Der Anaesthesist
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Rebound pain as a side effect of regional anaesthesia is an excessive sensation of pain after the effect of local anaesthesia has subsided. This sensation goes well beyond the normal wound pain following a surgical intervention. This phenomenon has entered focus of research in the past 10 years now, but the specific causes are so far unclear and there are still no targeted treatment recommendations. ⋯ A total of 22 original papers from the years 2005-2021 were evaluated regarding the differences between the definitions of rebound pain, the assumption of its occurrence as well as possible treatment options. It turns out that there is no uniform definition by the professional societies, the pathophysiology has not yet been clearly identified and no clear recommendations for prophylaxis or treatment can be given to date; however, early administration of pain medication (e.g. NSAIDs) before the end of the nerve block has proven to be helpful. Likewise, dexamethasone as an adjuvant to regional anaesthesia shows positive effects regarding the occurrence of rebound pain. In any case, it makes sense to provide patients with comprehensive information about this special side effect of regional anaesthesia so that those affected can correctly classify the excessive pain reaction. Targeted studies to avoid severe pain after regional anaesthesia, e.g. through the addition of adjuvants, are necessary in order to keep side effects as low as possible and thereby improve patient comfort and the acceptance of regional anaesthesia.
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While many hospitals in Germany perform thoracic surgery, anesthetic techniques and methods that are actually used are usually only known for individual departments. This study describes the general anesthetic management of three typical thoracic surgical procedures across multiple institutions. ⋯ Our data indicate that less invasive thoracic operations are associated with a reduction of invasive anesthetic procedures. As the presented data are descriptive, further studies are required to determine the impact of invasive anesthetic procedures on patient-related outcomes. This evaluation of the anesthetic management in experienced thoracic anesthesiology departments represents the next step towards establishing national quality standards and promoting structural quality in thoracic anesthesia.
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In today's rapidly changing world, the technology of social media is widely used for educational purposes. Our aim in this study was to investigate the accuracy and efficacy of video presentations of percutaneous dilatational tracheostomy procedures available on the international video sharing website YouTube. ⋯ The use of inexpensive or freely available teaching materials is possible but should always be checked before use with respect to the completeness and correctness of the content conveyed. The unreflected adoption of such content can lead to serious treatment errors.
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Review
[Perioperative management of the brain-dead organ donor : Anesthesia between ethics and evidence].
The number of organs donated after brain death in Germany is far lower than the demand. This underlines the importance of providing the brain-dead donor with optimal medical care throughout the donation process to decrease the risk of graft dysfunction. Several international guidelines and national recommendations guide the intensivists in organ-protective intensive care management of the brain-dead donor. ⋯ Due to the lack of evidence, perioperative treatment should be guided by intensive care therapy strategies. The discussion about using anesthetic drugs during organ retrieval remains controversial. Pathophysiological considerations support the use of volatile anesthetics because of possible organ-protective effects. The use of neuromuscular blocking is justified to control any possible motor response resulting from spinal cord reflexes, whereas there is no evidence for a benefit from using opioids. Apart from that, it seems ethically problematic to anesthetise a brain-dead donor. Consequently, knowledge about the pathophysiological processes caused by brain death and about organ-protective therapy concepts are just as much a basic requirement as the consideration of ethical problems in organ donation after brain death. Only then are the caregivers able to do justice to both the organ recipient and the organ donor, as well as their relatives in this challenging situation.