Der Anaesthesist
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In a medical liability process a medical expert takes on an outstanding position. He is the one process participant who preprograms the decision of the judge. However, he does not as such have an independent investigative competence and must understand his role as being an accessory to the judge. ⋯ In contrast the procedure in criminal processes follows the principle of official investigation and the absolute principle of in dubio pro reo. From this it follows that the evidence of causality must be proven with a probability close to certainty. Advice for the construction of expert opinion statements can be found in this article.
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Neuraxial anesthesia is an established and safe procedure in perioperative pain therapy which can help to minimize complications and to improve perioperative outcome. In patients with acquired bleeding disorders by comorbidities or concomitant antithrombotic medication an individual decision should be made based on risks and benefits. A large number of literature references and guidelines help making a decision, for example the recently updated evidence-based guidelines of the American Society of Regional Anesthesia and Pain Medicine for patients receiving antithrombotic or thrombolytic therapy. ⋯ Evidence-based recommendations for neuraxial anaesthesia in patients with hemophilia, vWD or ITP cannot be offered. Each patient has to be treated individually with appropriate caution. This overview is intended to assist in the decision for or against neuraxial anesthesia in these patients, with emphasis on the pathophysiological background, blood investigations and case reports from the literature.
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Surgical replacement of aortic valves is the gold standard for therapy of high grade aortic valve stenosis. However, the changes in demography confront the responsible medical discipline with an increasingly higher risk profile of patients which necessitates the development of new less invasive alternative forms of treatment for the surgical therapy of aortic valve stenosis. This developmental process has progressed from mini-thoracotomy to transcatheter aortic valve implantation (TAVI). ⋯ Because TAVI can be carried out while the heart is still beating and without a sternotomy or heart-lung maschine, this procedure is particularly suitable for elderly multimorbid patients and/or patients with previous cardiac surgery. The initial results of large prospective multicenter studies underline the value of TAVI in the modern treatment of high risk patients with symptomatic aortic valve stenosis. In addition to an understanding of the surgical procedure, anesthetists must have precise knowledge of the perioperative anesthesia management and possible complications of the procedure.
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Airway management is a core task for anesthesiologists. Deficiencies in training or equipment as well as fateful complications in this field are responsible for a significant proportion of anesthesia-associated morbidity and mortality. ⋯ Nevertheless, the "cannot intubate cannot ventilate scenario" still occurs and regularly results in poor outcome, such as permanent neurological deficits or even death. Therefore, awake fiberoptic intubation remains the gold standard in the expected difficult airway because when applied correctly this technique never leads to a point where a patient's respiration is compromised as a result of medical measures before a secure airway has been established.
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With the demands faced by anesthetists and intensive care physicians apparently increasing continuously in Germany, the increased risk of burnout in comparison with the general working population is discussed. This debate has previously been merely speculative because of the lack of studies comparing the burn-out risk of the German working population with anesthetists. Accordingly it was not certain whether anesthetists really are at greater risk of developing burnout as has often been suggested. Moreover, age, gender, function, workplace environment, e.g. working at a hospital compared to a general practitioner (GP) surgery, may influence the risk of burnout. Therefore, this study examined whether the risk for anesthetists in Germany suffering from burnout really is greater than in other occupations. In addition, factors influencing the burnout risks of anesthetists were analyzed. ⋯ Despite 40.1% of anesthetists being at high risk of burnout, generally speaking the risk of burnout among anesthetists was not higher than in other occupational groups in Germany. However, burnout risks for specific groups, such as female junior doctors in anesthesia, were higher and the possibility of providing social support in the workplace should be considered.