[Practice Guidelines for Central Venous Access 2020 - Time for German Guidelines].

The American Society of Anesthesiologists released practice guidelines for central venous access in 2020, and the entire world literature was examined for evidence on how to perform the entire process with best practice and minimal risk and harm to the patient. These guidelines may serve as a gold standard for individual procedural steps, allowing practitioners and hospital departments to critically question the own standard and improve upon them.We interpreted the guidelines for individual procedural steps on how to improve success of catheterization, minimize risks or adverse effects, enhance the management of accidental arterial punctures, adhere to evidence-based practices, and generally reduce the trauma of puncturing.

[Lung Ultrasound for Anesthesia, Intensive Care and Emergency Medicine].

Lung ultrasound is an underrated tool in preclinical emergency situations, intensive care units, ORs and emergency rooms. For certain clinical questions, there is a drastically higher sensitivity in comparison to chest X-ray examinations (sensitivity in pneumothorax diagnostics 86 vs. 28%, specificity 97 vs.

Phrenic nerve block caused by interscalene brachial plexus block: breathing effects of different sites of injection.

Background: Interscalene brachial plexus (ISB) block is often associated with phrenic nerve block and diaphragmatic paresis. The goal of our study was to test if the anterior or the posterior ultrasound guided approach of the ISB is associated with a lower incidence of phrenic nerve blocks and impaired lung function.

Methods: This was a prospective, randomized and single-blinded study of 84 patients scheduled for elective shoulder surgery who fullfilled the inclusion and exclusion critereria.

[Thoracoabdominal sonography (E-FAST plus) -AI training module 5 in anaesthesiologist: performed focussed sonography].

Anesthesiologists and Critical Care Physicians are confronted with the differential diagnoses of dyspnea, complications of mechanical ventilation or rapid assessment of trauma patients on a nearly daily basis. This requires the timely diagnosis or exclusion of a wide variety of disease processes including pleura effusion, pneumonia, pneumothorax as well as thoracical or abdominal bleeding. Furthermore, the anaesthesiologist or intensivist often makes decisions leading to invasive procedures like thoracentesis or percutaneous dilatational tracheostomy.

Enhanced stability of somatosensory evoked potentials attained in the median nerve by using temporal electrodes for intraoperative recording in patients in the semisitting position.

Object: Findings published in case reports indicate that monitoring of median nerve somatosensory evoked potentials (MN-SSEPs) is unreliable in patients who undergo surgery while in the semisitting position due to the occurrence of changes in the potentials that are unrelated to neurological damage. The present study was designed to test the hypothesis that in these patients MN-SSEPs are more stable when recording electrodes are placed over the temporal region.

Methods: In 30 patients who underwent surgery in the semisitting position, MN-SSEPs were recorded intraoperatively by using electrodes placed over the temporal region as well as those placed at conventional recording sites.

Hypothermia does not alter somatosensory evoked potential amplitude and global cerebral oxygen extraction during marked sodium nitroprusside-induced arterial hypotension.

Background: To prevent neurologic damage, monitoring cerebral function by somatosensory evoked potentials is used in selected settings. Excision of intraocular melanoma provides a unique opportunity to assess independently during anesthesia the effects on median nerve somatosensory evoked potentials (MN-SSEPs) and cerebral oxygen extraction of sodium nitroprusside-evoked arterial hypotension with and without hypothermia.

Methods: Median nerve somatosensory evoked potentials, arterial pressure, jugular venous bulb oxygen saturation (Sjo(2)) and lactate concentration, and arterial-jugular bulb oxygen content difference were assessed during propofol-remifentanil anesthesia under sodium nitroprusside-evoked arterial hypotension (mean arterial pressure, 40 mmHg) with and without surface hypothermia (32 degrees C) in 11 otherwise healthy patients undergoing resection of choroidal melanoma.