Der Anaesthesist
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Physical, cognitive and social frailty is increasingly being recognized as a prognostic factor in the perioperative treatment of older patients; however, the concept of frailty has not been introduced into clinical routine in anesthesia. ⋯ In contrast to commonly used perioperative risk classifications, frailty is a sensitive marker for the patient's biological age. Therefore, it appears more suitable for estimating the perioperative risk than chronological age or other conventional tools, such as the ASA classification and is therefore a prerequisite for patient centered treatment pathways.
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Difficult airway management is a key skill in preclinical emergency medicine. A lower rate of subjective difficult airways and an increased success rate of endotracheal intubation have been reported for highly trained emergency physicians. The aim of this study was therefore to analyze the effect for different specialists and the individual state of training in the German emergency medical system. ⋯ The level of training in airway management especially for non-anesthetists is inhomogeneous. The recently published German S1 guidelines for prehospital airway management recommend education and training as well as the primary use of the video laryngoscope with Macintosh blade. The implementation could lower the incidence of subjective difficult airways.
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In recent years, ultrasound (US) has become more incorporated into anesthesia and intensive care medicine. The German Anesthesia Society established a modular curriculum to teach US skills. Until now, the efficacy of this modular curriculum has not been validated. ⋯ This study shows that although this US course curriculum has positively enhanced the trainees' theoretical knowledge of US practice, it does not enhance the practical application of that theoretical knowledge. To improve this curriculum, a supervised clinically practical training should follow the course.
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Approximately one third of all children in Germany are delivered by cesarean section. Depending on the individual patient's condition and the situation, the anesthesiologist has to choose between a general or a regional anesthesia regimen. The decisive factor for the selection is the obstetric urgency (decision-delivery time) after ascertainment of the indications. Furthermore, the need for postoperative analgesia varies depending on the chosen anesthesia regimen.