Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS最新文献

Abstract: Postoperative delirium (POD) and perioperative neurocognitive disorders (PND) are among the most common and clinically relevant complications following surgical procedures. Older and vulnerable patients are particularly affected, with reported delirium incidences ranging from 20% to 50%, depending on patient risk profile, surgical procedure, and screening methodology. Beyond increased morbidity and mortality, postoperative neurocognitive complications are associated with functional decline, reduced quality of life, prolonged hospital stays, and substantial healthcare costs.The evidence base for the prevention, early detection, and management of perioperative neurocognitive disorders includes preoperative risk stratification, structured delirium screening, EEG-guided anesthesia, and multimodal perioperative care pathways. These measures are supported by contemporary international recommendations, including the European Society of Anaesthesiology and Intensive Care (ESAIC) guideline on postoperative delirium in adult patients. Despite the growing body of evidence, the successful implementation of these strategies into routine clinical practice remains challenging.This CME article summarizes the current evidence regarding the assessment, prevention, and follow-up of perioperative neurocognitive disorders and discusses the Safe Brain Initiative (SBI) together with its Patient-Centered Precision Care - (PC)² - framework as an example of a structured implementation strategy for evidence-based perioperative care. Three clinical case studies illustrate the practical application of guideline-based recommendations throughout the perioperative pathway. Statements supported by published evidence are clearly distinguished from working hypotheses and implementation concepts whose effectiveness remains the subject of ongoing scientific investigation.

Abstract: In current anaesthetic practice, monitoring remains largely focused on cardiorespiratory parameters, while the brain, the primary target organ of anaesthesia, is insufficiently monitored. EEG-based neuromonitoring enables direct, continuous, and non-invasive evaluation of the cerebral effects of anaesthetics, yet its clinical application is often limited to numerical indices derived from proprietary algorithms. This simplification of a complex biosignal is prone to artifacts, delays, and systematic bias, particularly in elderly and frail patients.We argue that index-guided anaesthesia alone may fail to detect clinically relevant states such as burst suppression, even when values remain within recommended ranges. Age-related EEG changes, including reduced alpha activity and increased susceptibility to suppression, can result in falsely reassuring index values despite excessive anaesthetic depth. Importantly, both the occurrence and duration of burst suppression are associated with postoperative delirium and adverse cognitive outcomes.Visual interpretation of raw EEG and spectral patterns provides essential additional information, enabling individualized anaesthetic titration and avoiding overdosage. However, implementation is limited by insufficient training. Structured educational concepts, such as the Safe Brain Initiative EEG Bootcamp, are therefore critical to meaningfully integrate EEG-based monitoring into routine practice and advancing precision, patient-centred neuroprotective anaesthesia.

Abstract: Interdisciplinary multimodal pain therapy (IMPT) is the gold standard for patients with refractory chronic pain. However, long-term treatment success varies considerably. While evidence for factors of success is scarce, this narrative review outlines key strategies to improve the long-term effectiveness of IMPT across all treatment phases, exemplified in a model patient with fibromyalgia. A comprehensive interdisciplinary assessment is essential to identify medical, psychological, functional, and social barriers to recovery while fostering patient engagement and shared decision-making. During therapy, patient education, individualized goal setting, and strengthening self-efficacy are crucial to promoting lasting behavioral change. In particular, early planning of discharge modalities may facilitate treatment adherence in an ambulatory setting. Discharge reports with concrete interdisciplinary recommendations enhance long-term success. Moreover, digital health applications and self-help groups may reinforce learned strategies and improve adherence. A structured booster session several months after IMPT is recommended to assess treatment success, review treatment goals, reinforce coping strategies, and strengthen motivation through peer support and interdisciplinary guidance. Overall, sustainable success after IMPT depends on careful patient assessment, continuous patient activation, individual approaches with concrete goals, seamless transition to outpatient care, and a structured long-term follow-up. These measures may improve patients' ability to manage chronic pain in everyday life.

Abstract: The 2025 European Resuscitation Council (ERC) guidelines introduce updated recommendations for adult Basic Life Support (BLS) and Advanced Life Support (ALS), with a strong focus on early recognition, high-quality cardiopulmonary resuscitation (CPR), timely defibrillation, and physiologically guided resuscitation. This article summarizes the most relevant changes and practical implications for healthcare professionals and bystander.

Abstract: Persistent postoperative opioid use (PPOU) has become an important quality indicator in perioperative medicine. While the North American opioid crisis has raised global awareness, data from Germany and other European countries have been limited. Recent population-based and clinical studies now provide robust evidence that PPOU is overall uncommon in Germany, with an incidence of approximately 1-1.4% among previously opioid-naïve patients. However, substantial variation exists between surgical procedures. Major amputations, spine surgery and revision arthroplasty show markedly elevated risks, indicating that the type of surgery is the strongest predictor of PPOU, exceeding the influence of patient-related factors. Psychiatric comorbidities, chronic pain, and especially preoperative opioid therapy significantly increase vulnerability. Perioperative processes also modulate risk: opioid administration on first postoperative day in patients with low pain intensity is associated with a higher likelihood of PPOU, whereas adequate opioid use in patients with severe pain does not increase this risk. High-quality multimodal analgesia, early integration of regional anesthesia, structured acute pain services and clear discharge recommendations are essential to prevent unnecessary long-term opioid use. These findings highlight the multifactorial nature of PPOU and underscore the importance of individualized, guideline-conform perioperative pain management. Targeted risk assessment, optimized perioperative pathways and coordinated follow-up care are key strategies to minimize persistent opioid use and improve postoperative outcomes.

Abstract: Healthcare-associated infections (HAIs) remain among the most frequent and preventable complications in intensive care units (ICUs), contributing substantially to morbidity, mortality, prolonged length of stay, and healthcare costs. This review summarizes current evidence-based strategies for infection prevention in critical care settings, focusing on key domains including hand hygiene, prevention of ventilator-associated pneumonia (VAP), central line-associated bloodstream infections (CLABSI), and catheter-associated urinary tract infections (CAUTI).ICUs represent a high-risk environment due to the frequent use of invasive devices, high patient acuity, and complex care processes. Device-associated infections account for a large proportion of HAIs, with incidence rates remaining significant despite advances in care. Hand hygiene remains the single most effective preventive measure, yet compliance is often suboptimal, particularly in high-intensity settings. The appropriate use of gloves as an adjunct, not a substitute, for hand hygiene is critical.Multimodal prevention strategies, particularly structured care bundles, have demonstrated significant reductions in infection rates when consistently implemented. Key interventions include elevation of the head of the bed, daily sedation interruption, early mobilization, aseptic catheter insertion techniques, and strict adherence to maintenance protocols. Daily reassessment of device necessity is among the most effective measures to reduce infection risk.Antimicrobial stewardship and targeted microbiological diagnostics are integral components of infection prevention, reducing unnecessary antibiotic exposure and limiting the emergence of multidrug-resistant organisms. Additionally, digital tools such as automated surveillance systems and predictive analytics offer emerging opportunities to enhance early detection, monitoring, and individualized prevention strategies.Sustainable infection prevention requires a multidisciplinary approach, combining structured protocols, regular staff training, continuous feedback, and strong leadership support. Ultimately, consistent implementation of evidence-based measures can significantly improve patient safety and reduce the burden of HAIs in intensive care.