Der Anaesthesist
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One of the main limitations concerning the use of local anesthetics is due to their restricted duration of action. In recent years, liposomal formulations with prolonged release kinetics have been developed to extend the pharmacological duration of action of the 1‑stage peripheral regional anesthesia (single-shot procedure) and thus bring about a longer duration of action. The focus here is particularly on achieving postoperative freedom from pain for at least 24 h (or even better 48 h) and thus early mobilization of patients using on-demand medication causing (at most) minor local sensory blockade without causing motor impairments (at least that is the ideal). ⋯ Recent systematic reviews and meta-analyses, combining the results of clinical studies regarding the analgesic efficiency of liposomal bupivacaine in different fields of application, consistently refuted any benefit of clinical relevance provided by the liposomal formulation. There is currently sufficient evidence to now end the ongoing debate around liposomal bupivacaine. The aim of this work is to give the reader a current, evidence-based overview of this substance.
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In 1989 the United Nations passed the "United Nations Convention on the Rights of the Child" (UNCRC) and, among others, demanded the highest attainable standard of health for children. Safe Anesthesia for Every Tot (SAFETOTS, www.safetots.org ), an association of internationally active pediatric anesthetists, has derived 10 rights, the 10 R's, which are of essential importance for the pediatric anesthetic practice. The first right (R1) postulates: "Children have the right to enjoy the highest possible standard of health. ⋯ The "pay for performance" must change to "pay for quality". In addition to broad basic pediatric care, all complex forms of pediatric treatment must be carried out in specialized pediatric centers, particularly for small and severely ill children. Significant improvement can be achieved at the local level by reorganization, bundling of pediatric surgical interventions within a clinical unit together with the concentration on a dedicated team.
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In 2019 a total of 756 people died in Germany while registered on the waiting list for an organ transplantation. With 10.8 organ donors/million inhabitants in 2019, Germany belongs to the bottom group in the Eurotransplant foundation as well as worldwide. ⋯ Critical care physicians play an important role in the identification of potential doners and are also the main point of contact for relatives; however, multiple uncertainties exist regarding the process of organ donation not only in discussions in the media and society but also among physicians involved in intensive care medicine. Many assumptions and hypotheses, which have been associated with the low number of donors, lack scientific evidence and are discussed in this article.
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The implementation of patient blood management (PBM) is increasingly becoming standard in operative medicine. Recently, interest has also been shown for the vulnerable collective of pregnant women and neonates. ⋯ Furthermore, loss of blood in anticipation of bleeding complications should be reduced by interdisciplinary preventive measures and an individually coordinated postpartum care should be organized. This results in an early diagnosis of anemia or iron deficiency with subsequent treatment also postpartum, analogous to the prepartum period.