Der Anaesthesist
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In 1985 Mallampati et al. published a non-invasive score for the evaluation of airways (Mallampati grading scale, MGS), which originally consisted of only three different classes and has been modified several times. At present it is mostly used in the version of Samsoon and Young consisting of four different classes. Class I: soft palate, fauces, uvula, palatopharyngeal arch visible, class II: soft palate, fauces, uvula visible, class III: soft palate, base of the uvula visible and class IV: soft palate not visible. ⋯ Most participants performed the practical evaluation correctly except the sitting position of the model. In agreement with earlier studies, these results show the lack of knowledge in evaluation of airways according to current guidelines of all relevant societies. This is likely to increase preventable risks for patients as unexpected difficult airway management increases the risk for hypoxia and intubation damage.
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It is mandatory for hospitals in Germany to employ infection control physicians and have an external consultation. The recommended coverage has substantially increased in the last years. Typically, infection control physicians are specialists for hygiene and environmental medicine and/or for microbiology. As there is already a shortage of these specialists, a curricular educational program in infection control was developed by the German Medical Association in 2011. This program addresses specialists of different clinical disciplines. It covers a period of 24 months and includes 200 h of courses, divided into 6 modules. In addition, 7 weeks of internships must be absolved in hospital hygiene, in a microbiological laboratory and in the public health service. During the program, the trainee must be accompanied by a qualified supervisor, who is a specialist in hygiene. The aim of this article is to describe the current status of this program. ⋯ The program was able to increase the number of infection control physicians in a relatively short period of time; however, to guarantee a comparable quality of education it is necessary to standardize the requirements on a national level. The supervision also needs to be further specified. A new program is currently being developed by the German Medical Association, which will hopefully lead to an improvement of the educational program. Special strengths of the new infection control physicians are the broad clinical experience as well as the additional qualifications in antibiotic stewardship and/or infectious diseases. The weaknesses are the lack of practical experience and knowledge of technical hygiene. A mandatory inclusion of antibiotic stewardship and infectious diseases in the program would increase its impact. Anesthesiologists are well-suited for training as infection control physicians. For them, a new, exciting field of activity has opened up with the chance to be the head of their own department.
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Review
[Central venous pressure in liver surgery : A primary therapeutic goal or a hemodynamic tessera?]
Central venous pressure (CVP) is deemed to be an important parameter of anesthesia management in liver surgery. To reduce blood loss during liver resections, a low target value of CVP is often propagated. Although current meta-analyses have shown a connection between low CVP and a reduction in blood loss, the underlying studies show methodological weaknesses and advantages with respect to morbidity and mortality can hardly be proven. ⋯ The definition of a generally valid target area for the CVP must be called into question. The primary objective is to maintain adequate oxygen supply and euvolemia. The CVP should be regarded as a mosaic stone of hemodynamic management.