with other analgesics, such as paracetamol or various opioids. Its long tradition in Anglo-American countries is also based on its safety and low rate of side effects.Methoxyflurane is easier to store and handle and may be slightly more effective in severe pain after trauma; however, its approval is restricted to adults, where it works significantly better with increasing age, based on the declining minimal alveolar concentration (MAC) of all inhaled anesthetics with increasing age. Furthermore, decades of use of inhaled methoxyflurane in Australia have shown the drug is effective, safe and low in side effects and has a broad spectrum of applications. The use of methoxyflurane is limited in patients with severe hepatic or renal insufficiency and the characteristic odor has been described as unpleasant by some patients. In Europe, three large in-hospital trials showed strong pain relief in trauma patients, even comparable to opioids.Overall, based on the current evidence, the use of nitrous oxide and even more of methoxyflurane may be recommended also for prehospital use by skilled paramedics.
Vrsajkov V, Ilić N, Uvelin A
… +3 more, Ilić R, Lukić-Šarkanović M, Plećaš-Đurić A
Anaesthesist
· 2021 Dec · PMID 34661682
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PURPOSE: After laparoscopic cholecystectomy patients have moderate pain in the early postoperative period. According to several studies an erector spinae plane (ESP) block can be a valuable part of multimodal analgesia....PURPOSE: After laparoscopic cholecystectomy patients have moderate pain in the early postoperative period. According to several studies an erector spinae plane (ESP) block can be a valuable part of multimodal analgesia. Our intention was to evaluate how ESP block influences postoperative pain scores and opioid consumption after laparoscopic cholecystectomy. METHODS: This single-blinded, prospective, randomized study included 60 patients undergoing laparoscopic cholecystectomy to receive either bilateral ESP block at the Th 7 level (n = 30) with 20 ml of 0.25% levobupivacaine plus dexamethasone 2 mg per side, or standard multimodal analgesia (n = 30). Patients from the standard multimodal analgesia group received tramadol 100 mg at the end of the procedure. Postoperative analgesia for both groups was acetaminophen 1 g/8 h i.v. and ketorolac 30 mg/8 h. Tramadol 1 mg/kg was a rescue treatment for pain breakthrough (numeric rating scale/NRS ≥ 6) in both groups. Pain at rest was recorded at 10 min, 30 min, 2 h, 4 h, 8 h, 12 h and 24 h after surgery using NRS (0-10). RESULTS: An ESP block significantly reduced postoperative pain scores compared to standard multimodal analgesia after 10 min (p = 0.011), 30 min (p = 0.004), 2 h (p = 0.011), 4 h (p = 0.003), 8 h (p = 0.013), 12 h (p = 0.004) and 24 h (p = 0.005). Tramadol consumption was significantly lower in the ESP group 25.02 ± 56.8g than in the standard analgesia group 208.3 ± 88.1g (p < 0.001). CONCLUSION: An ESP block can provide superior postoperative analgesia and reduction in opioid requirement after laparoscopic cholecystectomy.
A young patient experienced a generalized seizure during the placement of an axillary plexus block. The mechanisms, essentially the presumed intravascular administration, which led to the local anesthetic toxicity as the...A young patient experienced a generalized seizure during the placement of an axillary plexus block. The mechanisms, essentially the presumed intravascular administration, which led to the local anesthetic toxicity as the cause of this event, are discussed. This case is an example of how visualization of the anatomy by ultrasound can give a false impression when certain details are not respected. It is assumed that the main mechanism in this case was venous compression by the ultrasound transducer.
Troppmair T, Egger J, Krösbacher A
… +4 more, Zanvettor A, Schinnerl A, Neumayr A, Baubin M
Anaesthesist
· 2022 Apr · PMID 34643756
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BACKGROUND: Human and vehicle resource management indicates a good emergency medical system (EMS). Frequently, an emergency medical technician (EMT) is the first responder to the emergency, which negates the necessity fo...BACKGROUND: Human and vehicle resource management indicates a good emergency medical system (EMS). Frequently, an emergency medical technician (EMT) is the first responder to the emergency, which negates the necessity for an emergency physician (EP) and is just as sensible as handing over a stable patient to the EMT for transport to the hospital. The Austrian EMS is utilized by EMTs, in cases of potential life-threatening emergencies the dispatch center dispatches an additional team with an on-board EP. During the years 2017-2018 nearly every fifth EP mission in Innsbruck (including surrounding areas) ended in a cancellation. The numbers of patient handovers from EP to EMT are slightly lower with mission cancellations resulting in every fourth patient. Therefore, due to the high number of cancellations and handovers evaluated in this study, the findings suggest that there is a potential need to re-evaluate procedures. The re-evaluation of these procedures could determine whether these cancellations/handovers were justified or if an over hasty decision making was at fault. All cases considered in this study were from the Innsbruck and Telfs EP bases between 1 January 2017 and 13 December 2018. METHODS: Out of a total of 96,908 emergency dispatches, there were 2470 cancellation/handover occurrences. These occurrences consisted of 1190 cancellations and 1280 patient handovers from the EP to the EMT. Patients who were transferred to the University Hospital Innsbruck were included in these figures. The protocols of the emergency dispatches have been filtered from the so-called CarPC. They have subsequently been grouped into cancellation and handover categories. The clinical diagnoses of the patients with inpatient treatment were evaluated from the hospital information system (KIS) of the University Hospital Innsbruck. This was done with the help of the so-called emergency physician indications catalogue of the German Medical Council. The diagnosis was documented in the hospital information system. The emergency protocols from the EMTs were also evaluated retrospectively. The Innsbruck based EP patients are hospitalized in the Innsbruck Hospital due their geographical position. When there is no need for a specific intervention the patients of the EPs based in Telfs are transferred to a local hospital. When a specific intervention is necessary, patient care must be provided by the University Hospital Innsbruck. Due to the privacy practices of the Innsbruck Medical University "vote of ethics" only the data of patients transferred to the Innsbruck Clinic can be evaluated. The information provided from the EPs based in Innsbruck was exclusively from the University Hospital Innsbruck's anesthesiologists. The physicians from the Telfs EP base are of mixed medical specialities. All of them, however, have an emergency medical physician diploma, in addition to the ius practicandi. Lastly, there are no EPs in Innsbruck or Telfs, who have any special obligations during their duty. RESULTS: The results show that in 210 cases (8.5%) the indications for the EP, based on the emergency physician indications catalogue of the German Medical Council were given. Also, 8.7% of all cancellations and 8.4% of patient handovers were not justified. Patients with emergency indications had a longer hospitalization. The EP base EMS Innsbruck had more cancellations than the EP base EMS Telfs. The EMS Innsbruck also had more cancellations than patient handovers. Conversely, the EMS Telfs had more patient handovers than cancellations. On the weekends between 6:00 pm and 6:00 am there were less cancellations and handovers from both EP bases. The documentation from the EMT protocols was incomplete in 284 cancellations (23.9% of the cancellations) and 339 handovers (26.5% of the handovers), 35 patients after cancellations (2.9%), 35 patients after handovers (2.7%) needed intensive care treatment, 20 patients after cancellations (1.7% of all cancellations), and 24 patients after handovers (1.9% of all handovers) who needed intensive care treatment had a critical diagnosis. In 40 cases of patient handovers, the EP was alerted to another emergency follow-up within 10 min. CONCLUSION: In Austria, the introduction of a standardized emergency indication checklist might help dispatch centers to provide a more accurate dispatch as well as all EMS team members. Furthermore, a better traceability system (according to EP cancellations and patient handovers from the EP to the EMT) could be achieved. The documentation requirements should be more precise by all members of the EMT staff, not only for the legal aspects but also for improving the overall management quality. Intense education and training as well as diagnosis feedbacks could help to reduce the number of risky cancellations/patient handovers.
Erlenwein J, Maring M, Emons MI
… +4 more, Gerbershagen HJ, Waeschle RM, Saager L, Petzke F
Anaesthesist
· 2022 May · PMID 34613456
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BACKGROUND: Areas of activity with many intersections pose an increased risk for errors and critical incidents. Therefore, procedures for acute pain therapy are potentially associated with an increased risk for adverse p...BACKGROUND: Areas of activity with many intersections pose an increased risk for errors and critical incidents. Therefore, procedures for acute pain therapy are potentially associated with an increased risk for adverse patient outcomes. OBJECTIVE: The aim was to identify and grade the risk of critical incidents in the context of acute pain management. MATERIAL AND METHODS: The register of the nationwide reporting system critical incident reporting system of the Professional Association of German Anesthesiologists, the German Society for Anesthesiology and Intensive Care Medicine and the Medical Center for Quality in Medicine (CIRSmedical Anesthesiology) was screened for incidents concerning pain management. Out of 5365 cases reported nationwide up to 24 March 2020, 508 reports with the selection criterion "pain" could be identified and reviewed and 281 reports (55%) were included in a systematic analysis. RESULTS: Of the 281 reports most came from anesthesiology departments (94%; 3% from surgery departments and 3% from other departments). The reported cases occurred most frequently on normal wards but a relevant proportion of the reports concerned intermediate and intensive care units or areas covered by a pain service (PS). Based on the description of the incident in the report, an involvement of the PS could be assumed for 42% of the cases. In terms of time, most of the events could be assigned to normal working hours (90%) and working days (84%; weekends 16%). The analyzed reports related to parenteral administration of analgesics (40%) and central (40%) or peripheral regional anesthesia procedures (23%) and 13% of the reports related to patient-controlled intravenous analgesia (PCIA; multiple answers possible). Most of the events were caused by technical errors, communication deficits and deviations from routine protocols. A relevant number of the cases were based on mix-ups in the administration route, the dosage, or the active agent. About one third of the sources of error were of an organizational nature, 59% of the cases posed a possible vital risk and in 16% of cases patients had vital complications. The risk grading by risk matrix resulted in an extremely high risk in 7%, a high risk in 62%, a moderate risk in 25% and a low risk in 6% of the cases. Comparing risk assessment of events with involvement of different analgesic methods, multiple medication, combination of analgesic methods or involvement of PS showed no significant differences. Likewise, no differences could be identified between the risk assessments of events at different superordinate cause levels. If more than one overriding cause of error had an impact, initially no higher risk profile was found. CONCLUSION: Incidents in the context of acute pain management can pose high risks for patients. Incidents or near-incidents are mostly related to mistakes and lack of skills of the staff, often due to time pressure and workload as well as to inadequate organization.
Anaesthesist
· 2022 Mar · PMID 34608518
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We present the case of a 46-year-old male who developed refractory bradycardia with cardiogenic shock after attempting suicide by ingestion of yew leaves. Due to delayed availability of the Digoxin immune fab, a va-ECMO...We present the case of a 46-year-old male who developed refractory bradycardia with cardiogenic shock after attempting suicide by ingestion of yew leaves. Due to delayed availability of the Digoxin immune fab, a va-ECMO was established to maintain sufficient circulation. Administration of the digoxin fab resulted in recovery of spontaneous circulation. Continuous venovenous hemodiafiltration with hemoadsorption and albumin dialysis were initiated with the intention to remove immune fab-toxin complexes and as organ support in acute kidney and liver failure. Within 5 days the patient was successfully weaned from ECMO, liver support and renal replacement and discharged without physical sequelae.
Kienbaum P, Schaefer MS, Weibel S
… +4 more, Schlesinger T, Meybohm P, Eberhart LH, Kranke P
Anaesthesist
· 2022 Feb · PMID 34596699
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The prophylaxis and treatment of postoperative pain to enhance patient comfort has been a primary goal of anesthesiologists for the last decades; however, avoiding postoperative nausea and vomiting (PONV) is, from a pati...The prophylaxis and treatment of postoperative pain to enhance patient comfort has been a primary goal of anesthesiologists for the last decades; however, avoiding postoperative nausea and vomiting (PONV) is, from a patient's perspective, a highly relevant and equally important goal of anesthesia. Recent consensus-based guidelines suggest the assessment of risk factors including female gender, postoperative opioid administration, non-smoking status, a history of PONV or motion sickness, young patient age, longer duration of anesthesia, volatile anesthetics and the type of surgery and reducing the patient's baseline risk (e.g. through the use of regional anesthesia and administration of non-opioid analgesics as part of a multimodal approach). In general, a liberal PONV prophylaxis is encouraged for adult patients and children, which should also be administered when no risk assessment is made. The basis for every adult patient should be a standard prophylaxis with two antiemetics, such as dexamethasone in combination with a 5-HT receptor antagonist. In patients at high risk, this should be supplemented by a third and potentially a fourth antiemetic prophylaxis with a different mechanism of action. A recently published comprehensive Cochrane meta-analysis comparing available antiemetic prophylaxes reported the highest effectiveness to prevent PONV for the NK receptor antagonist aprepitant (relative risk, RR 0.26), followed by ramosetron (RR 0.44), granisetron (RR 0.45), dexamethasone (RR 0.51) and ondansetron (RR 0.55), thereby revising the dogma that every antiemetic is equally effective. Adverse events of antiemetics were generally rare and reported in less than half of the included studies, yielding a low quality of evidence for these end points. In general, combinations of different antiemetics were more effective than single prophylaxes. In children above 3 years of age, the same principles should be applied as in adults. For these patients, there is a high degree of evidence for the combination of dexamethasone and 5‑HT receptor antagonists. When PONV occurs, the consensus guidelines suggest that antiemetics from a class different than given as prophylaxis should be administered. To decrease the incidence of PONV and increase the quality of care, the importance of the implementation of institutional-level guidelines and protocols as well as assessment of PONV prophylaxis and PONV incidence is highly recommended.
Anaesthesist
· 2021 Oct · PMID 34570250
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The first public demonstration of ether anesthesia took place 175 years ago. Since that time, insensitivity to pain during surgical operations has been possible. The "Ether Day" has been portrayed in many ways. News of t...The first public demonstration of ether anesthesia took place 175 years ago. Since that time, insensitivity to pain during surgical operations has been possible. The "Ether Day" has been portrayed in many ways. News of the event soon reached Europe and the rest of the world. The development of suitable apparatuses and anesthetics pathed the way for acceptance of the new method. Since the end of the nineteenth century, quality management has become more and more important. In the first half of the twentieth century the use of anesthetic apparatuses prevailed. In Germany, the medical discipline of anesthesiology was established only after 1945. This happened with support from Anglo-American countries. Further methods, such as intubation and muscle relaxation were introduced. The development of atraumatic cannulas made of plastic greatly facilitated the application of drugs. Consideration of workplace safety as a problem was a long time coming. The first concepts were not developed until the late 1970s. By the 1980s the essential elements of modern anesthesia had finally been implemented. In the beginning of the twenty-first century, the focus was initially on procedures that saved allogeneic blood. New topics emerged, ranging from the effects of anesthesia on tumors up to climate change. Anesthesiology must continue to face new challenges in the future.
Seeber C, Popp M, Meerpohl JJ
… +9 more, Fichtner F, Werner A, Schmaderer C, Holzmann-Littig C, Dickel S, Grimm C, Moerer O, Kranke P, AP6 CEOsys
Anaesthesist
· 2022 Apr · PMID 34546394
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BACKGROUND: In the context of COVID-19, the German CEOsys project (COVID-19 Evidenz Ökosystem, www.covid-evidenz.de ) identifies, evaluates and summarizes the results of scientific studies to obtain evidence on this dise...BACKGROUND: In the context of COVID-19, the German CEOsys project (COVID-19 Evidenz Ökosystem, www.covid-evidenz.de ) identifies, evaluates and summarizes the results of scientific studies to obtain evidence on this disease. The evidence syntheses are used to derive specific recommendations for clinical practice and to contribute to national guidelines. Besides the necessity of conducting good quality evidence syntheses during a pandemic, just as important is that the dissemination of evidence needs to be quick and efficient, especially in a health crisis. The CEOsys project has set itself this challenge. OBJECTIVE: Preparing the most suitable distribution of evidence syntheses as part of the CEOsys project tasks. METHODS: Intensive care unit (ICU) personnel in Germany were surveyed via categorical and free text questions. The survey focused on the following topics: evidence syntheses, channels and strategies of distribution, possibility of feedback, structure and barriers of dissemination and trustworthiness of various organizations. Profession, qualification, setting and size of the facility were recorded. Questionnaires were pretested throughout the queried professions (physician, nurse, others). The survey was anonymously carried out online through SosciSurvey® and an e‑mail was sent directly to 940 addresses. The survey was launched on 3 December, a reminder was sent after 14 days and it ended on 31 December. The survey was also announced via e‑mail through DIVI. RESULTS: Of 317 respondents 200 completed the questionnaire. All information was analyzed including the responses from incomplete questionnaires. The most stated barriers were lack of time and access. Especially residents and nurses without specialization in intensive care mentioned uncertainty or insufficient experience in dealing with evidence syntheses as a barrier. Active distribution of evidence syntheses was clearly preferred. More than half of the participants chose websites of public institutions, medical journals, professional societies and e‑mail newsletters for drawing attention to new evidence syntheses. Short versions, algorithms and webinars were the most preferred strategies for dissemination. Trust in organizations supplying information on the COVID-19 pandemic was given to professional societies and the Robert Koch Institute (RKI) as the German governmental institute for infections and public health. The respondents' prioritized topics are long-term consequences of the disease, protection of medical personnel against infection and possibilities of ventilation treatment. CONCLUSION: Even though universally valid, evidence syntheses should be actively brought to the target audience, especially during a health crisis such as the COVID-19 pandemic with its exceptional challenges including lack of time and uncertainties in patient care. The contents should be clear, short (short versions, algorithms) and with free access. E‑mail newsletters, websites or medical journals should continuously report on new evidence syntheses. Professional societies and the governmental institute for infections and public health should be involved in dissemination due to their obvious trustworthiness.
Anaesthesist
· 2021 Oct · PMID 34529093
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The Ether Day, a key moment in the history of mankind, commemorates its 175th anniversary on 16 October 2021. On that day the dentist William T. G. Morton successfully gave the first public ether anesthesia in Boston. Fr...The Ether Day, a key moment in the history of mankind, commemorates its 175th anniversary on 16 October 2021. On that day the dentist William T. G. Morton successfully gave the first public ether anesthesia in Boston. From then on it was possible to save people from pain with justifiable risk and at the same time to protect them from psychological damage by inducing unconsciousness. The German philosopher Peter Sloterdijk, one of the most renowned and effective philosophers of our times, deduced that from then on humans, to some extent, had a right to unconsciousness when in psychophysical distress. This postulate unfolded from his concept of "anthropotechnics" developed around 1997, meaning the idea of treating human nature as an object of possible improvements. According to Sloterdijk, in favorable cases a synthesis of man and technology can result in a significant improvement of human capabilities in the sense of "enhancement", i.e. an increase, an improvement or even an expansion of intellectual, physical or psychological possibilities, as it were in a transgression of the human (so-called transhumanism). Man should go into vertical tension, i.e. strive for higher aims and exploit his inherent potential, he should not dwell in the horizontal. This is not meant as an appeal but as an imperative: "You must change your life!". In this context modern anesthesia may prove helpful: be operated on by others in order to undergo an enhancement. Or, in its most extreme form, the operation in the "auto-operational curved space", a person can even operate on himself as has been dramatically demonstrated by Rogozov, a young Russian physician and trainee surgeon who successfully performed a self-appendectomy under local anesthesia at the Novolazarevskaya Antarctic Station in 1961; however, the implementation of this idea is a long way off. On the one hand, many countries lack qualified personnel in sufficiently large numbers to perform even vital operations with patients under anesthesia. On the other hand, over the decades it has become clear that anesthesia is obviously beneficial for mankind in that it offers relief from pain and psychological stress but that it can also often show its dark side: substance abuse, use of anesthetics in torture and in executions. In addition, the role of anesthetics in resuscitation, palliative care, and allaying executions is unclear or controversial. Finally, the necessary formal legal steps to acknowledge a "human right to unconsciousness" have not yet been implemented.
Anaesthesist
· 2021 Oct · PMID 34495345
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In developed countries, peripartum hemorrhage, thromboembolic events and hypertensive pregnancy disorders are the most frequent complications in pregnancy. They pose a significant challenge for the interdisciplinary team...In developed countries, peripartum hemorrhage, thromboembolic events and hypertensive pregnancy disorders are the most frequent complications in pregnancy. They pose a significant challenge for the interdisciplinary team of gynecology and anesthesiology. Untreated, these pregnancy-related complications result in a fulminant course. Close consultation between the specialist departments and knowledge of the area of responsibility are essential. In the case of acute bleeding the anesthesiologist is responsible for maintaining adequate circulatory conditions and management of hemostasis. Thromboembolic events require immediate anticoagulation and focused diagnostics. Thereby, both the fetal and the maternal risks must be weighed up. The hypertensive diseases in pregnancy have a very high risk of complications. In addition to symptomatic treatment in the intensive care unit, the optimal time of delivery must be determined by an interdisciplinary consensus. This is the only causal treatment option possible.