TY  - JOUR
A1  - Schlesinger, Tobias
A1  - Weibel, Stephanie
A1  - Steinfeldt, Thorsten
A1  - Sitter, Magdalena
A1  - Meybohm, Patrick
A1  - Kranke, Peter
T1  - Intraoperative management of combined general anesthesia and thoracic epidural analgesia: A survey among German anesthetists
JF  - Acta Anaesthesiologica Scandinavica
N2  - Background
Evidence concerning combined general anesthesia (GA) and thoracic epidural analgesia (EA) is controversial and the procedure appears heterogeneous in clinical implementation. We aimed to gain an overview of different approaches and to unveil a suspected heterogeneity concerning the intraoperative management of combined GA and EA.

Methods
This was an anonymous survey among Members of the Scientific working group for regional anesthesia within the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) conducted from February 2020 to August 2020.

Results
The response rate was 38%. The majority of participants were experienced anesthetists with high expertise for the specific regimen of combined GA and EA. Most participants establish EA in the sitting position (94%), prefer early epidural initiation (prior to skin incision: 80%; intraoperative: 14%) and administer ropivacaine (89%) in rather low concentrations (0.2%: 45%; 0.375%: 30%; 0.75%: 15%) mostly with an opioid (84%) in a bolus-based mode (95%). The majority reduce systemic opioid doses intraoperatively if EA works sufficiently (minimal systemic opioids: 58%; analgesia exclusively via EA: 34%). About 85% manage intraoperative EA insufficiency with systemic opioids, 52% try to escalate EA, and only 25% use non-opioids, e.g. intravenous ketamine or lidocaine.

Conclusions
Although, consensus seems to be present for several aspects (patient's position during epidural puncture, main epidural substance, application mode), there is considerable heterogeneity regarding systemic opioids, rescue strategies for insufficient EA, and hemodynamic management, which might explain inconsistent results of previous trials and meta-analyses.
KW  - analgesics
KW  - enhanced recovery after surgery
KW  - multimodal treatments
KW  - perioperative care
KW  - epidural analgesia
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-258286
VL  - 65
IS  - 10
ER  - 
TY  - JOUR
A1  - Herrmann, Johannes
A1  - Adam, Elisabeth Hannah
A1  - Notz, Quirin
A1  - Helmer, Philipp
A1  - Sonntagbauer, Michael
A1  - Ungemach-Papenberg, Peter
A1  - Sanns, Andreas
A1  - Zausig, York
A1  - Steinfeldt, Thorsten
A1  - Torje, Iuliu
A1  - Schmid, Benedikt
A1  - Schlesinger, Tobias
A1  - Rolfes, Caroline
A1  - Reyher, Christian
A1  - Kredel, Markus
A1  - Stumpner, Jan
A1  - Brack, Alexander
A1  - Wurmb, Thomas
A1  - Gill-Schuster, Daniel
A1  - Kranke, Peter
A1  - Weismann, Dirk
A1  - Klinker, Hartwig
A1  - Heuschmann, Peter
A1  - Rücker, Viktoria
A1  - Frantz, Stefan
A1  - Ertl, Georg
A1  - Muellenbach, Ralf Michael
A1  - Mutlak, Haitham
A1  - Meybohm, Patrick
A1  - Zacharowski, Kai
A1  - Lotz, Christopher
T1  - COVID-19 Induced Acute Respiratory Distress Syndrome — A Multicenter Observational Study
JF  - Frontiers in Medicine
N2  - Background: Proportions of patients dying from the coronavirus disease-19 (COVID-19) vary between different countries. We report the characteristics; clinical course and outcome of patients requiring intensive care due to COVID-19 induced acute respiratory distress syndrome (ARDS).
Methods: This is a retrospective, observational multicentre study in five German secondary or tertiary care hospitals. All patients consecutively admitted to the intensive care unit (ICU) in any of the participating hospitals between March 12 and May 4, 2020 with a COVID-19 induced ARDS were included.
Results: A total of 106 ICU patients were treated for COVID-19 induced ARDS, whereas severe ARDS was present in the majority of cases. Survival of ICU treatment was 65.0%. Median duration of ICU treatment was 11 days; median duration of mechanical ventilation was 9 days. The majority of ICU treated patients (75.5%) did not receive any antiviral or anti-inflammatory therapies. Venovenous (vv) ECMO was utilized in 16.3%. ICU triage with population-level decision making was not necessary at any time. Univariate analysis associated older age, diabetes mellitus or a higher SOFA score on admission with non-survival during ICU stay.
Conclusions: A high level of care adhering to standard ARDS treatments lead to a good outcome in critically ill COVID-19 patients.
KW  - COVID-19
KW  - ARDS (acute respiratory distress syndrome)
KW  - intensive care medicine
KW  - pandemia
KW  - Germany
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-219834
SN  - 2296-858X
VL  - 7
ER  -