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Der Anaesthesist [journal]
- [Nocebo effects and negative suggestion in anesthesia.] [JOURNAL ARTICLE]
- Anaesthesist 2014 Oct 19.
Anesthetists have an impact on patients and healing processes not only through drugs, interventions and therapy but also significantly by their words and personality. A substantial part of observed side effects is caused by nocebo effects and negative suggestion, i.e. by the doctor and the medical surroundings. Every symptom of an illness, side effect or complication can also be induced by the wrong way of talking about it. Patients perceive medical situations, such as an emergency, anesthesia or intensive care as extreme or even as life-threatening. This can induce a natural trance, an altered state of consciousness characterized by increased suggestibility. Suggestions affect mental functions, such as anxiety and pain as well as physical functions. Strong figurative words, ambiguity, misunderstandings, incidental conversations, medical jargon and risk information are prone to generate negative suggestion. Not the informed consent per se but the way it is presented should be under scrutiny. Knowledge about nocebo effects and negative suggestion can help recognize and avoid these more easily. These negative factors depend on the context, i.e. they are strongly influenced by the individual background history and anxieties of the patient and also by the physician-patient relationship. The best protection against harm from informed consent and negative suggestion is a supportive therapeutic relationship.
- [Question prompt list for premedication consultation : Patient-oriented information on anesthesia.] [JOURNAL ARTICLE]
- Anaesthesist 2014 Oct 17.
The anesthesia premedication consultation is an obligatory procedure prior to any upcoming surgery. It is the anesthesiologist's responsibility to collect all necessary information regarding the patient's medical condition to decide on the appropriate narcosis and to ensure that the patient comprehends the anesthesia procedure and its effects.Information needs of patients regarding anesthesia are often not adequately fulfilled. This study was carried out to develop a structured questionnaire containing questions that patients may wish to ask the anesthesiologist (question prompt list anesthesiology QPL-A) to support information transfer from the anesthesiologist to the patient in the premedication consultation. The questionnaire should measure the information needs of the patient regarding different aspects of the anesthesia process with good psychometric qualities.Based on a literature review and interviews with experts a list of anesthesia-related questions was developed and distributed to patients receiving premedication consultation at the University Medical Center in Mainz, Germany (n = 202). In addition, patients were also asked to complete the state trait operation anxiety inventory (STOA).Using principal component analysis and subsequent varimax rotation (declaration of total variance 68 %), four reliable information needs scales were extrapolated: (1) anesthesia procedure and effects (QPL-A-E, α = 0.92), (2) anesthesia safety (QPL-A-S, α = 0.86), (3) advice concerning preanesthesia behavior (QPL-A-B, α = 0.85) and (4) anesthetists actions (QPL-A-A, α = 0.79). In order to obtain sufficient information regarding the QPL-A-S, the procedure itself and its effects (QPL-A-E) were found to be of greatest importance for the patients and behavioral changes (QPL-A-B), e. g. stopping smoking, were judged to be less important by the patients. Women scored higher on the QPL-A-E (U-test p ≤ 0.001) and QPL-A-A (U-test p ≤ 0.05) than men. Elderly patients (≥ 70) showed significantly more interest in safety information (QPL-A-S) than younger patients (≤ 39, U-test p ≤ 0.05). All scales showed a significant positive correlation with STOA trait anxiety (r = 0.29-0.50) but only the QPL-A-E and the QPL-A-S scales were associated with STOA state anxiety (QPL-A-E: affective r = 30, cognitive r = 0.36, both p ≤ 0.001; QPL-A-S: affective r = 19, p ≤ 0.05, cognitive r = 0.23, p ≤ 0.01). Self-assessed knowledge on narcosis correlated only weakly with the QPL-A-E (r = 0.21 p ≤ 0.01) but not with the other information areas. Information needs were not associated with the education level of the patient, American Society of Anesthesiologists (ASA) classification and malignancy of the disease. Most of the participants (77 %) evaluated the QPL-A to be very or fairly helpful for the expression of their information needs.The QPL-A is a useful tool for meeting the subjective information needs of patients which could improve the patient orientation of the anesthesia premedication consultation.
- [Perioperative management of patients with rheumatoid arthritis.] [JOURNAL ARTICLE]
- Anaesthesist 2014 Oct 17.
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint and systemic manifestations. As the prevalence in the adult population is approximately 1 %, anesthesia management in patients with RA has to be performed on a regular basis. Besides elective orthopedic surgery, e.g. surgery of the cervical spine, all other types of planned and emergency surgery should also be anticipated. Administering anesthesia to a patient with RA can be challenging not only due to a higher incidence of difficult intubation but also because of various organ manifestations as well as an elevated cardiovascular risk. Furthermore, possible complications should be considered in patients with chronic medication, particularly in patients treated with immunomodulating drugs. Therefore, a careful preoperative evaluation, preparation for possible difficult airway management and a selective anesthesia management in patients with RA can prevent possible complications.
- [Which learning methods are expected for ultrasound training? : Blended learning on trial]. [English Abstract, Journal Article]
- Anaesthesist 2014 Oct; 63(10):745-52.
Current teaching methods in graduate and postgraduate training often include frontal presentations. Especially in ultrasound education not only knowledge but also sensomotory and visual skills need to be taught. This requires new learning methods.This study examined which types of teaching methods are preferred by participants in ultrasound training courses before, during and after the course by analyzing a blended learning concept. It also investigated how much time trainees are willing to spend on such activities.A survey was conducted at the end of a certified ultrasound training course. Participants were asked to complete a questionnaire based on a visual analogue scale (VAS) in which three categories were defined: category (1) vote for acceptance with a two thirds majority (VAS 67-100 %), category (2) simple acceptance (50-67 %) and category (3) rejection (< 50 %).A total of 176 trainees participated in this survey. Participants preferred an e-learning program with interactive elements, short presentations (less than 20 min), incorporating interaction with the audience, hands-on sessions in small groups, an alternation between presentations and hands-on-sessions, live demonstrations and quizzes. For post-course learning, interactive and media-assisted approaches were preferred, such as e-learning, films of the presentations and the possibility to stay in contact with instructors in order to discuss the results. Participants also voted for maintaining a logbook for documentation of results.The results of this study indicate the need for interactive learning concepts and blended learning activities. Directors of ultrasound courses may consider these aspects and are encouraged to develop sustainable learning pathways.
- [Rational fluid and volume replacement therapy : Wishful dream or realistic future option]. [Journal Article]
- Anaesthesist 2014 Oct; 63(10):727-9.
- [Terminology in the context of anesthesia for preterm and term newborns and infants.] [JOURNAL ARTICLE]
- Anaesthesist 2014 Oct 8.
An acceptable, standardized and mandatory terminology is important for the planning and implementation of anesthetic procedures on term and preterm newborns and infants. Contradictory use of perinatal terminology poses a problem in current medical practice. This article provides an overview of conventional definitions and technical terms. It also puts forward terminological principles for a model of risk stratification of anesthesia in the newborn period and infancy.
- [Venoarterial extracorporeal membrane oxygenation : Be-all and end-all of cardiopulmonary support]. [Journal Article]
- Anaesthesist 2014 Sep; 63(8-9):623-4.
- [Unexpected hemorrhage complications in association with celecoxib : Spontaneously reported case series after perioperative pain treatment in gynecological operations.] [JOURNAL ARTICLE]
- Anaesthesist 2014 Oct 4.
A series of cases of postoperative bleeding were reported to the Drug Commission of the German Medical Association (Arzneimittelkommission der deutschen Ärzteschaft, AkdÄ) within the spontaneous reporting system after the regimen for postoperative pain treatment was changed from diclofenac (150 mg per day) to celecoxib (400 mg per day). All patients underwent elective gynecological surgery and 7 out of 11 patients with postoperative bleeding required revision surgery. Although alternative causes for the hemorrhage incidents could not be excluded, the documented circumstances could have been indicative of a possible causal association. Studies on perioperative pain treatment with celecoxib had previously shown no increased risk of hemorrhage. The tendency to hemorrhage observed in the registered cases could not be pharmacologically explained; however, due to the high dosages of celecoxib and the extensive co-medications used, a relative overdosing due to drug interactions or differences in the metabolism of the affected patients was conceivable. Celecoxib is not approved for the treatment of acute postoperative pain although a number of studies were carried out on the effectiveness and safety in patients undergoing surgery.
- [From fishing trip to the critical care unit : Successful resuscitation after a near drowning accident.] [JOURNAL ARTICLE]
- Anaesthesist 2014 Sep 18.
In the context of the European Resuscitation Council (ERC) guidelines, modifications of the proposed treatment algorithm need to be performed in order to respond to different parameters. In this respect several factors interacting with cardiac arrest are essential and need to be included in the therapy. This case report demonstrates an example of resuscitation in the situation of hypothermia.After a near drowning accident and approximately 30 min underwater, a patient suffering from severe hypothermia initially required resuscitation after the rescue. A return of spontaneous circulation (ROSC) was successfully achieved within a short length of time and after 15 days on the intensive care unit the patient was discharged to a rehabilitation facility without any signs of focal neurological deficits.Section 8 of the ERC guidelines provides additional information for resuscitation under specific conditions. In this case report, hypothermia was one of the main criteria leading to an adjusted pharmacological therapy. Furthermore, selection of the appropriate hospital for an optimal advanced treatment including controlled warming of the patient and management of hypothermia-induced complications had to be evaluated.
- [Spectrum of missions for a rescue helicopter : Changes in a south German urban area over the last 25 years.] [JOURNAL ARTICLE]
- Anaesthesist 2014 Sep 18.
Over the past decade the number of air rescue missions has increased continuously. The reasons for this are still discussed at great length. In addition to the demographic changes to becoming an increasingly older and sicker society, the political reform in the healthcare system with a simultaneous reduction and concentration of hospitals and formation of centers is also under discussion.The key questions to be answered are, therefore, can the increasing demands on the emergency physician really be explained by an increasing number of severely ill and injured patients? Is a proportion of the missions really not indicated because they do not involve immediately life-threatening "acute medical" emergencies and are caused by a lack of alternative paramedical service infrastructures, unavailability of a general practitioner or the only temporary availability of medical on-call standby services?This study therefore analyzed the alterations of a possible change with respect to the spectrum of missions and the utilization of air rescue services in the metropolitan area of Stuttgart. All primary missions of the rescue helicopter (RTH) "Christoph 41" (based in Leonberg) from 2006 to 2011 were included in the study and compared to the data from 1987 to 1992.The indications for missions and the spectrum of patients for the RTH Christoph 41 have changed over the last 25 years. The proportion of emergency trauma cases has significantly decreased and missions for non-trauma cases have increased. The proportion of patients with life-threatening conditions has increased. Despite the change in the spectrum of missions, emergency physicians are confronted with a greater number of patients with life-threatening conditions than 25 years ago. The patients treated were on average clearly older than the patients who were treated by the air rescue service 25 years ago.The changes in the spectrum of missions up to more emergencies involving non-trauma patients and older patients must be taken into consideration during training and advanced training.