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

The single administration of 8 mg dexamethasone during surgery reduces postoperative nausea, pain and hospitalisation without increasing the risk of wound healing disorders. This application is also safe for patients with well-controlled diabetes mellitus and, although it leads to a slight increase in blood sugar, this usually remains clinically insignificant.

Phantom pain (PP) is a neuropathic pain syndrome that occurs after limb amputation and is perceived in the absent body part. Its exact pathophysiology remains unclear but involves peripheral nerve lesions, central sensitization, and cortical reorganization. Psychological and social factors also play a significant role in its manifestation. Phantom pain after amputation shows wide variability, affecting up to 82% of patients within the first postoperative year, with lifetime prevalence exceeding 80%, and higher rates observed after proximal or major amputations (e.g., transfemoral). Symptoms are typically described as intermittent, burning, or electric-like pain, often accompanied by non-painful phantom sensations. Diagnosis requires thorough neurological evaluation, detailed pain documentation, and the exclusion of differential diagnoses. Preventive strategies include perioperative nerve blocks and adequate surgical soft tissue coverage. Effective treatment is based on a multimodal approach. Pharmacological options such as morphine and pregabalin have shown efficacy, while others like tramadol or gabapentin appear less effective. Non-pharmacological methods - including mirror therapy and transcutaneous electrical nerve stimulation (TENS) - can support pain relief. Psychological interventions, particularly trauma-focused therapy, may be beneficial, especially in patients with post-traumatic stress symptoms. For optimal management, an individualized treatment plan combining pharmacological, physical, and psychological strategies is recommended.

Hospitals play a major role in civil protection. Maintaining medical care in the event of major emergencies, disasters, crises and wars is an essential component in coping with such situations and forms an important pillar for increasing the resilience of a society. In order to meet these requirements, hospitals must not only be designated as critical infrastructure, they must also be treated and equipped as such in order to form the basis for a robust healthcare system. In addition to the essential organizational measures to increase the safety of hospitals, structural and non-structural components must be incorporated into the planning of hospitals. Just as fire protection and hygiene do not need to be discussed when planning new hospitals, this should also be required for all aspects of safety listed in this article.

Meralgia paraesthetica (MP) is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN), typically caused by compression at the level of the inguinal ligament. The syndrome presents with burning pain, paraesthesia, and hypaesthesia in the anterolateral thigh, without motor deficits. The LFCN, derived from the L2-L3 spinal nerves, is vulnerable to compression or traction due to its anatomical course under the inguinal ligament. MP may result from both traumatic (e.g., surgery, injury) and non-traumatic causes (e.g., obesity, pregnancy, tight clothing). In some cases, the etiology remains unknown. Diagnosis is primarily clinical and based on patient history and physical examination. Imaging techniques and electroneurography can support diagnostic confirmation in unclear cases. If symptoms extend beyond the typical LFCN territory, are bilateral, or are accompanied by motor or reflex abnormalities, differential diagnoses - including radiculopathy, involvement of adjacent nerves, or anatomical variations of the LFCN - should be considered. Initial treatment is conservative and includes patient education, avoidance of precipitating factors, pharmacological pain management (NSAIDs, opioids, co-analgesics), and physiotherapy. Diagnostic and therapeutic nerve blocks using local anesthetics can provide symptom relief and aid diagnosis. Non-invasive adjunct therapies such as transcutaneous electrical nerve stimulation (TENS), Botulinum toxin A injections, acupuncture, and kinesio taping may offer additional pain relief in selected patients. In refractory cases, minimally invasive procedures including radiofrequency therapy or surgical decompression of the LFCN may be considered.

A difficult airway, whether expected or unexpected, represents a rare but challenging situation for anaesthesiologists in clinical practice. Knowledge of predictors of a difficult airway, technical characteristics of individual airway techniques, algorithms, and final documentation are essential for every anaesthesiologist. This article discusses definitions, perioperative risk assessment, and approaches to managing expected and unexpected difficult airways.

On May 4, 2024, the 23rd Obstetric Anesthesia Symposium took place as an event of the scientific working group "Obstetric Anesthesia" of the German Society of Anesthesiology (DGAI). As in previous years, topics related to obstetric anesthesiological practice were presented by experienced speakers and intensively discussed with the participants. Among other things, personal "recipes" and recommendations for daily practice, various options for analgesia in the delivery room, patient blood management in the delivery room, alternatives to obstetric epidurals, management of post-puncture headaches, and analgesia after cesarean section were addressed.

One-lung ventilation (OLV) is a crucial technique in thoracic surgery, enabling effective lung isolation for procedures such as lung resections, lung-transplant, and the management of unilateral pulmonary diseases. The development of double-lumen tubes (DLTs) in 1949 by Carlens revolutionized lung separation, providing controlled ventilation of one lung while the other is deflated. Frank Robertshaw's modifications in 1962 improved safety and usability, making DLTs the gold standard for OLV. Modern DLTs, available as left- and right-sided DLTs, vary in size and material, allowing individual selection based on patient anatomy and procedure. Correct placement, verified via bronchoscopy, ensures optimal ventilation and minimizes complications like hypoxemia or airway trauma. Recent advancements include video-assisted DLTs (e.g., VivaSight), integrating real-time imaging to simplify placement and reduce the need for additional bronchoscopy.Bronchial blockers (BBs) offer an alternative to DLTs, particularly for patients with difficult airways or pediatric patients. However, BBs require advanced expertise and may dislocate more frequently than DLTs.Effective management of intraoperative hypoxemia during OLV includes recruitment maneuvers, PEEP, CPAP, or in severe cases, extracorporeal membrane oxygenation (ECMO). A comprehensive understanding of airway anatomy, device options, and ventilation strategies is crucial to the safe and effective application of OLV.

Airway management is a fundamental skill for anesthesiologists, particularly in the context of anticipated difficult airways. In such scenarios, current guidelines advocate for intubation under preserved spontaneous breathing - commonly referred to as awake intubation - as this approach minimizes the risk of upper airway collapse and ensures continuous ventilation.Flexible endoscopic intubation (FOI) has long been regarded as the gold standard for awake intubation. However, videolaryngoscopy (VL) is now firmly established in routine airway management, owing to its higher first-pass success rate and the growing familiarity among clinicians. As a result, VL is increasingly being used as a practical alternative to FOI in awake intubation, gradually displacing the latter in many institutions.This development presents both opportunities and challenges. While VL often enhances patient comfort and safety - especially in the hands of experienced users - it has also contributed to a decline in FOI proficiency. This is particularly concerning in cases where FOI remains indispensable, such as in patients with significantly restricted mouth opening or tumors of the oral or pharyngeal cavity. In such situations, the loss of routine FOI experience may compromise clinical outcomes.Future research and guideline development must acknowledge this evolving dynamic and seek to strike a balance between clinical efficiency, patient safety, and the preservation of core airway management competencies.