Application of quality indicators and critical lessons learned assessment as a research approach for the evaluation of rescue missions during terrorist attacks.

In Wuerzburg, Germany, a terrorist attack and a killing rampage occurred five years apart (2016 and 2021). Following a structured evaluation of the rescue mission in 2016, a bundle of quality indicators and ten "lessons learned" were defined. Aim of the presented study was to compare the two rescue missions and to critically review the lessons learned from 2016 for their implementation and feasibility.

A Review of PTSD Augmentation Strategies for Older Adults and Case of rTMS-Augmented Prolonged Exposure.

Evidence-based psychotherapies such as prolonged exposure therapy (PE) are recommended by clinical practice guidelines as first-line treatments for post-traumatic stress disorder (PTSD) and are safe and acceptable for use with older adults. One third to one half of all patients do not achieve a clinically meaningful response to standard outpatient PE and recent research suggests that older adults in particular may experience barriers to full engagement and response. Standard treatment may be challenging in older adults due to cognitive, medical, and psychosocial barriers.

The choice of anaesthesia for glioblastoma surgery does not impact the time to recurrence.

Anaesthetics used during cancer surgery may influence tumour cells and immunological response. The aim of this study was to evaluate a potential influence of the anaesthetic method (inhaled anaesthetics versus total-intravenous anaesthesia using propofol) on recurrence-free and overall survival in glioblastoma patients. We retrospectively identified patients undergoing resection of contrast enhancing glioblastoma under general anaesthesia followed by standard adjuvant treatment between January 2010 and February 2017 at two University Hospitals.

Vestibular Schwannoma Resection in a Consecutive Series of 502 Cases via the Retrosigmoid Approach: Technical Aspects, Complications, and Functional Outcome.

Objective: Outcome in vestibular schwannoma (VS) surgery has improved enormously over the last decades. Surgical positioning remains a matter of discussion. A standardized protocol for diagnostics and management has been applied and evaluated for complications and functional outcome.

Comparison of the C-MAC(®) and GlideScope(®) videolaryngoscopes in patients with cervical spine disorders and immobilisation.

In-line stabilisation of the neck can increase the difficulty of tracheal intubation with direct laryngoscopy. We randomly assigned 56 patients with cervical spine pathology scheduled for elective surgery to tracheal intubation using either the C-MAC(®) (n = 26) or GlideScope(®) (n = 30), when the head and neck were stabilised in-line. There was no significant difference in the median (IQR [range]) intubation times between the C-MAC (19 (14-35 [9-90]) s and the GlideScope (23, (15-32 [8-65]) s.

[The DGAI training module 2 in anaesthetic focussed sonography: vascular sonography].

Modul 2 will provide the theory and practical training of the sonographically guided puncture of central and peripheral veins and arteries. In doing so patients of all age groups are taken into consideration. Combined with the content of the other modules this series of workshops, which was initiated by our society, might be a first step in defining a new core competency of our specialty.

[Tension pneumothorax after acute airway displacement due to pulmonary aspergillosis].

Acute lymphoblastic leukaemia is the most common malignancy in childhood. This disease and its associated therapy may lead to specific life-threatening complications if general anaesthesia has to be carried out. The case of a 14-year-old boy suffering from aspergillosis because of immunosuppression in the course of chemotherapy is reported.

Comparison of the Glidescope and Airtraq optical laryngoscopes in patients undergoing direct microlaryngoscopy.

Optical laryngoscopes have been developed to facilitate difficult airway management. The Airtraq is a single-use device and the GlideScope is reusable. In this study, the Airtraq and the Glidescope were compared in 60 ASA I-III patients with tumours of the upper airway undergoing direct endoscopic microlaryngoscopy.

[Paediatric anaesthesia for neurosurgical procedures].

Paediatric neurosurgical procedures request special considerations for the anaesthetic management. Due to patients age and diagnostic findings certain therapeutic procedures are performed under anaesthetic care. Main reasons for craniotomy are hydrocephalus, intracranial tumors and craniofacial synostosis.

[Anesthesia in pediatric neurosurgery].

Due to the complexity of neurosurgical and neuroradiologic interventions and diagnostic procedures in pediatric patients the anesthesiologist is particularly challenged. Anesthesiological management in neuropediatric interventions necessitates both profound knowledge of pediatric anesthesia and thorough understanding of neurological pathophysiology. This review describes in detail neuropediatric anesthesiology with an emphasis on airway management, intraoperative positioning, volume therapy and intraoperative monitoring.

Early treatment with arteriovenous extracorporeal lung assist and high-frequency oscillatory ventilation in a case of severe acute respiratory distress syndrome.

Background: Lung protective ventilation can reduce mortality in acute respiratory distress syndrome (ARDS). However, many patients with severe ARDS remain hypoxemic and more aggressive ventilation is necessary to maintain sufficient gas exchange. Pumpless arteriovenous extracorporeal lung assist (av-ECLA) has been shown to remove up to 95% of the systemic CO(2) production, thereby allowing ventilator settings and modes prioritizing oxygenation and lung protection.

Ultrasound-guided arterial cannulation in infants improves success rate.

Background And Objective: In small children, the placement of arterial catheters can be technically challenging for even the most experienced anaesthetist. We investigated whether ultrasound imaging would improve the success rate and reduce time demand and complications of radial artery cannulation.

Method: In this prospective randomized study, we performed radial artery cannulation in 30 small children (age 40 +/- 33 months) using two different techniques for localization of the vessel.

Gender subgroups and intergroup perception: adolescents' views of own-gender and other-gender groups.

The authors examined intergroup bias and perceived group variability regarding gender subgroups relevant to the adolescent culture. Participants were 126 high school students, between 16 years and 19 years of age, who listed male and female subgroups, performed a series of group perception tasks, and, for each subgroup, indicated whether they themselves belonged to the group. Results showed that adolescents' perceptions of gender subgroups were subject to in-group favoritism and out-group derogation, as well as to group homogeneity effects.

Sonographic imaging of the sciatic nerve and its division in the popliteal fossa in children.

Background: High resolution ultrasound is a possible option for anesthetists to detect nerves. We tested the possibility of imaging the sciatic nerve and its division into the tibial and peroneal part using high resolution ultrasound in children.

Methods: Twelve children up to 45 kg body weight were randomly selected.

[Ultrasound-guided central venous cannulation in neuropaediatric patients to avoid measures causing potential increase in brain pressure].

Background: Certain measures such as the Trendelenburg position or an increase in intrathoracic pressure raise the chances for a successful puncture of the internal jugular vein (IJV) particularly in paediatric patients. However, these measures are contraindicated in patients with increased intracranial pressure. Therefore, in anaesthetised and ventilated neuropaediatric patients we investigated whether ultrasound-guided cannulation of the IJV can replace these measures.

Echocardiographic monitoring during induction of general anesthesia with a miniaturized esophageal probe.

Unlabelled: Standard transesophageal echocardiography (TEE) does not allow cardiac monitoring during the induction of anesthesia because standard probes would limit the oropharyngeal space and impair mask ventilation and tracheal intubation. We hypothesized that a prototype, miniaturized TEE probe could be safely introduced transnasally in awake patients and that mask ventilation and orotracheal intubation could be performed while continuously monitoring left ventricular (LV) function during the induction of anesthesia. Forty-five patients were studied prospectively.

Intra-operative electromyographic monitoring of the lower cranial motor nerves (LCN IX-XII) in skull base surgery.

The functional preservation of lower (motor) cranial nerves (LCN) is endangered during skull base surgery. Intra-operative EMG monitoring of the LCN IX-XII was investigated in 78 patients undergoing 80 operations on various skull base tumors with regard to technical feasibility and clinical efficacy. Ongoing 'spontaneous muscle activity' (SMA) and 'compound muscle action potentials' (CMAP) following supramaximal bipolar stimulation were intra-operatively recorded applying needle electrodes into the soft palate (CN IX: n=76), the vocal cord (CN X: n=72), the trapezius muscle (CN XI: n=18), and the tongue (CN XII: n=71).

The detection of interatrial flow patency in awake and anesthetized patients: a comparative study using transnasal transesophageal echocardiography.

Unlabelled: The Valsalva maneuver in the awake patient and the ventilation maneuver in the tracheally intubated anesthetized patient are two provocation methods to detect a patent foramen ovale (PFO) by means of contrast transesophageal echocardiography. In 60 patients undergoing posterior fossa surgery, a contrast agent was administered via a peripheral vein during a Valsalva maneuver immediately before anesthesia induction, followed by central venous administration during a ventilation maneuver in the same patients when anesthetized and endotracheally intubated. We evaluated both maneuvers with a 32-element monoplane transnasal transesophageal echocardiography probe to trace the atrial flow of the contrast agent in a 90 degrees bicaval view.

[Suppression of the adrenal cortex by enoximone. A proband study with documentation of the hemodynamic course].

In contrast to the bipyridine derivatives amrinone and milrinone, the phosphodiesterase III/IV inhibitor enoximone is an imidazolone that creates the possibility of inhibiting adrenal steroid synthesis, as has already been demonstrated for other imidazoles, e.g. ketoconazole and etomidate.

Information integration by children: the identification of rules by an alternative method.

Two empirical studies were conducted with 136 preschool children, aged 5 to 6, and 89 adults. Using rectangles of varying sizes, a paired-comparisons procedure revealed two integration rules that determined the children's responses: a multiplying rule and a centration rule characterized by a preference for the maximum of height and width. The adults applied the multiplying rule, but if this rule failed, they used rules similar to those applied by the children.

Heart innervation after ligation of the left anterior descending coronary artery (LAD).

Distribution and amount of neuropeptide Y- and synaptophysin-immunoreactive nervous structures within the heart were investigated in dogs 4 days after ligation of the left anterior descending coronary artery (LAD). In the right atrium and posterior left ventricular regions, which were taken as (non-infarcted) control areas, neuropeptide Y-immunoreactive paravascular nerves and a perivascular nerve plexus running within the adventitia of the coronary arteries and their branches down to the arterioles were observed. Morphometric measurements of the area density revealed 0.