H. Aust

Comparison between intubation and the laryngeal mask airway in moderately obese adults

Background: Obesity is a well‐established risk factor for perioperative pulmonary complications. Anaesthetic drugs and the effect of obesity on respiratory mechanics are responsible for these pathophysiological changes, but tracheal intubation with muscle relaxation may also contribute. This study evaluates the influence of airway management, i.e. intubation vs. laryngeal mask airway (LMA), on postoperative lung volumes and arterial oxygen saturation in the early postoperative period.

Hypoxemia after general anesthesia

ZusammenfassungHintergrundStudien aus den Zeiten der klinischen Einführung der Pulsoxymetrie zeigten, dass nach Allgemeinanästhesien ein großer Anteil der Patienten auf dem Weg vom OP in den Aufwachraum (AWR) unter Atmung von Raumluft hypoxämisch [pulsoxymetrisch gemessene Sauerstoffsättigung (SpO2) < 90%] war und dass das Erkennen der Hypoxämie anhand von klinischen Kriterien sehr unzuverlässig ist. Unklarheit besteht darüber, ob die Inzidenz von Hypoxämien trotz modernerer Anästhesieverfahren immer noch so hoch ist, ob sich die Unzuverlässigkeit der Detektion von Hypoxämien nach klinischen Kriterien bestätigt und was die Risikofaktoren für Hypoxämien nach Allgemeinanästhesie sind.MethodenBei 970 in Allgemeinanästhesie operierten Patienten wurde nach dem Transport vom OP in den AWR unter Atmung von Raumluft die SpO2 gemessen, nachdem der betreuende Anästhesist eine Schätzung der SpO2 vorgenommen hatte. Zusammenhänge zwischen biometrischen, operativen und anästhesiologischen Variablen einerseits sowie Hypoxämie andererseits wurden multivariat untersucht.ErgebnisseEs hatten 17% der 959 ausgewerteten Patienten eine SpO2 < 90%; hierbei wiesen 6,6% der Patienten eine SpO2 < 85% auf. Die Hypoxämie wurde in 82% der Fälle nicht erkannt. Unabhängige Einflussfaktoren auf eine Hypoxämie waren: Ausgangssättigung, Body-Mass-Index, Alter, körperlicher Status gemäß Klassifikation der American Society of Anesthesiologists, Differenz zwischen maximalem und minimalem Beatmungsdruck, Beatmungsmodus, Wahl des Opioids, des Relaxans und Verwendung von Lachgas.SchlussfolgerungDurch die Wahl von Anästhetika können Hypoxämien und Sättigungsabfälle günstig beeinflusst werden, ohne dass dadurch diese Problematik vollständig gelöst werden kann, weil die stärksten Risikofaktoren patientenassoziiert sind. Da bislang selbst bei Kenntnis von Risikofaktoren nicht vorherzusagen ist, wer nach Allgemeinanästhesie eine SpO2 < 90% haben wird und überdies die Abschätzung der SpO2 anhand klinischer Kriterien höchst unzuverlässig ist, erscheint der Transport von spontan-atmenden Patienten nach Narkose ohne Überwachung der SpO2 bzw. ohne O2-Gabe überdenkenswert.AbstractBackgroundStudies conducted shortly after the implementation of pulse oximetry (PO) into clinical practice 20–25 years ago revealed that many patients breathing room air during transfer from the operating room (OR) to the post-anesthesia care unit (PACU) directly after general anesthesia (GA) had a peripheral oxygen saturation (SpO2) below 90%. Moreover, it was shown that the detection of hypoxemia by clinical criteria is extremely unreliable. Meanwhile, the use of PO has become part of the obligatory standard monitoring during GA in Germany and many other countries. Likewise, the use of PO is standard care in the PACU although there are no official recommendations. However, for the time period in between, i.e. immediately after GA during transportation of patients from the OR to the PACU, monitoring of the SpO2 in patients breathing room air is neither obligatory in Germany nor are there any official recommendations or guidelines in this respect. Given the introduction of shorter acting anesthetic agents within the last 25 years, the main goal of this study was to explore whether the incidence of hypoxemia in the immediate period after GA is still so high. Additional aims of this study were to examine whether the detection of hypoxemia based on clinical criteria can be confirmed to be very unreliable, what the risk factors for hypoxemia following GA are and how common it is in Germany to transport patients from the OR to the PACU without PO and supplemental oxygen.MethodsIn a prospective observational study 970 patients who underwent a broad spectrum of elective surgery under GA in a university hospital setting were included. The SpO2 was measured at the end of the transfer from the OR to the PACU immediately after the anesthetist who had taken care of the patient during the operation had estimated the SpO2. The association between biometric, surgical and anesthesiological variables on the one hand and hypoxemia as well as a decrease of SpO2 on the other hand were studied using multivariate methods. Finally, a survey including all university hospitals was carried out to find out about the use of PO and oxygen during patient transfer from the OR to the PACU.ResultsOf the 959 patients who were eligible for analysis 17% had a SpO2 < 90% and 6.6% a SpO2 < 85%. Hypoxemia was not recognized in 82% of the patients in whom an assessment based on clinical grounds was carried out. Variables with an independent influence on hypoxemia and decrease of SpO2 were as follows: saturation before induction of GA, body mass index, age, American Society of Anesthesiologists (ASA) physical status, difference between maximum and minimum inspiratory pressure, mode of ventilation, the choice of opioid and muscle relaxant as well as the use of nitrous oxide. Patient-dependent risk factors had the strongest impact on hypoxemia. In about 80% of the university hospitals neither PO nor supplemental oxygen is used during transportation of the patient from the OR to the PACU.ConclusionsThe use of opioids and relaxants with short duration of action may have favorable effects on preventing hypoxemia and decreases of SpO2. These measures will, however, not be sufficient to solve this problem because the highest risk factors for hypoxemia are patient-related. Despite knowing risk factors for oxygen desaturation, it is currently not possible to reliably predict which patients will become hypoxemic or have a decrease of SpO2. Therefore, transportation of patients breathing room air from the OR to the PACU directly after GA without use of PO or supplemental oxygen seems to be questionable in terms of patient safety.BACKGROUND Studies conducted shortly after the implementation of pulse oximetry (PO) into clinical practice 20-25 years ago revealed that many patients breathing room air during transfer from the operating room (OR) to the post-anesthesia care unit (PACU) directly after general anesthesia (GA) had a peripheral oxygen saturation (S(p)O(2)) below 90%. Moreover, it was shown that the detection of hypoxemia by clinical criteria is extremely unreliable. Meanwhile, the use of PO has become part of the obligatory standard monitoring during GA in Germany and many other countries. Likewise, the use of PO is standard care in the PACU although there are no official recommendations. However, for the time period in between, i.e. immediately after GA during transportation of patients from the OR to the PACU, monitoring of the S(p)O(2) in patients breathing room air is neither obligatory in Germany nor are there any official recommendations or guidelines in this respect. Given the introduction of shorter acting anesthetic agents within the last 25 years, the main goal of this study was to explore whether the incidence of hypoxemia in the immediate period after GA is still so high. Additional aims of this study were to examine whether the detection of hypoxemia based on clinical criteria can be confirmed to be very unreliable, what the risk factors for hypoxemia following GA are and how common it is in Germany to transport patients from the OR to the PACU without PO and supplemental oxygen. METHODS In a prospective observational study 970 patients who underwent a broad spectrum of elective surgery under GA in a university hospital setting were included. The S(p)O(2) was measured at the end of the transfer from the OR to the PACU immediately after the anesthetist who had taken care of the patient during the operation had estimated the S(p)O(2). The association between biometric, surgical and anesthesiological variables on the one hand and hypoxemia as well as a decrease of S(p)O(2) on the other hand were studied using multivariate methods. Finally, a survey including all university hospitals was carried out to find out about the use of PO and oxygen during patient transfer from the OR to the PACU. RESULTS Of the 959 patients who were eligible for analysis 17% had a S(p)O(2) < 90% and 6.6% a S(p)O(2) < 85%. Hypoxemia was not recognized in 82% of the patients in whom an assessment based on clinical grounds was carried out. Variables with an independent influence on hypoxemia and decrease of S(p)O(2) were as follows: saturation before induction of GA, body mass index, age, American Society of Anesthesiologists (ASA) physical status, difference between maximum and minimum inspiratory pressure, mode of ventilation, the choice of opioid and muscle relaxant as well as the use of nitrous oxide. Patient-dependent risk factors had the strongest impact on hypoxemia. In about 80% of the university hospitals neither PO nor supplemental oxygen is used during transportation of the patient from the OR to the PACU. CONCLUSIONS The use of opioids and relaxants with short duration of action may have favorable effects on preventing hypoxemia and decreases of S(p)O(2). These measures will, however, not be sufficient to solve this problem because the highest risk factors for hypoxemia are patient-related. Despite knowing risk factors for oxygen desaturation, it is currently not possible to reliably predict which patients will become hypoxemic or have a decrease of S(p)O(2). Therefore, transportation of patients breathing room air from the OR to the PACU directly after GA without use of PO or supplemental oxygen seems to be questionable in terms of patient safety.

Hypoxämie nach Allgemeinanästhesie

ZusammenfassungHintergrundStudien aus den Zeiten der klinischen Einführung der Pulsoxymetrie zeigten, dass nach Allgemeinanästhesien ein großer Anteil der Patienten auf dem Weg vom OP in den Aufwachraum (AWR) unter Atmung von Raumluft hypoxämisch [pulsoxymetrisch gemessene Sauerstoffsättigung (SpO2) < 90%] war und dass das Erkennen der Hypoxämie anhand von klinischen Kriterien sehr unzuverlässig ist. Unklarheit besteht darüber, ob die Inzidenz von Hypoxämien trotz modernerer Anästhesieverfahren immer noch so hoch ist, ob sich die Unzuverlässigkeit der Detektion von Hypoxämien nach klinischen Kriterien bestätigt und was die Risikofaktoren für Hypoxämien nach Allgemeinanästhesie sind.MethodenBei 970 in Allgemeinanästhesie operierten Patienten wurde nach dem Transport vom OP in den AWR unter Atmung von Raumluft die SpO2 gemessen, nachdem der betreuende Anästhesist eine Schätzung der SpO2 vorgenommen hatte. Zusammenhänge zwischen biometrischen, operativen und anästhesiologischen Variablen einerseits sowie Hypoxämie andererseits wurden multivariat untersucht.ErgebnisseEs hatten 17% der 959 ausgewerteten Patienten eine SpO2 < 90%; hierbei wiesen 6,6% der Patienten eine SpO2 < 85% auf. Die Hypoxämie wurde in 82% der Fälle nicht erkannt. Unabhängige Einflussfaktoren auf eine Hypoxämie waren: Ausgangssättigung, Body-Mass-Index, Alter, körperlicher Status gemäß Klassifikation der American Society of Anesthesiologists, Differenz zwischen maximalem und minimalem Beatmungsdruck, Beatmungsmodus, Wahl des Opioids, des Relaxans und Verwendung von Lachgas.SchlussfolgerungDurch die Wahl von Anästhetika können Hypoxämien und Sättigungsabfälle günstig beeinflusst werden, ohne dass dadurch diese Problematik vollständig gelöst werden kann, weil die stärksten Risikofaktoren patientenassoziiert sind. Da bislang selbst bei Kenntnis von Risikofaktoren nicht vorherzusagen ist, wer nach Allgemeinanästhesie eine SpO2 < 90% haben wird und überdies die Abschätzung der SpO2 anhand klinischer Kriterien höchst unzuverlässig ist, erscheint der Transport von spontan-atmenden Patienten nach Narkose ohne Überwachung der SpO2 bzw. ohne O2-Gabe überdenkenswert.AbstractBackgroundStudies conducted shortly after the implementation of pulse oximetry (PO) into clinical practice 20–25 years ago revealed that many patients breathing room air during transfer from the operating room (OR) to the post-anesthesia care unit (PACU) directly after general anesthesia (GA) had a peripheral oxygen saturation (SpO2) below 90%. Moreover, it was shown that the detection of hypoxemia by clinical criteria is extremely unreliable. Meanwhile, the use of PO has become part of the obligatory standard monitoring during GA in Germany and many other countries. Likewise, the use of PO is standard care in the PACU although there are no official recommendations. However, for the time period in between, i.e. immediately after GA during transportation of patients from the OR to the PACU, monitoring of the SpO2 in patients breathing room air is neither obligatory in Germany nor are there any official recommendations or guidelines in this respect. Given the introduction of shorter acting anesthetic agents within the last 25 years, the main goal of this study was to explore whether the incidence of hypoxemia in the immediate period after GA is still so high. Additional aims of this study were to examine whether the detection of hypoxemia based on clinical criteria can be confirmed to be very unreliable, what the risk factors for hypoxemia following GA are and how common it is in Germany to transport patients from the OR to the PACU without PO and supplemental oxygen.MethodsIn a prospective observational study 970 patients who underwent a broad spectrum of elective surgery under GA in a university hospital setting were included. The SpO2 was measured at the end of the transfer from the OR to the PACU immediately after the anesthetist who had taken care of the patient during the operation had estimated the SpO2. The association between biometric, surgical and anesthesiological variables on the one hand and hypoxemia as well as a decrease of SpO2 on the other hand were studied using multivariate methods. Finally, a survey including all university hospitals was carried out to find out about the use of PO and oxygen during patient transfer from the OR to the PACU.ResultsOf the 959 patients who were eligible for analysis 17% had a SpO2 < 90% and 6.6% a SpO2 < 85%. Hypoxemia was not recognized in 82% of the patients in whom an assessment based on clinical grounds was carried out. Variables with an independent influence on hypoxemia and decrease of SpO2 were as follows: saturation before induction of GA, body mass index, age, American Society of Anesthesiologists (ASA) physical status, difference between maximum and minimum inspiratory pressure, mode of ventilation, the choice of opioid and muscle relaxant as well as the use of nitrous oxide. Patient-dependent risk factors had the strongest impact on hypoxemia. In about 80% of the university hospitals neither PO nor supplemental oxygen is used during transportation of the patient from the OR to the PACU.ConclusionsThe use of opioids and relaxants with short duration of action may have favorable effects on preventing hypoxemia and decreases of SpO2. These measures will, however, not be sufficient to solve this problem because the highest risk factors for hypoxemia are patient-related. Despite knowing risk factors for oxygen desaturation, it is currently not possible to reliably predict which patients will become hypoxemic or have a decrease of SpO2. Therefore, transportation of patients breathing room air from the OR to the PACU directly after GA without use of PO or supplemental oxygen seems to be questionable in terms of patient safety.BACKGROUND Studies conducted shortly after the implementation of pulse oximetry (PO) into clinical practice 20-25 years ago revealed that many patients breathing room air during transfer from the operating room (OR) to the post-anesthesia care unit (PACU) directly after general anesthesia (GA) had a peripheral oxygen saturation (S(p)O(2)) below 90%. Moreover, it was shown that the detection of hypoxemia by clinical criteria is extremely unreliable. Meanwhile, the use of PO has become part of the obligatory standard monitoring during GA in Germany and many other countries. Likewise, the use of PO is standard care in the PACU although there are no official recommendations. However, for the time period in between, i.e. immediately after GA during transportation of patients from the OR to the PACU, monitoring of the S(p)O(2) in patients breathing room air is neither obligatory in Germany nor are there any official recommendations or guidelines in this respect. Given the introduction of shorter acting anesthetic agents within the last 25 years, the main goal of this study was to explore whether the incidence of hypoxemia in the immediate period after GA is still so high. Additional aims of this study were to examine whether the detection of hypoxemia based on clinical criteria can be confirmed to be very unreliable, what the risk factors for hypoxemia following GA are and how common it is in Germany to transport patients from the OR to the PACU without PO and supplemental oxygen. METHODS In a prospective observational study 970 patients who underwent a broad spectrum of elective surgery under GA in a university hospital setting were included. The S(p)O(2) was measured at the end of the transfer from the OR to the PACU immediately after the anesthetist who had taken care of the patient during the operation had estimated the S(p)O(2). The association between biometric, surgical and anesthesiological variables on the one hand and hypoxemia as well as a decrease of S(p)O(2) on the other hand were studied using multivariate methods. Finally, a survey including all university hospitals was carried out to find out about the use of PO and oxygen during patient transfer from the OR to the PACU. RESULTS Of the 959 patients who were eligible for analysis 17% had a S(p)O(2) < 90% and 6.6% a S(p)O(2) < 85%. Hypoxemia was not recognized in 82% of the patients in whom an assessment based on clinical grounds was carried out. Variables with an independent influence on hypoxemia and decrease of S(p)O(2) were as follows: saturation before induction of GA, body mass index, age, American Society of Anesthesiologists (ASA) physical status, difference between maximum and minimum inspiratory pressure, mode of ventilation, the choice of opioid and muscle relaxant as well as the use of nitrous oxide. Patient-dependent risk factors had the strongest impact on hypoxemia. In about 80% of the university hospitals neither PO nor supplemental oxygen is used during transportation of the patient from the OR to the PACU. CONCLUSIONS The use of opioids and relaxants with short duration of action may have favorable effects on preventing hypoxemia and decreases of S(p)O(2). These measures will, however, not be sufficient to solve this problem because the highest risk factors for hypoxemia are patient-related. Despite knowing risk factors for oxygen desaturation, it is currently not possible to reliably predict which patients will become hypoxemic or have a decrease of S(p)O(2). Therefore, transportation of patients breathing room air from the OR to the PACU directly after GA without use of PO or supplemental oxygen seems to be questionable in terms of patient safety.

Prämedikationsvisiten der anästhesiologischen Fachabteilungen in Hessen

ZusammenfassungHintergrundViele Anästhesieabteilungen betreiben eine Prämedikationsambulanz. Daten zur Häufigkeit solcher Einrichtungen, deren Organisation, Ausstattung oder Struktur finden sich bisher nicht. Verweise auf moderne Techniken und Verfahren könnten dort zur emotionalen Stressreduktion der Patienten beitragen. Allerdings ist dies häufig mit zusätzlichen Kosten sowie erhöhter technischer Ausstattung verbunden und unterschiedlich etabliert.Ziel der ArbeitDiese Befragung untersucht die aktuellen Strukturen von Prämedikationsambulanzen, veranschaulicht Verfahrenskonzepte und verknüpft dies mit dem Leistungsportfolio der Abteilungen.Material und MethodeDie Befragung erfolgte online. Es wurden Daten bezüglich Struktur, Ausstattung, Organisation und zu den angebotenen Verfahren erfasst. Flankierend wurde der individuelle Stellenwert der Prämedikationsarbeit aus Anästhesistensicht festgehalten.ErgebnisseAn der Befragung beteiligten sich 84 % aller hessischen Anästhesieabteilungen. Von diesen betreiben 91 % Prämedikationsambulanzen. Ein präoperativer Kontakt zum später versorgenden Anästhesisten existiert noch in 19 % der Abteilungen. Multimediale Konzepte bei der Patientenaufklärung sind allgemein selten. Viele moderne Verfahren und Anästhesietechniken sind mittlerweile weitgehend unabhängig von der Klinikgröße etabliert. Bei Betrachtung des Stellenwerts eines präoperativen Patientengesprächs aus Sicht der Anästhesisten zeigt sich, dass die psychologische und medizinische Bedeutung der Prämedikationsvisite als sehr hoch eingestuft wird.SchlussfolgerungPrämedikationsambulanzen sind mittlerweile allgemein etabliert. Dies mag ökonomisch sinnvoll sein, geht jedoch mit einer Anonymisierung der Versorgung einher. Die hohe Qualität, Sicherheit und Verfügbarkeit moderner anästhesiologischer Verfahrens- und Überwachungskonzepte sollten umso mehr als Ausdruck der Fürsorge und hohen Patientensicherheit kommuniziert werden. Hierfür bieten sich die bisher nur spärlich genutzten multimedialen Hilfsmittel im Ambulanzbetrieb besonders an.AbstractBackgroundMany anesthesia departments operate a pre-anesthesia assessment clinic (PAAC). Data regarding organization, equipment and structure of such clinics are not yet available. Information about modern anesthesiology techniques and procedures contributes to a reduction in emotional stress of the patients but such modern techniques often require additional technical hardware and costs and are not equally available.AimThis survey examined the current structures of PAAC in the state of Hessen, demonstrated current concepts and associated these with the performance and the portfolio of procedures in these departments.Material and methodsAn online survey was carried out. Data on structure, equipment, organization and available methods were compiled. In addition, anesthesia department personnel were asked to give individual subjective attitudes toward the premedication work.ResultsOf the anesthesia departments in Hessen 84 % participated in the survey of which 91 % operated a PAAC. A preoperative contact with the anesthesiologist who would perform anesthesia existed in only 19 % of the departments. Multimedia processing concepts for informed consent in a PAAC setting were in general rare. Many modern procedures and anesthesia techniques were broadly established independent of the hospital size. Regarding the individual and subjective attitudes of anesthetists towards the work, the psychological and medical importance of the pre-medication visit was considered to be very high.ConclusionThe PAACs are now well established. This may make economic sense but is accompanied by an anonymization of care in anesthesiology. The high quality, safety and availability of modern anesthesiology procedures and monitoring concepts should be communicated to patients all the more as an expression of trust and high patient safety. These factors can be facilitated in particular by multimedia tools which have as yet only been sparsely implemented in PAACs.BACKGROUND Many anesthesia departments operate a pre-anesthesia assessment clinic (PAAC). Data regarding organization, equipment and structure of such clinics are not yet available. Information about modern anesthesiology techniques and procedures contributes to a reduction in emotional stress of the patients but such modern techniques often require additional technical hardware and costs and are not equally available. AIM This survey examined the current structures of PAAC in the state of Hessen, demonstrated current concepts and associated these with the performance and the portfolio of procedures in these departments. MATERIAL AND METHODS An online survey was carried out. Data on structure, equipment, organization and available methods were compiled. In addition, anesthesia department personnel were asked to give individual subjective attitudes toward the premedication work. RESULTS Of the anesthesia departments in Hessen 84 % participated in the survey of which 91 % operated a PAAC. A preoperative contact with the anesthesiologist who would perform anesthesia existed in only 19 % of the departments. Multimedia processing concepts for informed consent in a PAAC setting were in general rare. Many modern procedures and anesthesia techniques were broadly established independent of the hospital size. Regarding the individual and subjective attitudes of anesthetists towards the work, the psychological and medical importance of the pre-medication visit was considered to be very high. CONCLUSION The PAACs are now well established. This may make economic sense but is accompanied by an anonymization of care in anesthesiology. The high quality, safety and availability of modern anesthesiology procedures and monitoring concepts should be communicated to patients all the more as an expression of trust and high patient safety. These factors can be facilitated in particular by multimedia tools which have as yet only been sparsely implemented in PAACs.

Pre‐operative fluid bolus for improved haemodynamic stability during minor surgery: A prospectively randomized clinical trial

Haemodynamic instability during the induction of anaesthesia and surgery is common and may be related to hypovolaemia caused by pre‐operative fasting or chronic diuretic therapy. The aim of our prospective, controlled, randomized study was to test the hypothesis that a predefined fluid bolus given prior to general anaesthesia for minor surgery would increase haemodynamic stability during anaesthetic induction.

Premedication visits in departments of anesthesiology in Hessen. Compilation of organizational and performance portfolios

ZusammenfassungHintergrundViele Anästhesieabteilungen betreiben eine Prämedikationsambulanz. Daten zur Häufigkeit solcher Einrichtungen, deren Organisation, Ausstattung oder Struktur finden sich bisher nicht. Verweise auf moderne Techniken und Verfahren könnten dort zur emotionalen Stressreduktion der Patienten beitragen. Allerdings ist dies häufig mit zusätzlichen Kosten sowie erhöhter technischer Ausstattung verbunden und unterschiedlich etabliert.Ziel der ArbeitDiese Befragung untersucht die aktuellen Strukturen von Prämedikationsambulanzen, veranschaulicht Verfahrenskonzepte und verknüpft dies mit dem Leistungsportfolio der Abteilungen.Material und MethodeDie Befragung erfolgte online. Es wurden Daten bezüglich Struktur, Ausstattung, Organisation und zu den angebotenen Verfahren erfasst. Flankierend wurde der individuelle Stellenwert der Prämedikationsarbeit aus Anästhesistensicht festgehalten.ErgebnisseAn der Befragung beteiligten sich 84 % aller hessischen Anästhesieabteilungen. Von diesen betreiben 91 % Prämedikationsambulanzen. Ein präoperativer Kontakt zum später versorgenden Anästhesisten existiert noch in 19 % der Abteilungen. Multimediale Konzepte bei der Patientenaufklärung sind allgemein selten. Viele moderne Verfahren und Anästhesietechniken sind mittlerweile weitgehend unabhängig von der Klinikgröße etabliert. Bei Betrachtung des Stellenwerts eines präoperativen Patientengesprächs aus Sicht der Anästhesisten zeigt sich, dass die psychologische und medizinische Bedeutung der Prämedikationsvisite als sehr hoch eingestuft wird.SchlussfolgerungPrämedikationsambulanzen sind mittlerweile allgemein etabliert. Dies mag ökonomisch sinnvoll sein, geht jedoch mit einer Anonymisierung der Versorgung einher. Die hohe Qualität, Sicherheit und Verfügbarkeit moderner anästhesiologischer Verfahrens- und Überwachungskonzepte sollten umso mehr als Ausdruck der Fürsorge und hohen Patientensicherheit kommuniziert werden. Hierfür bieten sich die bisher nur spärlich genutzten multimedialen Hilfsmittel im Ambulanzbetrieb besonders an.AbstractBackgroundMany anesthesia departments operate a pre-anesthesia assessment clinic (PAAC). Data regarding organization, equipment and structure of such clinics are not yet available. Information about modern anesthesiology techniques and procedures contributes to a reduction in emotional stress of the patients but such modern techniques often require additional technical hardware and costs and are not equally available.AimThis survey examined the current structures of PAAC in the state of Hessen, demonstrated current concepts and associated these with the performance and the portfolio of procedures in these departments.Material and methodsAn online survey was carried out. Data on structure, equipment, organization and available methods were compiled. In addition, anesthesia department personnel were asked to give individual subjective attitudes toward the premedication work.ResultsOf the anesthesia departments in Hessen 84 % participated in the survey of which 91 % operated a PAAC. A preoperative contact with the anesthesiologist who would perform anesthesia existed in only 19 % of the departments. Multimedia processing concepts for informed consent in a PAAC setting were in general rare. Many modern procedures and anesthesia techniques were broadly established independent of the hospital size. Regarding the individual and subjective attitudes of anesthetists towards the work, the psychological and medical importance of the pre-medication visit was considered to be very high.ConclusionThe PAACs are now well established. This may make economic sense but is accompanied by an anonymization of care in anesthesiology. The high quality, safety and availability of modern anesthesiology procedures and monitoring concepts should be communicated to patients all the more as an expression of trust and high patient safety. These factors can be facilitated in particular by multimedia tools which have as yet only been sparsely implemented in PAACs.BACKGROUND Many anesthesia departments operate a pre-anesthesia assessment clinic (PAAC). Data regarding organization, equipment and structure of such clinics are not yet available. Information about modern anesthesiology techniques and procedures contributes to a reduction in emotional stress of the patients but such modern techniques often require additional technical hardware and costs and are not equally available. AIM This survey examined the current structures of PAAC in the state of Hessen, demonstrated current concepts and associated these with the performance and the portfolio of procedures in these departments. MATERIAL AND METHODS An online survey was carried out. Data on structure, equipment, organization and available methods were compiled. In addition, anesthesia department personnel were asked to give individual subjective attitudes toward the premedication work. RESULTS Of the anesthesia departments in Hessen 84 % participated in the survey of which 91 % operated a PAAC. A preoperative contact with the anesthesiologist who would perform anesthesia existed in only 19 % of the departments. Multimedia processing concepts for informed consent in a PAAC setting were in general rare. Many modern procedures and anesthesia techniques were broadly established independent of the hospital size. Regarding the individual and subjective attitudes of anesthetists towards the work, the psychological and medical importance of the pre-medication visit was considered to be very high. CONCLUSION The PAACs are now well established. This may make economic sense but is accompanied by an anonymization of care in anesthesiology. The high quality, safety and availability of modern anesthesiology procedures and monitoring concepts should be communicated to patients all the more as an expression of trust and high patient safety. These factors can be facilitated in particular by multimedia tools which have as yet only been sparsely implemented in PAACs.

Prämedikationsvisiten der anästhesiologischen Fachabteilungen in Hessen@@@Premedication visits in departments of anesthesiology in Hessen: Statuserfassung des Organisations- und Leistungsportfolios@@@Compilation of organizational and performance portfolios

ZusammenfassungHintergrundViele Anästhesieabteilungen betreiben eine Prämedikationsambulanz. Daten zur Häufigkeit solcher Einrichtungen, deren Organisation, Ausstattung oder Struktur finden sich bisher nicht. Verweise auf moderne Techniken und Verfahren könnten dort zur emotionalen Stressreduktion der Patienten beitragen. Allerdings ist dies häufig mit zusätzlichen Kosten sowie erhöhter technischer Ausstattung verbunden und unterschiedlich etabliert.Ziel der ArbeitDiese Befragung untersucht die aktuellen Strukturen von Prämedikationsambulanzen, veranschaulicht Verfahrenskonzepte und verknüpft dies mit dem Leistungsportfolio der Abteilungen.Material und MethodeDie Befragung erfolgte online. Es wurden Daten bezüglich Struktur, Ausstattung, Organisation und zu den angebotenen Verfahren erfasst. Flankierend wurde der individuelle Stellenwert der Prämedikationsarbeit aus Anästhesistensicht festgehalten.ErgebnisseAn der Befragung beteiligten sich 84 % aller hessischen Anästhesieabteilungen. Von diesen betreiben 91 % Prämedikationsambulanzen. Ein präoperativer Kontakt zum später versorgenden Anästhesisten existiert noch in 19 % der Abteilungen. Multimediale Konzepte bei der Patientenaufklärung sind allgemein selten. Viele moderne Verfahren und Anästhesietechniken sind mittlerweile weitgehend unabhängig von der Klinikgröße etabliert. Bei Betrachtung des Stellenwerts eines präoperativen Patientengesprächs aus Sicht der Anästhesisten zeigt sich, dass die psychologische und medizinische Bedeutung der Prämedikationsvisite als sehr hoch eingestuft wird.SchlussfolgerungPrämedikationsambulanzen sind mittlerweile allgemein etabliert. Dies mag ökonomisch sinnvoll sein, geht jedoch mit einer Anonymisierung der Versorgung einher. Die hohe Qualität, Sicherheit und Verfügbarkeit moderner anästhesiologischer Verfahrens- und Überwachungskonzepte sollten umso mehr als Ausdruck der Fürsorge und hohen Patientensicherheit kommuniziert werden. Hierfür bieten sich die bisher nur spärlich genutzten multimedialen Hilfsmittel im Ambulanzbetrieb besonders an.AbstractBackgroundMany anesthesia departments operate a pre-anesthesia assessment clinic (PAAC). Data regarding organization, equipment and structure of such clinics are not yet available. Information about modern anesthesiology techniques and procedures contributes to a reduction in emotional stress of the patients but such modern techniques often require additional technical hardware and costs and are not equally available.AimThis survey examined the current structures of PAAC in the state of Hessen, demonstrated current concepts and associated these with the performance and the portfolio of procedures in these departments.Material and methodsAn online survey was carried out. Data on structure, equipment, organization and available methods were compiled. In addition, anesthesia department personnel were asked to give individual subjective attitudes toward the premedication work.ResultsOf the anesthesia departments in Hessen 84 % participated in the survey of which 91 % operated a PAAC. A preoperative contact with the anesthesiologist who would perform anesthesia existed in only 19 % of the departments. Multimedia processing concepts for informed consent in a PAAC setting were in general rare. Many modern procedures and anesthesia techniques were broadly established independent of the hospital size. Regarding the individual and subjective attitudes of anesthetists towards the work, the psychological and medical importance of the pre-medication visit was considered to be very high.ConclusionThe PAACs are now well established. This may make economic sense but is accompanied by an anonymization of care in anesthesiology. The high quality, safety and availability of modern anesthesiology procedures and monitoring concepts should be communicated to patients all the more as an expression of trust and high patient safety. These factors can be facilitated in particular by multimedia tools which have as yet only been sparsely implemented in PAACs.BACKGROUND Many anesthesia departments operate a pre-anesthesia assessment clinic (PAAC). Data regarding organization, equipment and structure of such clinics are not yet available. Information about modern anesthesiology techniques and procedures contributes to a reduction in emotional stress of the patients but such modern techniques often require additional technical hardware and costs and are not equally available. AIM This survey examined the current structures of PAAC in the state of Hessen, demonstrated current concepts and associated these with the performance and the portfolio of procedures in these departments. MATERIAL AND METHODS An online survey was carried out. Data on structure, equipment, organization and available methods were compiled. In addition, anesthesia department personnel were asked to give individual subjective attitudes toward the premedication work. RESULTS Of the anesthesia departments in Hessen 84 % participated in the survey of which 91 % operated a PAAC. A preoperative contact with the anesthesiologist who would perform anesthesia existed in only 19 % of the departments. Multimedia processing concepts for informed consent in a PAAC setting were in general rare. Many modern procedures and anesthesia techniques were broadly established independent of the hospital size. Regarding the individual and subjective attitudes of anesthetists towards the work, the psychological and medical importance of the pre-medication visit was considered to be very high. CONCLUSION The PAACs are now well established. This may make economic sense but is accompanied by an anonymization of care in anesthesiology. The high quality, safety and availability of modern anesthesiology procedures and monitoring concepts should be communicated to patients all the more as an expression of trust and high patient safety. These factors can be facilitated in particular by multimedia tools which have as yet only been sparsely implemented in PAACs.

[Caesarean sections under regional anesthesia: pros and cons of supplementary oxygen].

The routine administration of supplemental oxygen to women undergoing elective caesarean section under regional anesthesia in order to optimize oxygen supply to the fetus is common anesthetic practice in many German hospitals. However, this practice has been controversially discussed in the non-German literature for many years. This review presents and discusses the pros and cons of routinely providing supplemental oxygen to a parturient during caesarean section on the basis of the literature published over the last 30 years. Proponents of routine oxygen administration point to potential and unforeseeable risks of caesarean sections and consider the prophylactic administration of oxygen based on physiological considerations to be advantageous in terms of patient safety. Interestingly, data regarding the effects of an increased maternal FIO2 on improvement of fetal oxygenation are inconsistent, therefore, no unambiguous recommendation concerning which FIO2 to choose can be given. Opponents of routine oxygen supplementation allude above all to an increase in free radical activity in both mother and fetus; however, data in this respect are not consistent either. As supplemental oxygen to patients undergoing elective caesarean section without any risk factors under regional anesthesia is associated with potential risks while no advantage has so far been demonstrated, routine administration of oxygen has to be challenged and is no longer considered to be indicated by many. On the contrary, in cases of emergency with a concomitant risk of hypoxia for mother and fetus, administration of oxygen is indispensable in the light of present data.

Sectio caesarea in Regionalanästhesie

The routine administration of supplemental oxygen to women undergoing elective caesarean section under regional anesthesia in order to optimize oxygen supply to the fetus is common anesthetic practice in many German hospitals. However, this practice has been controversially discussed in the non-German literature for many years. This review presents and discusses the pros and cons of routinely providing supplemental oxygen to a parturient during caesarean section on the basis of the literature published over the last 30 years. Proponents of routine oxygen administration point to potential and unforeseeable risks of caesarean sections and consider the prophylactic administration of oxygen based on physiological considerations to be advantageous in terms of patient safety. Interestingly, data regarding the effects of an increased maternal FIO2 on improvement of fetal oxygenation are inconsistent, therefore, no unambiguous recommendation concerning which FIO2 to choose can be given. Opponents of routine oxygen supplementation allude above all to an increase in free radical activity in both mother and fetus; however, data in this respect are not consistent either. As supplemental oxygen to patients undergoing elective caesarean section without any risk factors under regional anesthesia is associated with potential risks while no advantage has so far been demonstrated, routine administration of oxygen has to be challenged and is no longer considered to be indicated by many. On the contrary, in cases of emergency with a concomitant risk of hypoxia for mother and fetus, administration of oxygen is indispensable in the light of present data.

Sectio caesarea in Regionalanästhesie@@@Caesarean sections under regional anesthesia: Pro und Kontra der supplementären Sauerstoffgabe@@@Pros and cons of supplementary oxygen

The routine administration of supplemental oxygen to women undergoing elective caesarean section under regional anesthesia in order to optimize oxygen supply to the fetus is common anesthetic practice in many German hospitals. However, this practice has been controversially discussed in the non-German literature for many years. This review presents and discusses the pros and cons of routinely providing supplemental oxygen to a parturient during caesarean section on the basis of the literature published over the last 30 years. Proponents of routine oxygen administration point to potential and unforeseeable risks of caesarean sections and consider the prophylactic administration of oxygen based on physiological considerations to be advantageous in terms of patient safety. Interestingly, data regarding the effects of an increased maternal FIO2 on improvement of fetal oxygenation are inconsistent, therefore, no unambiguous recommendation concerning which FIO2 to choose can be given. Opponents of routine oxygen supplementation allude above all to an increase in free radical activity in both mother and fetus; however, data in this respect are not consistent either. As supplemental oxygen to patients undergoing elective caesarean section without any risk factors under regional anesthesia is associated with potential risks while no advantage has so far been demonstrated, routine administration of oxygen has to be challenged and is no longer considered to be indicated by many. On the contrary, in cases of emergency with a concomitant risk of hypoxia for mother and fetus, administration of oxygen is indispensable in the light of present data.