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Vetter L, Sümpelmann R, Rudolph D, Röher K, Vetter M, Boethig D, Eich C, Dennhardt N. Short anesthesia without intravenous fluid therapy in children: Results of a prospective non-interventional multicenter observational study. Paediatr Anaesth 2024; 34:454-458. [PMID: 38269449 DOI: 10.1111/pan.14847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND The German guidelines recommend that intravenous fluid therapy should not be mandatorily performed in children with short fasting times undergoing short anesthesia, but there is a lack of clinical studies including a large number of pediatric patients. Therefore, we performed a prospective non-interventional multicenter observational study to evaluate the perioperative hemodynamic and metabolic stability of children undergoing short anesthesia without intravenous fluid therapy. AIMS The primary aim was to assess the incidence of hypotension and the secondary aim was to assess the real preoperative fasting times, the incidence of hypoglycemia and the impact on ketone bodies and acid-base balance. METHODS Children aged 1 month-18 years undergoing short anesthesia (<1 h) without intravenous fluid therapy were enrolled. Patient demographics, the surgical or diagnostic procedure performed, anesthesia, hemodynamic, laboratory data, and adverse events were documented using a standardized case report form. RESULTS Four hundred and twenty seven children that were investigated at three pediatric centers from July 2021 to June 2022 (mean age 83.4 ± 58.9 months, body weight 27.9 ± 19.8 kg) were included in the analysis. The real preoperative fasting times were 14.2 ± 3.6 h for solids, 7.2 ± 3.5 h for milk and 5 ± 4.8 h for clear fluids. During the course of anesthesia, hypotension (<2.5th percentile) was detected in 3 of 427 cases (0.7%), hypoglycemia (glucose <3.0 mmol L-1) in 1 of 355 cases (0.3%), and ketosis (ketone bodies ≥0.6 mmol L-1) in 51 of 233 cases (21.9%). The occurrence of ketosis was associated with lower body weight (p <.001) and longer fasting times for solids or milk (p =.021), but not for clear fluids (p =.69). CONCLUSIONS Our study supported the German guidelines recommendation that perioperative intravenous fluid therapy is not mandatory in children beyond the neonatal period with short pre- and postoperative fasting times undergoing short anesthesia (<1 h).
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Affiliation(s)
- Lisa Vetter
- Clinic of Anesthesiology, Hannover Medical School, Hannover, Germany
| | - Robert Sümpelmann
- Clinic of Anesthesiology, Hannover Medical School, Hannover, Germany
| | - Diana Rudolph
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany
| | - Katharina Röher
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mathäus Vetter
- Clinic of Anesthesiology, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Clinic for Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Eich
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany
| | - Nils Dennhardt
- Clinic of Anesthesiology, Hannover Medical School, Hannover, Germany
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Deitmer T, Beck CE, Becke-Jakob K, Eich C, Hackenberg S, Hoffmann TK, Koitschev A, Löhler J, Röher K, Sittel C, Welkoborsky HJ, Wienke A, Badelt G. [Statement on the lower age limit for outpatient adenotomies and tonsillotomies]. Laryngorhinootologie 2024; 103:17-24. [PMID: 38086413 DOI: 10.1055/a-2216-8474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
At the beginning of 2023, there have been significant changes to the regulations for outpatient surgery in Germany, which were set out in a trilateral self-administration agreement between the umbrella association of statutory health insurance companies, the German Hospital Association and the Federal Association of Statutory Health Insurance Physicians. Among other things, a catalog stated circumstances under which an operation should not be carried out on an outpatient basis or should only be carried out with doubt. This catalog explains the patient's age: up to the first year of life, inpatient performance of a service can be justified. This formulation in itself means that children from one year of age on should regularly undergo outpatient surgery.In the german scientific societies for otolaryngology, head and neck surgery as well as for anesthesiology and intensive care medicine, doubts arose as to whether this age limit could also be scientifically justified for operations in the throat such as adenotomy or tonsillotomy.A search was carried out in international guidelines and in the international literature and the statements were evaluated. The results of this literature search were discussed with representatives of the Pediatric Otorhinolaryngology Working Group (AG PädHNO) of the German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC) and the scientific working group for pediatric anesthesia (WAKKA) of the German Society for Anesthesiology and Intensive Care Medicine (DGAI) in conferences.The consensus revealed that a strict age limit of the first year of life is not appropriate for the outpatient performance of adenotomies and tonsillotomies. First of all, specifying a strict age limit is questionable because, regardless of age, a number of other medical and social factors influence the responsible performance of outpatient operations. Furthermore, the age limit of one year is not considered appropriate in view of literature, guidelines and practical experience in the international area. The assessment of the literature and the consideration of the implementation in the international area make an age limit in the range of 2-3 years seem more appropriate.This review provides the responsible doctors with a variety of insights, aspects and arguments so that they can make their decision to carry out these operations on an outpatient or inpatient basis appropriately and responsibly.
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Affiliation(s)
- T Deitmer
- Arbeitsgemeinschaft pädiatrische HNO-Heilkunde (AG PädHNO) der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC), Bonn
| | - C E Beck
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover
| | - K Becke-Jakob
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Berufsverband Deutscher Anästhesistinnen und Anästhesisten. Klinik Hallerwiese-Cnopfsche Kinderklinik, Nürnberg
| | - C Eich
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Abteilung Anästhesie, Kinderintensiv- und Notfallmedizin, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover
| | - S Hackenberg
- Arbeitsgemeinschaft pädiatrische HNO-Heilkunde (AG PädHNO) der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC), Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg
| | - T K Hoffmann
- Arbeitsgemeinschaft pädiatrische HNO-Heilkunde (AG PädHNO) der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC), Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Ulm
| | - A Koitschev
- Arbeitsgemeinschaft pädiatrische HNO-Heilkunde (AG PädHNO) der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC), Klinik für Hals-Nasen-Ohrenkrankheiten, Plastische Operationen, Klinikum Stuttgart
| | - J Löhler
- Deutscher Berufsverband der HNO-Ärzte, Neumünster
| | - K Röher
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Eppendorf, Hamburg
| | - C Sittel
- Arbeitsgemeinschaft pädiatrische HNO-Heilkunde (AG PädHNO) der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC), Klinik für Hals-Nasen-Ohrenkrankheiten, Plastische Operationen, Klinikum Stuttgart
| | - H J Welkoborsky
- Arbeitsgemeinschaft pädiatrische HNO-Heilkunde (AG PädHNO) der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC), Klinik für HNO-Heilkunde, Krankenhaus Nordstadt, Kliniken Region Hannover
| | - A Wienke
- Fachanwalt für Medizinrecht, Justiziar der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC), Bonn
| | - G Badelt
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Klinik für Anästhesie und Kinderanästhesie, Krankenhaus Barmherzige Brüder Regensburg, Klinik St. Hedwig, Regenburg
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Abstract
PURPOSE OF REVIEW This review gives an overview of the safety aspects for paediatric procedural sedation and a discussion of possibilities for optimizing structure, processes and outcomes. RECENT FINDINGS Procedural sedation in paediatric patients is performed by providers of different specialties and compliance with safety standards is a basic requirement regardless of provider specialty. This includes preprocedural evaluation, monitoring, equipment and profound expertise of sedation teams. The choice of sedative medications and the possibility of incorporating nonpharmacological methods play an important role for optimal outcome. In addition, an ideal outcome from the patient's perspective includes optimized processes and clear and empathetic communication. SUMMARY Institutions providing paediatric procedural sedation must ensure the comprehensive training of sedations teams. Furthermore, institutional standards for equipment, processes and optimal choice of medication depending on performed procedure and comorbidities of the patient must be established. At the same time, organizational and communication aspects should be considered.
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Affiliation(s)
- Katharina Röher
- Department of Anesthesiolgy, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Karin Becke-Jakob
- Department of Anesthesia, Hospital Hallerwiese - Cnopf Children's Hospital, St.-Johannis-Mühlgasse 19, Nürnberg
| | - Christoph Eich
- Department of Anaesthesia, Paediatric Intensiv Care and Emergency Medicine, Auf der Bult Children' s Hospital, Hannover, Germany
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Güth J, Jung P, Schiele A, Urban B, Parsch A, Matsche B, Eich C, Becke-Jakob K, Landsleitner B, Russo SG, Bernhard M, Hossfeld B, Olivieri M, Hoffmann F. [Update 2022: interdisciplinary statement on airway management with supraglottic airway devices in pediatric emergency medicine-The laryngeal mask is and remains state of the art : Joint statement of the Institute for Emergency Medicine and Medicine Management (INM), the University Clinic Munich, LMU Munich, Germany, the Working Group for Pediatric Critical Care and Emergency Medicine of the German Interdisciplinary Society for Critical Care and Emergency Medicine (DIVI), the Medical Directors of Emergency Medical Services in Bavaria (ÄLRD), the Scientific Working Group for Pediatric Anesthesia (WAKKA) of the German Society for Anesthesiology and Intensive Care Medicine (DGAI), the Scientific Working Group for Emergency Medicine of the German Society for Anesthesiology and Intensive Care Medicine (DGAI) and the Society of Neonatology and Pediatric Critical Care Medicine (GNPI)]. Anaesthesiologie 2023:10.1007/s00101-023-01284-2. [PMID: 37222766 DOI: 10.1007/s00101-023-01284-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Airway management with supraglottic airway devices (SGA) in life-threatening emergencies in children is increasingly being used. Different specifications of laryngeal masks (LM) and the laryngeal tube (LT) are commonly used devices for this purpose. We present a literature review and interdisciplinary consensus statement of different societies on the use of SGA in pediatric emergency medicine. MATERIAL AND METHODS Literature review in the PubMed database and classification of studies according to the criteria of the Oxford Centre for Evidence-based Medicine. Levels and consensus finding within the group of authors. RESULTS The evidence for successful applications of the various types of LM is significantly higher than for LT application. Reported smaller series of successful applications of LT are currently limited to selected research groups and centers. Especially for children below 10 kg body weight there currently exists insufficient evidence for the successful application of the LT and therefore its routine use cannot be recommended. SGAs used for emergencies should have a gastric drainage possibility. DISCUSSION Considering the scientific data and the large clinical experience with the LM in medical routine and emergency situations in children currently only the LM can be recommended for alternative (i.e., non-intubation) emergency airway management in children. If alternative airway management is part of a local emergency strategy, the LM should be provided in all pediatric sizes (1, 1½, 2, 2½, 3) for out of hospital use and in hospital emergency use and all users should regularly be trained in its application.
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Affiliation(s)
- J Güth
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, München, Deutschland
| | - P Jung
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - A Schiele
- Ärztliche Leitung, Rettungsdienst Bayern (ÄLRD Bayern), München, Deutschland
| | - B Urban
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, München, Deutschland
| | - A Parsch
- Ärztliche Leitung, Rettungsdienst Bayern (ÄLRD Bayern), München, Deutschland
| | - B Matsche
- Ärztliche Leitung, Rettungsdienst Bayern (ÄLRD Bayern), München, Deutschland
| | - C Eich
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - K Becke-Jakob
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - B Landsleitner
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - S G Russo
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - M Bernhard
- Wissenschaftlicher Arbeitskreis Notfallmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - B Hossfeld
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - M Olivieri
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - F Hoffmann
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland.
- Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin (GNPI), Berlin, Deutschland.
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Institut für Notfallmedizin und Medizinmanagement (INM), Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337, München, Deutschland.
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Jung P, Brenner S, Bachmann I, Both C, Cardona F, Dohna-Schwake C, Eich C, Eifinger F, Huth R, Heimberg E, Landsleitner B, Olivieri M, Sasse M, Weisner T, Wagner M, Warnke G, Ziegler B, Boettiger BW, Nadkarni V, Hoffmann F. Mehr als 500 Kinder pro Jahr könnten gerettet werden! Zehn Thesen zur Verbesserung der Qualität pädiatrischer Reanimationen im deutschsprachigen Raum. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sümpelmann R, Camporesi A, Gálvez I, Pechilkov D, Eich C, Kretz FJ, Perera Sarri R, Tancheva D, Serrano-Casabon S, Murphy P, Astuto M, Zanaboni C, Becke K, Dennhardt N. Modified fluid gelatin 4% for perioperative volume replacement in pediatric patients (GPS): Results of a European prospective noninterventional multicenter study. Paediatr Anaesth 2022; 32:825-833. [PMID: 35426196 DOI: 10.1111/pan.14459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/01/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Modified fluid gelatin 4% is approved for use in children, but there is still a surprising lack of clinical studies including large numbers of pediatric patients. Therefore, we performed a European prospective noninterventional multicenter study to evaluate the use of a modified fluid gelatin 4% in saline (sal-GEL) or an acetate-containing balanced electrolyte solution (bal-GEL) in children undergoing major pediatric surgery. AIMS The primary aim was to assess the indications and dosing of modified fluid gelatin, and the secondary aim was to assess the safety and efficacy, focusing, in particular, on routinely collected clinical parameters. METHODS Children aged up to 12 years with ASA risk scores of I-III receiving sal-GEL or bal-GEL were followed perioperatively. Demographic data, surgical procedures performed, anesthesia, hemodynamic and laboratory data, adverse events, and adverse drug reactions were documented using a standardized case report form. RESULTS 601 children that were investigated at 13 European pediatric centers from May 2015 to March 2020 (sal-GEL 20.1%, bal-GEL 79.9%; mean age 29.1 ± 38.6 (range 0-144) months; body weight 12.1 ± 10.5 (1.4-70) kg) were included in the analysis. The most frequent indications for GEL infusion were hemodynamic instability without bleeding (76.0%), crystalloids alone not being sufficient for hemodynamic stabilization (55.7%), replacement of preoperative deficit (26.0%), and significant bleeding (13.0%). Mean infused GEL volume was 13.0 ± 5.3 (2.4-37.5) ml kg-1 . The total dose was affected by age, with higher doses in younger patients. After gelatin infusion, mean arterial pressure increased (mean change 8.5 ± 7.3 [95% CI: 8 to 9.1] mmHg), and the hemoglobin concentrations decreased significantly (mean change -1.1 ± 1.8 [95% CI: -1.2 to -0.9] g·dL-1 ). Acid-base parameters were more stable with bal-GEL. No serious adverse drug reactions directly related to gelatin (i.e., anaphylactoid reaction, clotting disorders, and renal failure) were observed. CONCLUSION Moderate doses up to 20 ml kg-1 of modified fluid gelatin were infused most frequently to improve hemodynamic stability in children undergoing major pediatric surgery. The acid-base balance was more stable when gelatin in a balanced electrolyte solution was used instead of saline. No serious adverse drug reactions associated with gelatin were observed.
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Affiliation(s)
- Robert Sümpelmann
- Clinic of Anaesthesiology, Hannover Medical School, Hannover, Germany
| | - Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, "V. Buzzi" Children's Hospital, University of Milan, Milan, Italy
| | - Ignacio Gálvez
- Department of Pediatric Anesthesia, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Dimitar Pechilkov
- Pediatric Cardiac Intensive Care Unit, Department of Pediatric Cardiology, National Cardiology Hospital, Sofia, Bulgaria
| | - Christoph Eich
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany
| | - Franz-Josef Kretz
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Remei Perera Sarri
- Department of Paediatric Anaesthesia, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Dora Tancheva
- Intensive Care Unit, Burn Injury Clinic, University Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov", Sofia, Bulgaria
| | | | - Peter Murphy
- Department of Paediatric Anaesthesia, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Marinella Astuto
- Department of Anesthesiology and Intensive Care, AOU Policlinico- San Marco Catania, Catania, Italy
| | - Clelia Zanaboni
- Department of Anaesthesia, Critical Care and Perinatal Medicine, Istituto Giannina Gaslini, Genoa, Italy
| | - Karin Becke
- Department of Anaesthesia and Intensive Care, Cnopfsche Kinderklinik/Klinik Hallerwiese, Nürnberg, Germany
| | - Nils Dennhardt
- Clinic of Anaesthesiology, Hannover Medical School, Hannover, Germany
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Eich C, Becke-Jakob K, Röher K. [Imagine that it was your child!]. Anaesthesist 2022; 71:253-254. [PMID: 35384442 DOI: 10.1007/s00101-022-01117-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Christoph Eich
- Kinder- und Jugendkrankenhaus Auf der Bult, Abteilung Anästhesie, Kinderintensiv- und Notfallmedizin, Janusz-Korczak-Allee 12, 30173, Hannover, Deutschland. .,Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), DGAI, .
| | - Karin Becke-Jakob
- Cnopfsche Kinderklinik/Klinik Hallerwiese, Abteilung Anästhesie, Kinderanästhesie und Intensivmedizin, Nürnberg, Deutschland.,Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), DGAI
| | - Katharina Röher
- Universitätsklinikum Hamburg-Eppendorf, Zentrum für Anästhesiologie und Intensivmedizin, Klinik und Poliklinik für Anästhesiologie, Hamburg, Deutschland.,Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), DGAI
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Schramm D, Freitag N, Nicolai T, Wiemers A, Hinrichs B, Amrhein P, DiDio D, Eich C, Landsleitner B, Eber E, Hammer J. Pediatric Airway Endoscopy: Recommendations of the Society for Pediatric Pneumology. Respiration 2021; 100:1128-1145. [PMID: 34098560 DOI: 10.1159/000517125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022] Open
Abstract
For many decades, pediatric bronchoscopy has been an integral part of the diagnosis and treatment of acute and chronic pulmonary diseases in children. Rapid technical advances have continuously influenced the performance of the procedure. Over the years, the application of pediatric bronchoscopy has considerably expanded to a broad range of indications. In this comprehensive and up-to-date guideline, the Special Interest Group of the Society for Pediatric Pneumology reviewed the most recent literature on pediatric bronchoscopy and reached a consensus on a safe technical performance of the procedure.
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Affiliation(s)
- Dirk Schramm
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Nadine Freitag
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Thomas Nicolai
- University Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Anna Wiemers
- Ruhr University Bochum, St. Josef-Hospital, University Hospital of Pediatrics and Adolescent Medicine, Department of Pediatric Pulmonology, Bochum, Germany
| | - Bernd Hinrichs
- Pediatric Practice Buchholz and Asklepios Medical School Hamburg, Hamburg, Germany
| | - Peter Amrhein
- Department of Pediatric Otorhinolaryngology, Klinikum Stuttgart Katharinenhospital, Olgahospital, Stuttgart, Germany
| | - Diana DiDio
- Department of Pediatric Otorhinolaryngology, Klinikum Stuttgart Katharinenhospital, Olgahospital, Stuttgart, Germany
| | - Christoph Eich
- Department of Anesthesia, Pediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany
| | - Bernd Landsleitner
- Department of Anaesthesia and Intensive Care Medicine, Hallerwiese Clinic-Cnopf Children's Hospital, Nuremberg, Germany
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Jürg Hammer
- Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland
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Kaufmann J, Grozeva B, Laschat M, Brackhahn M, Rudolph D, Neuhaus N, Hubertus J, Wappler F, Eich C. Rapid and safe removal of foreign bodies in the upper esophagus in children using an optimized Miller size 3 video laryngoscope blade. Paediatr Anaesth 2021; 31:587-593. [PMID: 33583069 DOI: 10.1111/pan.14158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Foreign bodies lodged in the upper esophagus in children may result in life-threatening complications, especially with button batteries. Rapid removal is essential to prevent complications. Experts report that extraction with a suitable laryngoscope and a forceps is feasible under general anesthesia, but no further data had been available so far. AIMS To study foreign body visualization and removal from the upper esophagus in children using a new optimized Miller size 3 blade video laryngoscope. METHODS This prospective observational study was performed in three pediatric hospitals. The clinical observations were reported anonymously on an electronic spreadsheet after obtaining the informed consent from the parents or guardians. During the observational period from January 2019 to October 2020, all children with a foreign body lodged into the upper esophagus were eligible for participation and 22 cases were included. Main outcome measures were rates of successful removal and complications as well as duration of the procedure. Secondary outcome was subjective assessment regarding the quality of the visualization and the feasibility of the procedure. RESULTS Success rate was 100% with no complications. Mean intervention and anesthesia times were 5 ± 4 minutes and 26 ± 25 minutes. Quality of visualization of the foreign body was judged as 'excellent' or 'good' in all cases and the feasibility of the procedure as 'without' or 'with little' effort in 95% of all cases. CONCLUSION The new Miller size 3 video laryngoscope enables rapid, easy, and reliable extraction of foreign bodies when they are located in the upper part of the esophagus. As early removal of esophageal foreign bodies, especially with button batteries, prevents life-threatening complications, we suggest this technique as the first choice of treatment.
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Affiliation(s)
- Jost Kaufmann
- Department for Paediatric Anaesthesia, Children's Hospital Cologne, Cologne, Germany.,Faculty for Health, University Witten/Herdecke, Witten, Germany
| | - Boyana Grozeva
- Department for Paediatric Anaesthesia, Children's Hospital Cologne, Cologne, Germany.,Faculty for Health, University Witten/Herdecke, Witten, Germany
| | - Michael Laschat
- Department for Paediatric Anaesthesia, Children's Hospital Cologne, Cologne, Germany
| | - Michael Brackhahn
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hanover, Germany
| | - Diana Rudolph
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hanover, Germany
| | - Nikolas Neuhaus
- Department of Paediatric Surgery, Dr. von, Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jochen Hubertus
- Department of Paediatric Surgery, Dr. von, Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Frank Wappler
- Department for Paediatric Anaesthesia, Children's Hospital Cologne, Cologne, Germany.,Faculty for Health, University Witten/Herdecke, Witten, Germany
| | - Christoph Eich
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hanover, Germany
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10
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Badelt G, Goeters C, Becke-Jakob K, Deitmer T, Eich C, Höhne C, Stuck BA, Wiater A. S1-Leitlinie: Obstruktive Schlafapnoe im Rahmen von Tonsillenchirurgie mit oder ohne Adenotomie bei Kindern – perioperatives Management. Somnologie 2021. [DOI: 10.1007/s11818-021-00303-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Badelt G, Goeters C, Becke-Jakob K, Deitmer T, Eich C, Höhne C, Stuck BA, Wiater A. [German S1 guideline: obstructive sleep apnea in the context of tonsil surgery with or without adenoidectomy in children-perioperative management]. HNO 2020; 69:3-13. [PMID: 33354732 DOI: 10.1007/s00106-020-00970-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
Otolaryngologic surgery is one of the most frequent operative interventions performed in children. Tonsil surgery with or without adenoidectomy due to hyperplasia of the tonsils and adenoids with obstruction of the upper airways with or without tympanic ventilation disorder is the most common of these procedures. Children with a history of sleep apnoea (OSA) suffer from a significantly increased risk of perioperative respiratory complications. Cases of death and severe permanent neurologic damage have been reported due to apnoea and increased opioid sensitivity. The current guideline represents a pragmatic risk-adjusted approach. Patients with confirmed or suspected OSA should be treated perioperatively according to their individual risks and requirements, in order to avoid severe permanent damage.
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Affiliation(s)
- G Badelt
- Klinik für Anästhesie und Kinderanästhesie, Krankenhaus Barmherzige Brüder Regensburg, Klinik St. Hedwig, Steinmetzstraße 1-3, 93049, Regensburg, Deutschland. .,Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI)
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Nürnberg, Deutschland.
| | - C Goeters
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI)
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Nürnberg, Deutschland
| | - K Becke-Jakob
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI)
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Nürnberg, Deutschland
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V. (DGHNO KHC), Friedrich-Wilhelm-Str. 2, 53113, Bonn, Deutschland
| | - C Eich
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI)
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Nürnberg, Deutschland
| | - C Höhne
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI)
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Nürnberg, Deutschland
| | - B A Stuck
- Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V. (DGHNO KHC), Friedrich-Wilhelm-Str. 2, 53113, Bonn, Deutschland
| | - A Wiater
- Kinder- und Jugendmedizin/Schlafmedizin, Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM)
- Arbeitsgruppe Pädiatrie im Konvent der Deutschen Gesllschaft für Kinder- und Jugendmedizin, Schwalmstadt-Treysa, Deutschland
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12
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13
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Hoffmann F, Böttiger BW, Eich C. [Best possible balance between risk to those providing help and the benefit for the patients]. Notf Rett Med 2020; 23:462-464. [PMID: 32863757 PMCID: PMC7445804 DOI: 10.1007/s10049-020-00769-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- F. Hoffmann
- Campus Innenstadt, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Interdisziplinäre Kinderintensivstation – Kindernotfallmedizin, LMU Klinikum, Lindwurmstr. 4, 80337 München, Deutschland
| | - B. W. Böttiger
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln (AöR), Köln, Deutschland
| | - C. Eich
- Abteilung Anästhesie, Kinderintensiv- und Notfallmedizin, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland
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14
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Beck CE, Rudolph D, Mahn C, Etspüler A, Korf M, Lüthke M, Schindler E, Päukert S, Trapp A, Megens JHAM, Oppitz F, Badelt G, Röher K, Genähr A, Fink G, Müller-Lobeck L, Becke-Jakob K, Wermelt JZ, Boethig D, Eich C, Sümpelmann R. Impact of clear fluid fasting on pulmonary aspiration in children undergoing general anesthesia: Results of the German prospective multicenter observational (NiKs) study. Paediatr Anaesth 2020; 30:892-899. [PMID: 32533888 DOI: 10.1111/pan.13948] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND A preliminary national audit of real fasting times including 3324 children showed that the fasting times for clear fluids and light meals were frequently shorter than recommended in current guidelines, but the sample size was too small for subgroup analyses. AIMS Therefore, the primary aim of this extended study with more participating centers and a larger sample size was to determine whether shortened fasting times for clear fluids or light meals have an impact on the incidence of regurgitation or pulmonary aspiration during general anesthesia in children. The secondary aim was to evaluate the impact of age, emergent status, ASA classification, induction method, airway management or surgical procedure. METHODS After the Ethics Committee's approval, at least more than 10 000 children in total were planned to be enrolled for this analysis. Patient demographics, real fasting times, anesthetic and surgical procedures, and occurrence of target adverse events defined as regurgitation or pulmonary aspiration were documented using a standardized case report form. RESULTS At fifteen pediatric centers, 12 093 children scheduled for surgery or interventional procedures were included between October 2018 and December 2019. Fasting times were shorter than recommended in current guidelines for large meals in 2.5%, for light meals in 22.4%, for formula milk in 5.3%, for breastmilk in 10.9%, and for clear fluids in 39.2%. Thirty-one cases (0.26%) of regurgitation, ten cases (0.08%) of suspected pulmonary aspiration, and four cases (0.03%) of confirmed pulmonary aspiration were reported, and all of them recovered quickly without any consequences. Fasting times for clear fluids shortened from 2 hours to 1 hour did not affect the incidence of adverse events (upper limit 95% CI 0.08%). The sample size of the cohort with fasting times for light meals shorter than 6 hours was too small for a subgroup analysis. An age between one and 3 years (odds ratio 2.7,95% CI 1.3 to 5.8%; P < .01) and emergent procedures (odds ratio 2.8,95% CI 1.4 to 5.7;P < .01) increased the incidence of adverse events, whereas ASA classification, induction method, or surgical procedure had no influence. The clear fluid fasting times were shortest under 6/4/0 as compared to 6/4/1 and 6/4/2 fasting regimens, all with an incidence of 0.3% for adverse events. CONCLUSION This study shows that a clear fluid fasting time shortened from 2 hours to 1 hour does not affect the incidence of regurgitation or pulmonary aspiration, that an age between one and 3 years and emergent status increase the incidence of regurgitation or pulmonary aspiration, and that pulmonary aspiration followed by postoperative respiratory distress is rare and usually shows a quick recovery.
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Affiliation(s)
- Christiane E Beck
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Diana Rudolph
- Department of Anesthesia, Pediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany
| | - Christoph Mahn
- Department of Anesthesia, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | | | - Michael Korf
- Anesthesia practice, Lüthke&Korf, Hamburg, Germany
| | | | - Ehrenfried Schindler
- Section Pediatric Anesthesiology, Department of Anesthesiology, University Hospital Bonn, Bonn, Germany.,Department of Anesthesia, Asklepios Children's Hospital, St. Augustin, Germany
| | - Susanne Päukert
- Department of Anesthesia, Asklepios Children's Hospital, St. Augustin, Germany
| | - Almut Trapp
- Department of Anesthesia, Intensive Care Medicine, Pain Medicine and Palliative Care Medicine, Sana Clinic Leipziger Land, Borna, Germany
| | - Johanna H A M Megens
- Department of Anesthesia, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Francesca Oppitz
- Department of Anesthesia, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Gregor Badelt
- Department of Anesthesiology and Pediatric Anesthesiology, Clinic St. Hedwig, Barmherzige Brüder Hospital Regensburg, Regensburg, Germany
| | - Katharina Röher
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arka Genähr
- Department of Anesthesia, Intensive Care Medicine, Emergency Medicine and Pain Medicine Vivantes Hospital Neukölln, Berlin, Germany
| | - Gordon Fink
- Department of Anesthesia, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Vivantes Hospital im Friedrichshain, Berlin, Germany
| | - Lutz Müller-Lobeck
- Clinic of Anesthesiology and Intensive Care Medicine, Lippe Hospital, Detmold, Germany
| | - Karin Becke-Jakob
- Department of Anesthesia, Cnopf'sches Children's Hospital, Nürnberg, Germany
| | - Julius Z Wermelt
- Department of Anesthesia and Pediatric Anesthesia, Bürgerhospital and Clementinen Children's Hospital, Frankfurt, Germany
| | - Dietmar Boethig
- Department for Paediatric Cardiology and Intensive Care, Hannover Medical School, Germany
| | - Christoph Eich
- Department of Anesthesia, Pediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany
| | - Robert Sümpelmann
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
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15
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Jung P, Brenner S, Bachmann I, Both C, Cardona F, Dohna-Schwake C, Eich C, Eifinger F, Huth R, Heimberg E, Landsleitner B, Olivieri M, Sasse M, Weisner T, Wagner M, Warnke G, Ziegler B, Boettiger BW, Nadkarni V, Hoffmann F. More Than 500 Kids Could Be Saved Each Year! Ten Consensus Actions to Improve Quality of Pediatric Resuscitation in DACH-Countries (Austria, Germany, and Switzerland). Front Pediatr 2020; 8:549710. [PMID: 33117762 PMCID: PMC7575775 DOI: 10.3389/fped.2020.549710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/31/2020] [Indexed: 12/21/2022] Open
Abstract
• Quality and outcome of pediatric resuscitation often does not achieve recommended goals. • Quality improvement initiatives with the aim of better survival rates and decreased morbidity of resuscitated children are urgently needed. • These initiatives should include an action framework for a comprehensive, fundamental, and interprofessional reorientation of clinical and organizational structures concerning resuscitation and post-resuscitation care of children. • The authors of this DACH position statement suggest the implementation of 10 evidence-based actions (for out-of-hospital and in-house cardiac arrests) that should improve survival rates and decrease morbidity of resuscitated children with better neurological outcome and quality of life.
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Affiliation(s)
- Philipp Jung
- University Children's Hospital, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Sebastian Brenner
- Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Iris Bachmann
- University Children's Hospital Zürich, Zurich, Switzerland
| | - Christian Both
- University Children's Hospital Zürich, Zurich, Switzerland
| | - Francesco Cardona
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Christoph Eich
- Department of Anaesthesia, Pediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hanover, Germany
| | | | - Ralf Huth
- University Children's Hospital, Mainz, Germany
| | - Ellen Heimberg
- Department of Pediatric Cardiology, Pulmology and Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany
| | | | - Martin Olivieri
- Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Sasse
- University Children's Hospital, Medical School Hannover, Hanover, Germany
| | - Thomas Weisner
- University Children's Hospital, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Gert Warnke
- University Children's Hospital Graz, Graz, Austria
| | | | - Bernd W Boettiger
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Vinay Nadkarni
- Children's Hospital of Philadelphia, University of Pennsylvania Perlman School of Medicine, Philadelphia, PA, United States
| | - Florian Hoffmann
- Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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16
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Beck CE, Rudolp D, Becke-Jakob K, Schindler E, Etspüler A, Trapp A, Fink G, Müller-Lobeck L, Röher K, Genähr A, Eich C, Sümpelmann R. Real fasting times and incidence of pulmonary aspiration in children: Results of a German prospective multicenter observational study. Paediatr Anaesth 2019; 29:1040-1045. [PMID: 31435997 DOI: 10.1111/pan.13725] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prolonged fasting before anesthesia is still common in children. Shortened fasting times may improve the metabolic and hemodynamic condition during induction of anesthesia and the perioperative experience for parents and children and simplify perioperative management. As a consequence, some centers in Germany have reduced fasting requirements, but the national guidelines are still unchanged. AIMS This prospective multicenter observational study was initiated by the Scientific Working Group for Pediatric Anesthesia of the German Society of Anesthesiology and Intensive Care Medicine to evaluate real fasting times and the incidence of pulmonary aspiration before a possible revision of national fasting guidelines. METHODS After the Ethics Committee's approval, at least 3000 children were planned to be enrolled for this analysis. Patient demographics, real fasting times, anesthetic and surgical procedures and occurrence of regurgitation or pulmonary aspiration were documented using a standardized case report form. Results were presented as median [interquartile range] (range) or incidence (percentage). RESULTS At ten pediatric centers, 3324 children were included between October 2018 and May 2019. The real fasting times for large meals were 14 [12.2-15.6] (0.5-24) hours, for light meals 9 [5.6-13.3] (0.25-28.3) hours, for formula milk 5.8 [4.5-7.4] (0.9-24) hours, for breast milk 4.8 [4.2-6.3] (1.3-25.3) hours and for clear fluids 2.7 [1.5-6] (0.03-22.8) hours. Prolonged fasting (deviation from guideline >2 hours) was reported for large meals in 88.3%, for light meals in 54.7%, for formula milk in 44.4%, for breast milk in 25.8% and for clear fluids in 34.2%. Eleven cases (0.33%) of regurgitation, four cases (0.12%) of suspected pulmonary aspiration and two cases (0.06%) of confirmed pulmonary aspiration were reported; all of them could be extubated after the end of the procedure and recovered without any incidents. CONCLUSION This study shows that prolonged fasting is still common in pediatric anesthesia in Germany that pulmonary aspiration with postoperative respiratory distress is rare and that improvements to current local fasting regimens and national fasting guidelines are urgently needed.
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Affiliation(s)
- Christiane E Beck
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Diana Rudolp
- Department of Anesthesia, Pediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany
| | - Karin Becke-Jakob
- Department of Anesthesia, Cnopf'sches Children's Hospital, Nürnberg, Germany
| | | | | | - Almut Trapp
- Department of Anesthesia, Intensive Care Medicine, Pain Medicine and Palliative Care Medicine, Sana Clinic Leipziger Land, Borna, Germany
| | - Gordon Fink
- Department of Anesthesia, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Vivantes Hospital im Friedrichshain, Berlin, Germany
| | - Lutz Müller-Lobeck
- Clinic of Anesthesiology and Intensive Care Medicine, Lippe Hospital, Detmold, Germany
| | - Katharina Röher
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arka Genähr
- Department of Anesthesia, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Vivantes Hospital Neukölln, Berlin, Germany
| | - Christoph Eich
- Department of Anesthesia, Pediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany
| | - Robert Sümpelmann
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
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17
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Nemeth M, Jacobsen N, Bantel C, Fieler M, Sümpelmann R, Eich C. Intranasal Analgesia and Sedation in Pediatric Emergency Care-A Prospective Observational Study on the Implementation of an Institutional Protocol in a Tertiary Children's Hospital. Pediatr Emerg Care 2019; 35:89-95. [PMID: 28121974 DOI: 10.1097/pec.0000000000001017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Children presenting with acute traumatic pain or in need of therapeutic or diagnostic procedures require rapid and effective analgesia and/or sedation. Intranasal administration (INA) promises to be a reliable, minimally invasive delivery route. However, INA is still underused in Germany. We hence developed a protocol for acute pain therapy (APT) and urgent analgesia and/or sedation (UAS). Our aim was to evaluate the effectiveness and safety of our protocol. METHODS We performed a prospective observational study in a tertiary children's hospital in Germany. Pediatric patients aged 0 to 17 years requiring APT or UAS were included. Fentanyl, s-ketamine, midazolam, or combinations were delivered according to protocol. Primary outcome variables included quality of analgesia and/or sedation as measured on age-appropriate scales and time to onset of drug action. Secondary outcomes were adverse events and serious adverse events. RESULTS One hundred pediatric patients aged 0.3 to 16 years were enrolled, 34 for APT and 66 for UAS. The median time onset of drug action was 5 minutes (ranging from 2 to 15 minutes). Fentanyl was most frequently used for APT (n = 19). Pain scores decreased by a median of 4 points (range, 0-10; P < 0.0001). For UAS, s-ketamine/midazolam was most frequently used (n = 25). Sedation score indicated minimal sedation in most cases. Overall success rate after the first attempt was 82%. Adverse events consisted of nasal burning (n = 2) and vomiting (n = 2). No serious adverse events were recorded. CONCLUSIONS A fentanyl-, s-ketamine-, and midazolam-based INA protocol was effective and safe for APT and UAS. It should then be considered where intravenous access is impossible or inappropriate.
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Affiliation(s)
| | - Nils Jacobsen
- University Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Klinikum Oldenburg, Oldenburg
| | - Carsten Bantel
- University Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Klinikum Oldenburg, Oldenburg
| | - Melanie Fieler
- Clinic for Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Robert Sümpelmann
- Clinic for Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Christoph Eich
- From the Departments of Anesthesia, Pediatric Intensive Care and Emergency Medicine, and
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18
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Kramer S, Krebs M, Spies C, Ghamari S, Höhne C, Becke K, Eich C, Hoeft A, Wermelt J, Ellerkmann RK. [Drama in the Recovery Unit: Paediatric Emergence Delirium]. Anasthesiol Intensivmed Notfallmed Schmerzther 2018; 53:766-776. [PMID: 30458574 DOI: 10.1055/a-0575-0473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The upcoming and ongoing debate on neurotoxicity of anesthetics at a young age put a new spotlight on the emergence delirium of children (paedED). The European Society for Anesthesiology published a consensus guideline on prevention and therapy in 2017 which can be a useful guidance in daily clinical practice. Patient data management systems with their clear documentation concerning pain/therapy of pain and paedED will be valuable tools in order to assess the real incidence of paedED. Differentiating between pain/agitation and paedED migth not always be easy. Age-adapted scores should always be applied. Main focus in the prevention of paedED is the reduction of anxiety. The way this is achieved by the dedicated pediatric anesthesia teams caring for children, e.g. by oral midazolam, clowns, music, smartphone induction, does not matter. Using α2-agonists in the perioperative phase and applying propofol seems to be effective. A quiet supportive environment for recovery adds to a relaxed, stress-free awakening. For the future detecting paedED on normal wards becomes an important issue. This may be achieved by structured interviews or questionnaires assessing postoperative negative behavioural changes at the same time.
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19
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Becke K, Eich C, Höhne C, Jöhr M, Machotta A, Schreiber M, Sümpelmann R. Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA). Paediatr Anaesth 2018; 28:588-596. [PMID: 29851190 DOI: 10.1111/pan.13383] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2018] [Indexed: 12/13/2022]
Abstract
Inspired by the Choosing Wisely initiative, a group of pediatric anesthesiologists representing the German Working Group on Paediatric Anaesthesia (WAKKA) coined and agreed upon 10 concise positive ("dos") or negative ("don'ts") evidence-based recommendations. (i) In infants and children with robust indications for surgical, interventional, or diagnostic procedures, anesthesia or sedation should not be avoided or delayed due to the potential neurotoxicity associated with the exposure to anesthetics. (ii) In children without relevant preexisting illnesses (ie, ASA status I/II) who are scheduled for elective minor or medium-risk surgical procedures, no routine blood tests should be performed. (iii) Parental presence during the induction of anesthesia should be an option for children whenever possible. (iv) Perioperative fasting should be safe and child-friendly with shorter real fasting times and more liberal postoperative drinking and enteral feeding. (v) Perioperative fluid therapy should be safe and effective with physiologically composed balanced electrolyte solutions to maintain a normal extracellular fluid volume; addition of 1%-2.5% glucose to avoid lipolysis, hypoglycemia, and hyperglycemia, and colloids as needed to maintain a normal blood volume. (vi) To achieve safe and successful airway management, the locally accepted airway algorithm and continued teaching and training of basic and alternative techniques of ventilation and endotracheal intubation are required. (vii) Ultrasound and imaging systems (eg, transillumination) should be available for achieving central venous access and challenging peripheral venous and arterial access. (viii) Perioperative disturbances of the patient's homeostasis, such as hypotension, hypocapnia, hypothermia, hypoglycemia, hyponatremia, and severe anemia, should not be ignored and should be prevented or treated immediately. (ix) Pediatric patients with an elevated perioperative risk, eg, preterm and term neonates, infants, and critically ill children, should be treated at institutions where all caregivers have sufficient expertise and continuous clinical exposure to such patients. (x) A strategy for preventing postoperative vomiting, emergence delirium, and acute pain should be a part of every anesthetic procedure.
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Affiliation(s)
- Karin Becke
- Department of Anaesthesia and Intensive Care, Cnopf Children's Hospital/Hospital Hallerwiese, Nürnberg, Germany
| | - Christoph Eich
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany
| | - Claudia Höhne
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Martin Jöhr
- Department of Anaesthesia, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Andreas Machotta
- Department of Anaesthesiology, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands
| | - Markus Schreiber
- Department of Anaesthesiology, University Hospital Ulm, Ulm, Germany
| | - Robert Sümpelmann
- Clinic for Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
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Sümpelmann R, Fieler M, Eich C, Becke K, Badelt G, Leimkühler K, Dennhardt N. Metamizole for Postoperative Pain Therapy in Infants Younger than 1 Year. Eur J Pediatr Surg 2017; 27:269-273. [PMID: 27595441 DOI: 10.1055/s-0036-1587332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background Due to possible serious adverse drug reactions (ADRs), the use of metamizole for postoperative pain therapy in infants is a subject of debate. Safety studies with large sample sizes are missing. Aim This prospective multicenter observational study was conducted to evaluate the use of metamizole in infants younger than 1 year undergoing surgery with a particular focus on possible serious ADRs (e.g., hemodynamic, anaphylactic or respiratory reactions, and agranulocytosis). Methods Infants aged up to 1 year (American Society of Anesthesiologists [ASA] I-III) receiving a single dose of metamizole for postoperative pain therapy were enrolled. Patient demographics, main and secondary diagnosis, surgical procedures performed, metamizole dose, hemodynamic data, use of other analgesics and regional blocks, results of pain measurement, and incidence of ADRs were documented using a standardized case report form. Results A total of 316 infants observed at five pediatric centers were included for analysis (age 4.4 ± 3.7 [0.06-12] months). Mean metamizole dose was 17.8 ± 3.1 (9.2-29.8) mg·kg-1. Mean arterial pressure (MAP) remained stable during metamizole infusion (MAP before infusion 45 ± 9.5 [25-95] and after infusion 45 ± 9.2 [25-99] mm Hg). Erythema was observed in one patient (ADRs total: 0.3%, 95% confidence interval: 0.27-0.32). No respiratory adverse events directly related to the metamizole administration and no clinical signs of agranulocytosis were reported. Conclusion Single intravenous doses of metamizole used for prevention or treatment of postoperative pain were safe in more than 300 infants younger than 1 year. The statistical probability of serious ADRs (e.g., hemodynamic, anaphylactic or respiratory reactions) was lower than 1%. The sample size and follow-up were not sufficient to detect agranulocytosis.
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Affiliation(s)
- Robert Sümpelmann
- Clinic for Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Melanie Fieler
- Clinic for Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Christoph Eich
- Department of Anesthesia, Pediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany
| | - Karin Becke
- Department of Anesthesiology and Intensive Care Medicine, Cnopf'sche Kinderklinik/Klinik Hallerwiese, Nuremberg, Germany
| | - Gregor Badelt
- Department of Anesthesiology and Pediatric Anesthesiology, Krankenhaus Barmherzige Brüder Regensburg/Klinik St. Hedwig, Regensburg, Germany
| | - Klaus Leimkühler
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine and Pain Therapy, Protestant Hospital Bielefeld, Bielefeld, Germany
| | - Nils Dennhardt
- Clinic for Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
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21
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Wirtz S, Eich C, Becke K, Brenner S, Callies A, Harding U, Höhne C, Hoffmann F, Kaufmann J, Landsleitner B, Marung H, Nicolai T, Reifferscheid F, Trappe U, Jung P. [Use of cognitive aids in pediatric emergency care : Interdisciplinary consensus statement]. Anaesthesist 2017; 66:340-346. [PMID: 28455650 DOI: 10.1007/s00101-017-0310-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Preclinical pediatric emergencies are rare events and are therefore often associated with stress and uncertainty for emergency medical service personnel. To ensure adequate treatment of pediatric patients a variety of different cognitive aids exist (e.g. books, apps, rulers, weight-adapted bag systems). Especially the size specifications of the medical equipment and the dosage of emergency medication are individually very different in children and are dependent on parameters, such as body height and weight. Therefore, cognitive aids often enable length measurement whereby it is possible to draw conclusions on body weight for calculating the child's medication dosage. These aids may help to avoid the wrong medication dose or the wrong therapy of children but uncritical and untrained usage of these aids carries a potential risk of mistakes. This recommendation gives an overview of the general requirements and different problems of cognitive aids and should help improve the general framework and the rational basis for the use and further development of cognitive aids in emergency medicine.
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Affiliation(s)
- S Wirtz
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland
| | - C Eich
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland.,Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutschen Gesellschaft für Anästhesie und Intensivmedizin (DGAI), Nürnberg, Deutschland.,Sektion Pädiatrische Intensiv- und Notfallmedizin der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - K Becke
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutschen Gesellschaft für Anästhesie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - S Brenner
- Sektion Pädiatrische Intensiv- und Notfallmedizin der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - A Callies
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland
| | - U Harding
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland
| | - C Höhne
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutschen Gesellschaft für Anästhesie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - F Hoffmann
- Sektion Pädiatrische Intensiv- und Notfallmedizin der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - J Kaufmann
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutschen Gesellschaft für Anästhesie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - B Landsleitner
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutschen Gesellschaft für Anästhesie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - H Marung
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland
| | - T Nicolai
- Sektion Pädiatrische Intensiv- und Notfallmedizin der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - F Reifferscheid
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland
| | - U Trappe
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland
| | - P Jung
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland. .,Sektion Pädiatrische Intensiv- und Notfallmedizin der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland. .,Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
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22
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Brenner S, Eich C, Rellensmann G, Schuhmann MU, Nicolai T, Hoffmann F. [Recommendation on temperature management after cardiopulmonary arrest and severe traumatic brain injury in childhood beyond the neonatal period : Statement of the German Society for Neonatology and Pediatric Intensive Care Medicine (GNPI) and the scientific Working Group for Paediatric Anaesthesia (WAKKA) of the German Society of Anaesthesiology and Intensive Care (DGAI)]. Anaesthesist 2017; 66:128-133. [PMID: 28091756 DOI: 10.1007/s00101-016-0256-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The available data on the effectiveness of therapeutic hypothermia in different patient groups are heterogeneous. Although the benefits have been proven for some collectives, recommendations for the use of hypothermia treatment in other groups are based on less robust data and conclusions by analogy. This article gives a review of the current evidence of temperature management in all age groups and based on this state of knowledge, recommends active temperature management with the primary aim of strict normothermia (36-36.5 °C) for 72 hours after cardiopulmonary arrest or severe traumatic brain injury for children beyond the neonatal period.
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Affiliation(s)
- S Brenner
- Neonatologie und pädiatrische Intensivmedizin, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - C Eich
- Abteilung Anästhesie, Kinderintensiv- und Notfallmedizin, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland
| | - G Rellensmann
- Neonatologie und pädiatrische Intensivmedizin, Klinik für Kinder- und Jugendmedizin - Allgemeine Pädiatrie, Universitätsklinikum Münster, Münster, Deutschland
| | - M U Schuhmann
- Bereich Pädiatrische Neurochirurgie, Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - T Nicolai
- Interdisziplinäre Kinderintensivstation, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, München, Deutschland
| | - F Hoffmann
- Interdisziplinäre Kinderintensivstation, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, München, Deutschland
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Sümpelmann R, Becke K, Brenner S, Breschan C, Eich C, Höhne C, Jöhr M, Kretz FJ, Marx G, Pape L, Schreiber M, Strauss J, Weiss M. Perioperative intravenous fluid therapy in children: guidelines from the Association of the Scientific Medical Societies in Germany. Paediatr Anaesth 2017; 27:10-18. [PMID: 27747968 DOI: 10.1111/pan.13007] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2016] [Indexed: 12/19/2022]
Abstract
This consensus- based S1 Guideline for perioperative infusion therapy in children is focused on safety and efficacy. The objective is to maintain or re-establish the child's normal physiological state (normovolemia, normal tissue perfusion, normal metabolic function, normal acid- base- electrolyte status). Therefore, the perioperative fasting times should be as short as possible to prevent patient discomfort, dehydration, and ketoacidosis. A physiologically composed balanced isotonic electrolyte solution (BS) with 1-2.5% glucose is recommended for the intraoperative background infusion to maintain normal glucose concentrations and to avoid hyponatremia, hyperchloremia, and lipolysis. Additional BS without glucose can be used in patients with circulatory instability until the desired effect is achieved. The additional use of colloids (albumin, gelatin, hydroxyethyl starch) is recommended to recover normovolemia and to avoid fluid overload when crystalloids alone are not sufficient and blood products are not indicated. Monitoring should be extended in cases with major surgery, and autotransfusion maneuvers should be performed to assess fluid responsiveness.
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Affiliation(s)
- Robert Sümpelmann
- Clinic for Anaesthesiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany
| | - Karin Becke
- Department of Anaesthesiology and Intensive Care Medicine, Cnopf'sche Kinderklinik/Klinik Hallerwiese, Nuremberg, Germany
| | - Sebastian Brenner
- Department of Pediatric and Adolescent Medicine, University Hospital Dresden, Dresden, Germany
| | | | - Christoph Eich
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hanover, Germany
| | - Claudia Höhne
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Martin Jöhr
- Section of Paediatric Anaesthesia, Department of Anaesthesia, Kantonsspital, Luzern, Switzerland
| | - Franz-Josef Kretz
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Gernot Marx
- Department of Intensive and Intermediate Care Medicine, University Hospital of RWTH Aachen, Aachen, Germany
| | - Lars Pape
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hanover Medical School, Hanover, Germany
| | - Markus Schreiber
- Department of Anesthesiology, Ulm University Medical Center, Ulm, Germany
| | - Jochen Strauss
- Clinic for Anesthesiology, Perioperative Medicine and Pain Therapy, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Markus Weiss
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
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Eich C, Nicolai T, Hammer J, Deitmer T, Schmittenbecher P, Schubert K, Laschat M, Sittel C, Claßen M, Becke K, Bootz F, Höhne C, Jungehülsing M, Windfuhr J. Interdisziplinäre Versorgung von Kindern nach Fremdkörperaspiration und -ingestion. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0159-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Eich C. Nicht Entweder-oder, sondern Sowohl-als-auch! Anaesthesist 2016; 65:413-4. [DOI: 10.1007/s00101-016-0182-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Eich C, Nicolai T, Hammer J, Deitmer T, Schmittenbecher P, Schubert KP, Laschat M, Sittel C, Claßen M, Becke K, Bootz F, Höhne C, Jungehülsing M, Windfuhr J. [In Process Citation]. Laryngorhinootologie 2016; 95:321-31. [PMID: 27135426 DOI: 10.1055/s-0042-102614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- C Eich
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)
| | - T Nicolai
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)
| | - J Hammer
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)
| | - T Deitmer
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)
| | - P Schmittenbecher
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)
| | - K-P Schubert
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)
| | - M Laschat
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)
| | - C Sittel
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)
| | - M Claßen
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)
| | - K Becke
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)
| | - F Bootz
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)
| | - C Höhne
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)
| | - M Jungehülsing
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)
| | - J Windfuhr
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)
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27
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Eich C, Deitmer T. Einführung zur S2K-Leitlinie interdisziplinäre Versorgung von Kindern nach Fremdkörperaspiration und Fremdkörperingestion. Laryngorhinootologie 2016; 95:320. [DOI: 10.1055/s-0042-102623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Eich C, Landsleitner B. [Resuscitation - cardiopulmonary resuscitation in infants and children (paediatric life support)]. Anasthesiol Intensivmed Notfallmed Schmerzther 2016; 51:196-207. [PMID: 27022699 DOI: 10.1055/s-0041-103639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In children, severe emergencies and cardiorespiratory arrests in particular are relatively rare but time-critical events. As compared to adults, hypoxic arrests caused by respiratory disorders that may subsequently result in pulseless electrical activity or asystole are more prevalent. The current Paediatric Life Support (PLS) Guidelines 2015 of the European Resuscitation Council (ERC) acknowledge both limited scientific evidence and aspects of practicability. They also take into account the rather limitedpaediatric routine that most providers have as well as national and local infrastructural differences. Particular emphasis was put on early recognition and treatment of a critically ill or injured child, hence the prevention of cardiorespiratory arrest and the early start of lay rescuer interventions. There have been no major changes in the 2010 algorithms, including retention of the ABC sequence (airway, breathing, circulation).
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Ott H, Eich C, Schriek K, Ludwikowski B. [Hereditary epidermolysis bullosa in school children and adolescents. Clinical picture and interdisciplinary management]. Hautarzt 2016; 67:279-86. [PMID: 26943360 DOI: 10.1007/s00105-016-3774-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hereditary epidermolysis bullosa (EB) represents a clinically heterogeneous group of congenital blistering disorders requiring multiprofessional care. EB is associated with a broad spectrum of potentially severe complications often reaching their full extent during school age and adolescence. This review aims at summarizing cutaneous manifestations of EB as well as extracutaneous complications of this complex disease and their interdisciplinary management.
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Affiliation(s)
- H Ott
- Fachbereich Pädiatrische Dermatologie und Allergologie, Kinder- und Jugendkrankenhaus AUF DER BULT, Janusz-Korczak-Allee 12, 30173, Hannover, Deutschland. .,Epidermolysis bullosa-Zentrum Hannover, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland.
| | - C Eich
- Abt. Anästhesie, Kinderintensiv- und Notfallmedizin, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland
| | - K Schriek
- Epidermolysis bullosa-Zentrum Hannover, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland.,Abt. Kinderchirurgie und Kinderurologie, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland
| | - B Ludwikowski
- Epidermolysis bullosa-Zentrum Hannover, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland.,Abt. Kinderchirurgie und Kinderurologie, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland
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Keil J, Jung P, Schiele A, Urban B, Parsch A, Matsche B, Eich C, Becke K, Landsleitner B, Russo SG, Bernhard M, Nicolai T, Hoffmann F. Erratum zu: Interdisziplinär konsentierte Stellungnahme zum Atemwegsmanagement mit supraglottischen Atemwegshilfen in der Kindernotfallmedizin – Larynxmaske ist State-of-the-art. Anaesthesist 2016; 65:121. [DOI: 10.1007/s00101-015-0132-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- Christoph Eich
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany.
| | - Oana-Roxana Funke
- Department of Paediatric Radiology and Sonography, Children's Hospital Auf der Bult, Hannover, Germany
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Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlář A, Wyllie J, Zideman DA, Alfonzo A, Arntz HR, Askitopoulou H, Bellou A, Beygui F, Biarent D, Bingham R, Bierens JJ, Böttiger BW, Bossaert LL, Brattebø G, Brugger H, Bruinenberg J, Cariou A, Carli P, Cassan P, Castrén M, Chalkias AF, Conaghan P, Deakin CD, De Buck ED, Dunning J, De Vries W, Evans TR, Eich C, Gräsner JT, Greif R, Hafner CM, Handley AJ, Haywood KL, Hunyadi-Antičević S, Koster RW, Lippert A, Lockey DJ, Lockey AS, López-Herce J, Lott C, Maconochie IK, Mentzelopoulos SD, Meyran D, Monsieurs KG, Nikolaou NI, Nolan JP, Olasveengen T, Paal P, Pellis T, Perkins GD, Rajka T, Raffay VI, Ristagno G, Rodríguez-Núñez A, Roehr CC, Rüdiger M, Sandroni C, Schunder-Tatzber S, Singletary EM, Skrifvars MB, Smith GB, Smyth MA, Soar J, Thies KC, Trevisanuto D, Truhlář A, Vandekerckhove PG, de Voorde PV, Sunde K, Urlesberger B, Wenzel V, Wyllie J, Xanthos TT, Zideman DA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95:1-80. [PMID: 26477410 DOI: 10.1016/j.resuscitation.2015.07.038] [Citation(s) in RCA: 564] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Koenraad G Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | - Ian K Maconochie
- Paediatric Emergency Medicine Department, Imperial College Healthcare NHS Trust and BRC Imperial NIHR, Imperial College, London, UK
| | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jonathan Wyllie
- Department of Neonatology, The James Cook University Hospital, Middlesbrough, UK
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Maconochie IK, Bingham R, Eich C, López-Herce J, Rodríguez-Núñez A, Rajka T, Van de Voorde P, Zideman DA, Biarent D, Monsieurs KG, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:223-48. [DOI: 10.1016/j.resuscitation.2015.07.028] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Fernandez Castelao E, Boos M, Ringer C, Eich C, Russo SG. Effect of CRM team leader training on team performance and leadership behavior in simulated cardiac arrest scenarios: a prospective, randomized, controlled study. BMC Med Educ 2015; 15:116. [PMID: 26205962 PMCID: PMC4526177 DOI: 10.1186/s12909-015-0389-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Effective team leadership in cardiopulmonary resuscitation (CPR) is well recognized as a crucial factor influencing performance. Generally, leadership training focuses on task requirements for leading as well as non-leading team members. We provided crisis resource management (CRM) training only for designated team leaders of advanced life support (ALS) trained teams. This study assessed the impact of the CRM team leader training on CPR performance and team leader verbalization. METHODS Forty-five teams of four members each were randomly assigned to one of two study groups: CRM team leader training (CRM-TL) and additional ALS-training (ALS add-on). After an initial lecture and three ALS skill training tutorials (basic life support, airway management and rhythm recognition/defibrillation) of 90-min each, one member of each team was randomly assigned to act as the team leader in the upcoming CPR simulation. Team leaders of the CRM-TL groups attended a 90-min CRM-TL training. All other participants received an additional 90-min ALS skill training. A simulated CPR scenario was videotaped and analyzed regarding no-flow time (NFT) percentage, adherence to the European Resuscitation Council 2010 ALS algorithm (ADH), and type and rate of team leader verbalizations (TLV). RESULTS CRM-TL teams showed shorter, albeit statistically insignificant, NFT rates compared to ALS-Add teams (mean difference 1.34 (95% CI -2.5, 5.2), p = 0.48). ADH scores in the CRM-TL group were significantly higher (difference -6.4 (95% CI -10.3, -2.4), p = 0.002). Significantly higher TLV proportions were found for the CRM-TL group: direct orders (difference -1.82 (95% CI -2.4, -1.2), p < 0.001); undirected orders (difference -1.82 (95% CI -2.8, -0.9), p < 0.001); planning (difference -0.27 (95% CI -0.5, -0.05) p = 0.018) and task assignments (difference -0.09 (95% CI -0.2, -0.01), p = 0.023). CONCLUSION Training only the designated team leaders in CRM improves performance of the entire team, in particular guideline adherence and team leader behavior. Emphasis on training of team leader behavior appears to be beneficial in resuscitation and emergency medical course performance.
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Affiliation(s)
- Ezequiel Fernandez Castelao
- Department of Social and Communication Psychology, Georg-Elias-Müller Institute of Psychology, Georg-August-University Göttingen, Gosslerstraße 14, 37073, Göttingen, Germany.
| | - Margarete Boos
- Department of Social and Communication Psychology, Georg-Elias-Müller Institute of Psychology, Georg-August-University Göttingen, Gosslerstraße 14, 37073, Göttingen, Germany.
| | - Christiane Ringer
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Christoph Eich
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Janusz-Korczak-Allee 12, 30173, Hannover, Germany.
| | - Sebastian G Russo
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
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Kaune KM, Lauerer P, Kietz S, Eich C, Thoms KM, Schön MP, Zutt M. Die Kombinationstherapie infantiler Hämangiome mit gepulstem Farbstofflaser und Nd:YAG-Laser ist wirksam und sicher. J Dtsch Dermatol Ges 2014. [DOI: 10.1111/ddg.12354_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kjell M. Kaune
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsmedizin Göttingen
- Klinik für Dermatologie und Allergologie; Klinikum Bremen-Mitte; Bremen
| | - Peter Lauerer
- Klinik für Pädiatrische Hämatologie und Onkologie; Universitätsmedizin Göttingen
- Klinik für Pädiatrische Kardiologie und Intensivmedizin mit Neonatologie; Universitätsmedizin Göttingen
| | - Silke Kietz
- Klinik für Pädiatrische Hämatologie und Onkologie; Universitätsmedizin Göttingen
- Klinik für Pädiatrische Onkologie und Hämatologie; Universitätsmedizin Greifswald
| | - Christoph Eich
- Klinik für Anästhesiologie; Rettungs- und Intensivmedizin; Universitätsmedizin Göttingen
- Abteilung Anästhesie, Kinderintensiv- und Notfallmedizin; Kinder- und Jugendkrankenhaus Auf der Bult; Hannover
| | - Kai-Martin Thoms
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsmedizin Göttingen
| | - Michael P. Schön
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsmedizin Göttingen
| | - Markus Zutt
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsmedizin Göttingen
- Klinik für Dermatologie und Allergologie; Klinikum Bremen-Mitte; Bremen
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Kaune KM, Lauerer P, Kietz S, Eich C, Thoms KM, Schön MP, Zutt M. Combination therapy of infantile hemangiomas with pulsed dye laser and Nd:YAG laser is effective and safe. J Dtsch Dermatol Ges 2014; 12:473-8. [PMID: 24825388 DOI: 10.1111/ddg.12354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 03/17/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Infantile hemangiomas (IH) can cause severe complications such as obstruction, ulceration or heart failure. Therefore, in certain difficult-to-treat areas, or when there is no sign of involution, early and effective therapy is required. In rare instances, systemic treatments, like the beta-blocker propranolol and oral corticosteroids, can cause serious side effects. Effective and well-tolerated local treatment options are thus desirable as additive or alternative methods. PATIENTS AND METHODS In this retrospective interdisciplinary study, 38 children with 77 IH were treated with pulsed dye laser (PDL) (595 nm) and Nd:YAG laser (1,064 nm). The treatment success and side effects were evaluated according to objective and subjective parameters, including hemangioma thickness measured by ultrasound and the parents' evaluation of treatment. RESULTS All 77 treated IH responded to the therapy, of which 52.8 % healed after the end of treatment and 47.2 % had only minimum residual components. The success of treatment was assessed by the parents in 92.6 % as very good or good. Transient blistering occurred as the main side effect in 45.9 %. CONCLUSIONS Combination therapy with PDL and Nd:YAG laser represents an effective local method for IH with minimal side effects.
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Affiliation(s)
- Kjell M Kaune
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Germany; Dermatology and Allergology, Klinikum Bremen-Mitte, Bremen, Germany
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Eich C, Sinnig M, Guericke H. Akutversorgung des brandverletzten Kindes. Notf Rett Med 2014. [DOI: 10.1007/s10049-013-1809-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Witt L, Dennhardt N, Eich C, Mader T, Fischer T, Bräuer A, Sümpelmann R. Prevention of intraoperative hypothermia in neonates and infants: results of a prospective multicenter observational study with a new forced-air warming system with increased warm air flow. Paediatr Anaesth 2013; 23:469-74. [PMID: 23565702 DOI: 10.1111/pan.12169] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Neonates and infants are at the highest risk of developing perioperative hypothermia. A number of methods to prevent hypothermia during pediatric anesthesia are in use, and despite the fact that conventional forced-air warmers are the most effective devices, they are not always sufficient enough to maintain body temperature. Therefore, recently a new forced-air warming system with an increased warm air flow was introduced to the market. AIM The aim of this study was to evaluate this new forced-air warming system in neonates and infants during pediatric anesthesia. We hypothesized that the new blanket alone is sufficient enough to prevent neonates and infants from intraoperative hypothermia. METHODS Neonates and infants (body weight <10 kg) were enrolled in this prospective multicenter observational study. After admission to the operating room, the children were placed on the new forced-air warming blanket. Body temperature was measured continuously until admission to the recovery room or pediatric intensive care unit (PICU). RESULTS Hundred and nineteen children with a median body weight of 4.1 kg (range: 0.7-9.8) were enrolled and received their intended treatment. Median body temperature at the induction of anesthesia was 36.5 °C (range: 35.3-38.2 °C) and increased with the length of the operation up to 37.8 °C (37.1-38.2 °C) after 180 min. Median body temperature after admission to the recovery room or PICU was 37.2 °C (36.0-38.6 °C) and remained significantly above baseline (P < 0.05). CONCLUSIONS The new forced-air warming system as a sole warming device is effective in preventing perioperative hypothermia during pediatric anesthesia in neonates and infants.
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Affiliation(s)
- Lars Witt
- Department of Anaesthesiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany.
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Abstract
A number of video laryngoscopy systems have been introduced into anesthetic practice in recent years. Due to the technical concepts of these systems exposure of the laryngeal structures is usually better than with direct laryngoscopy, both in normal airways as well as in those that are difficult to manage. With the increasing use of video laryngoscopy it seems as if direct laryngoscopy and flexible fibrescopic intubation are at risk of becoming redundant. This article describes current developments and discusses why expertise in direct laryngoscopy and flexible fibrescopic intubation should be maintained, particularly by experts in airway management.
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Affiliation(s)
- S G Russo
- Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Deutschland.
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Russi EW, Karrer W, Brutsche M, Eich C, Fitting JW, Frey M, Geiser T, Kuhn M, Nicod L, Quadri F, Rochat T, Steurer-Stey C, Stolz D. Diagnosis and management of chronic obstructive pulmonary disease: the Swiss guidelines. Official guidelines of the Swiss Respiratory Society. ACTA ACUST UNITED AC 2013; 85:160-74. [PMID: 23406723 DOI: 10.1159/000346025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/21/2012] [Indexed: 02/05/2023]
Abstract
The new Swiss Chronic Obstructive Pulmonary Disease (COPD) Guidelines are based on a previous version, which was published 10 years ago. The Swiss Respiratory Society felt the need to update the previous document due to new knowledge and novel therapeutic developments about this prevalent and important disease. The recommendations and statements are based on the available literature, on other national guidelines and, in particular, on the GOLD (Global Initiative for Chronic Obstructive Lung Disease) report. Our aim is to advise pulmonary physicians, general practitioners and other health care workers on the early detection and diagnosis, prevention, best symptomatic control, and avoidance of COPD as well as its complications and deterioration.
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Affiliation(s)
- E W Russi
- Pulmonary Division, Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
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Russo S, Cremer S, Eich C, Jipp M, Cohnen J, Strack M, Quintel M, Mohr A. Magnetic resonance imaging study of the in vivo position of the extraglottic airway devices i-gel™ and LMA-Supreme™ in anaesthetized human volunteers. Br J Anaesth 2012; 109:996-1004. [DOI: 10.1093/bja/aes314] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Russo SG, Cremer S, Galli T, Eich C, Bräuer A, Crozier TA, Bauer M, Strack M. Randomized comparison of the i-gel™, the LMA Supreme™, and the Laryngeal Tube Suction-D using clinical and fibreoptic assessments in elective patients. BMC Anesthesiol 2012; 12:18. [PMID: 22871204 PMCID: PMC3434115 DOI: 10.1186/1471-2253-12-18] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 07/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The i-gel™, LMA-Supreme (LMA-S) and Laryngeal Tube Suction-D (LTS-D) are single-use supraglottic airway devices with an inbuilt drainage channel. We compared them with regard to their position in situ as well as to clinical performance data during elective surgery. METHODS Prospective, randomized, comparative study of three groups of 40 elective surgical patients each. Speed of insertion and success rates, leak pressures (LP) at different cuff pressures, dynamic airway compliance, and signs of postoperative airway morbidity were recorded. Fibreoptic evaluation was used to determine the devices' position in situ. RESULTS Leak pressures were similar (i-gel™ 25.9, LMA-S 27.1, LTS-D 24.0 cmH2O; the latter two at 60 cmH2O cuff pressure) as were insertion times (i-gel™ 10, LMA-S 11, LTS-D 14 sec). LP of the LMA-S was higher than that of the LTS-D at lower cuff pressures (p <0.05). Insertion success rates differed significantly: i-gel™ 95%, LMA-S 95%, LTS-D 70% (p <0.05). The fibreoptically assessed position was more frequently suboptimal with the LTS-D but this was not associated with impaired ventilation. Dynamic airway compliance was highest with the i-gel™ and lowest with the LTS-D (p <0.05). Airway morbidity was more pronounced with the LTS-D (p <0.01). CONCLUSION All devices were suitable for ventilating the patients' lungs during elective surgery. TRIAL REGISTRATION German Clinical Trial Register DRKS00000760.
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Affiliation(s)
- Sebastian G Russo
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medical Centre Göttingen, Robert-Koch-Straße 40, Göttingen, 37083, Germany.
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Sümpelmann R, Kretz FJ, Luntzer R, de Leeuw TG, Mixa V, Gäbler R, Eich C, Hollmann MW, Osthaus WA. Hydroxyethyl starch 130/0.42/6:1 for perioperative plasma volume replacement in 1130 children: results of an European prospective multicenter observational postauthorization safety study (PASS). Paediatr Anaesth 2012; 22:371-8. [PMID: 22211931 DOI: 10.1111/j.1460-9592.2011.03776.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Third-generation hydroxyethyl starch (HES) is now approved also for the use in children, but safety studies including large numbers of pediatric patients are still missing. Therefore, we performed an European multicentric prospective observational postauthorization safety study (PASS) to evaluate the use of HES 130/0.42/6:1 in normal saline (ns-HES) or a balanced electrolyte solution (bal-HES) in children undergoing surgery. METHODS Children aged up to 12 years with ASA risk scores of I-III receiving ns-HES (Venofundin 6%; Braun) or bal-HES (Tetraspan 6%; Braun) were followed perioperatively. Demographic data, surgical procedures performed, anesthesia, hemodynamic and laboratory data, adverse events (AE), and adverse drug reactions (ADR) were documented using a standardized case report form. RESULTS Of 1130 children studied at 11 European pediatric centers from 2006 to 2009 (ns-HES, 629 children; bal-HES, 475 children; mean age, 3.6 ± 3.8 [range, day of birth-12 years]; and body weight, 15.4 ± 13 [0.9-90 kg]), 1104 were included for analysis. The mean infused HES volume was 10.6 ± 5.8 (0.83-50) ml·kg(-1). In the 399 (36.1%) cases with blood gas analysis before and after HES infusion, hemoglobin and strong ion difference decreased significantly in both groups, whereas bicarbonate and base excess (BE before infusion: ns-HES -1.8 ± 3.1, bal-HES -1.2 ± 3.3 mm; after infusion: ns-HES -2.5 ± 2.8; bal-HES -1.1 ± 3.2 mm, P < 0.05) decreased only with ns-HES but remained stable with bal-HES. Chloride concentrations increased in both groups and were significantly higher with ns-HES (Cl before infusion: ns-HES 105.5 ± 3.6, bal-HES 104.9 ± 2.9 mm; Cl after infusion: ns-HES 107.6 ± 3.4, bal-HES 106.3 ± 2.9 mm, P < 0.05). For the AE/ADR rates, dose-response but no age relationships could be demonstrated. No serious and no severe ADR directly related to HES (i.e. anaphylactoid reaction, clotting disorders, renal failure) were observed. CONCLUSION Moderate doses of HES 130/0.42/6:1 for perioperative plasma volume replacement seem to be safe even in neonates and small infants. The probability of serious ADR is lower than 0.3%. Changes in acid-base balance may be decreased when HES is used in an acetate-containing balanced electrolyte solution instead of normal saline. Caution should be exercised in patients with renal function disturbances and those with an increased bleeding risk.
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Affiliation(s)
- Robert Sümpelmann
- Medizinische Hochschule Hannover, Klinik für Anästhesiologie und Intensivmedizin, Hannover, Germany.
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G. Russo S, Cremer S, Mühlhäuser U, Eich C, Quintel M, Bauer M. Investigating the Fluid Seal of Supraglottic Airway Devices in Humans Using Indicator Dye via the Drainage Tube: A Potential Roadmap for Future Studies. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojanes.2012.22006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sümpelmann R, Mader T, Dennhardt N, Witt L, Eich C, Osthaus WA. A novel isotonic balanced electrolyte solution with 1% glucose for intraoperative fluid therapy in neonates: results of a prospective multicentre observational postauthorisation safety study (PASS). Paediatr Anaesth 2011; 21:1114-8. [PMID: 21564388 DOI: 10.1111/j.1460-9592.2011.03610.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neonates have a higher metabolic rate and an increased risk of perioperative hypoglycemia and lipolysis, but during anesthesia, both oxygen consumption and metabolic rate are decreased, and this may lead to reduced intraoperative glucose requirements. OBJECTIVE The objective of this prospective multicentre observational postauthorisation safety study was to evaluate the intraoperative use of a novel isotonic balanced electrolyte solution with a low glucose concentration of 1% (BS-G1) in neonates with a particular focus on changes in acid-base, electrolyte, and glucose concentrations. METHODS Following the local ethics committee approval, neonates with a postmenstrual age under 45 weeks and an ASA risk score of I-IV undergoing intraoperative administration of BS-G1 were enrolled. Patient demographics, the performed procedure, adverse drug reactions, hemodynamic data, and the results of blood gas analysis before and after infusion were documented with a focus on changes in acid-base, electrolyte, and glucose concentrations. RESULTS In 66 neonates (ASA I-IV; postmenstrual age 38 ± 4, range 25-45 weeks; body weight 2.9 ± 0.9, range 0.65-4.6 kg), the mean infusion rate was 10.4 ± 3.2 (range 4.5-19.6) ml·kg(-1) ·h(-1) BS-G1. During the infusion, hemoglobin, hematocrit, bicarbonate, base excess, anion gap, strong ion difference, and calcium decreased, and chloride and glucose increased significantly within the physiological range. All other measured parameters including sodium and lactate remained stable. Neither hypoglycemia (glucose < 3 mm) nor hyperglycemia (glucose > 10 mm) was documented after BS-G1 infusion. No adverse drug reactions were reported. CONCLUSION The study shows that the intraoperative use of an isotonic balanced electrolyte solution with 1% glucose and a mean infusion rate of 10 ml·kg(-1) ·h(-1) helps to avoid acid-base dysbalance, hyponatraemia, hypoglycemia, ketoacidosis, and hyperglycemia in surgical neonates. A careful intraoperative monitoring and adaptation of the infusion rate as needed is crucial because the glucose and fluid requirements may vary widely between subjects.
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Affiliation(s)
- Robert Sümpelmann
- Medizinische Hochschule Hannover, Klinik für Anästhesiologie und Intensivmedizin-OE 8050, Hannover, Germany.
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Fernandez Castelao E, Russo SG, Cremer S, Strack M, Kaminski L, Eich C, Timmermann A, Boos M. Positive impact of crisis resource management training on no-flow time and team member verbalisations during simulated cardiopulmonary resuscitation: a randomised controlled trial. Resuscitation 2011; 82:1338-43. [PMID: 21664757 DOI: 10.1016/j.resuscitation.2011.05.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 05/04/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the impact of video-based interactive crisis resource management (CRM) training on no-flow time (NFT) and on proportions of team member verbalisations (TMV) during simulated cardiopulmonary resuscitation (CPR). Further, to investigate the link between team leader verbalisation accuracy and NFT. METHODS The randomised controlled study was embedded in the obligatory advanced life support (ALS) course for final-year medical students. Students (176; 25.35±1.03 years, 63% female) were alphabetically assigned to 44 four-person teams that were then randomly (computer-generated) assigned to either CRM intervention (n=26), receiving interactive video-based CRM-training, or to control intervention (n=18), receiving an additional ALS-training. Primary outcomes were NFT and proportions of TMV, which were subdivided into eight categories: four team leader verbalisations (TLV) with different accuracy levels and four follower verbalisation categories (FV). Measurements were made of all groups administering simulated adult CPR. RESULTS NFT rates were significantly lower in the CRM-training group (31.4±6.1% vs. 36.3±6.6%, p=0.014). Proportions of all TLV categories were higher in the CRM-training group (p<0.001). Differences in FV were only found for one category (unsolicited information) (p=0.012). The highest correlation with NFT was found for high accuracy TLV (direct orders) (p=0.06). CONCLUSIONS The inclusion of CRM training in undergraduate medical education reduces NFT in simulated CPR and improves TLV proportions during simulated CPR. Further research will test how these results translate into clinical performance and patient outcome.
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Affiliation(s)
- Ezequiel Fernandez Castelao
- Department of Social and Communication Psychology, Georg-August-University Göttingen, Gosslerstrasse 14, Germany.
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Biarent D, Bingham R, Eich C, López-Herce J, Maconochie I, Rodríguez-Núñez A, Rajka T, Zideman D. Erratum zu: Lebensrettende Maßnahmen bei Kindern („paediatric life support“). Notf Rett Med 2011. [DOI: 10.1007/s10049-011-1440-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Biarent D, Bingham R, Eich C, López-Herce J, Maconochie I, Rodríguez-Núñez A, Rajka T, Zideman D. European Resuscitation Council Guidelines for Resuscitation 2010 Section 6. Paediatric life support. Resuscitation 2011; 81:1364-88. [PMID: 20956047 DOI: 10.1016/j.resuscitation.2010.08.012] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dominique Biarent
- Paediatric Intensive Care, Hôpital Universitaire des Enfants, 15 av JJ Crocq, Brussels, Belgium.
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Wenzel V, Russo SG, Arntz HR, Bahr J, Baubin MA, Böttiger BW, Dirks B, Kreimeier U, Fries M, Eich C. [Comments on the 2010 guidelines on cardiopulmonary resuscitation of the European Resuscitation Council]. Anaesthesist 2011; 59:1105-23. [PMID: 21125214 DOI: 10.1007/s00101-010-1820-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
ADULTS Administer chest compressions (minimum 100/min, minimum 5 cm depth) at a ratio of 30:2 with ventilation (tidal volume 500-600 ml, inspiration time 1 s, F(I)O₂ if possible 1.0). Avoid any interruptions in chest compressions. After every single defibrillation attempt (initially biphasic 120-200 J, monophasic 360 J, subsequently with the respective highest energy), chest compressions are initiated again immediately for 2 min independent of the ECG rhythm. Tracheal intubation is the optimal method for securing the airway during resuscitation but should be performed only by experienced airway management providers. Laryngoscopy is performed during ongoing chest compressions; interruption of chest compressions for a maximum of 10 s to pass the tube through the vocal cords. Supraglottic airway devices are alternatives to tracheal intubation. Drug administration routes for adults and children: first choice i.v., second choice intraosseous (i.o.). Vasopressors: 1 mg epinephrine every 3-5 min i.v. After the third unsuccessful defibrillation amiodarone (300 mg i.v.), repetition (150 mg) possible. Sodium bicarbonate (50 ml 8.4%) only for excessive hyperkaliemia, metabolic acidosis, or intoxication with tricyclic antidepressants. Consider aminophylline (5 mg/kgBW). Thrombolysis during spontaneous circulation only for myocardial infarction or massive pulmonary embolism; during on-going cardiopulmonary resuscitation (CPR) only when indications of massive pulmonary embolism. Active compression-decompression (ACD-CPR) and inspiratory threshold valve (ITV-CPR) are not superior to good standard CPR. CHILDREN Most effective improvement of outcome by prevention of full cardiorespiratory arrest. Basic life support: initially five rescue breaths, followed by chest compressions (100-120/min depth about one third of chest diameter), compression-ventilation ratio 15:2. Foreign body airway obstruction with insufficient cough: alternate back blows and chest compressions (infants), or abdominal compressions (children >1 year). Treatment of potentially reversible causes: ("4 Hs and 4 Ts") hypoxia and hypovolaemia, hypokalaemia and hyperkalaemia, hypothermia, and tension pneumothorax, tamponade, toxic/therapeutic disturbances, thrombosis (coronary/pulmonary). Advanced life support: adrenaline (epinephrine) 10 µg/kgBW i.v. or i.o. every 3-5 min. Defibrillation (4 J/kgBW; monophasic or biphasic) followed by 2 min CPR, then ECG and pulse check. NEWBORNS: Initially inflate the lungs with bag-valve mask ventilation (p(AW) 20-40 cmH₂O). If heart rate remains <60/min, start chest compressions (120 chest compressions/min) and ventilation with a ratio 3:1. Maintain normothermia in preterm babies by covering them with foodgrade plastic wrap or similar. POSTRESUSCITATION PHASE: Early protocol-based intensive care stabilization; initiate mild hypothermia early regardless of initial cardiac rhythm [32-34°C for 12-24 h (adults) or 24 h (children); slow rewarming (<0.5°C/h)]. Consider percutaneous coronary intervention (PCI) in patients with presumed cardiac ischemia. Prediction of CPR outcome is not possible at the scene, determine neurological outcome <72 h after cardiac arrest with somatosensory evoked potentials, biochemical tests and neurological examination. ACUTE CORONARY SYNDROME: Even if only a weak suspicion of an acute coronary syndrome is present, record a prehospital 12-lead ECG. In parallel to pain therapy, administer aspirin (160-325 mg p.o. or i.v.) and clopidogrel (75-600 mg depending on strategy); in ST-elevation myocardial infarction (STEMI) and planned PCI also prasugrel (60 mg p.o.). Antithrombins, such as heparin (60 IU/kgBW, max. 4000 IU), enoxaparin, bivalirudin or fondaparinux depending on the diagnosis (STEMI or non-STEMI-ACS) and the planned therapeutic strategy. In STEMI define reperfusion strategy depending on duration of symptoms until PCI, age and location of infarction. TRAUMA: In severe hemorrhagic shock, definitive control of bleeding is the most important goal. For successful CPR of trauma patients a minimal intravascular volume status and management of hypoxia are essential. Aggressive fluid resuscitation, hyperventilation and excessive ventilation pressure may impair outcome in patients with severe hemorrhagic shock. TRAINING Any CPR training is better than nothing; simplification of contents and processes is the main aim.
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Affiliation(s)
- V Wenzel
- Univ.-Klinik für Anaesthesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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