[Check valves : Important facts for safe use]. / Rückschlagventile : Wissenswerte Eigenschaften für die sichere Anwendung.

Patients benefit from the use of check valves when drugs with a particularly short half-life (e.g., catecholamines) are continually administered through a one-way valve or when an accidental retrograde bolus application must be prevented, as in the event of a rapid sequence induction and intubation. The lack of a check valve can prevent the administered drug from working in the intended manner resulting in potentially insufficient treatment and negative consequences for the patient. In order to ensure the highest level of patient safety while using check valves appropriate training of medical personnel is essential. In contrast, preventable dangers (e.g., infections, awareness) exist when safety measures are disregarded, including the re-use of medications, syringes or disposable materials in successive patients after having only exchanged the check valves. It is not clear how often this is practiced in German-speaking areas.

[The second victim phenomenon-What personnel in anesthesiology should know about it]. / Das Second-Victim-Phänomen ­ Was anästhesiologisches Fachpersonal darüber wissen sollte.

Adverse events can occur at any time during medical treatment of patients. These adverse events not only negatively impact patients but also the medical personnel involved. The impairment of medical personnel after an adverse event is known as the second victim phenomenon (SVP). Although the concept of second victims is relatively unknown, the chances to become a second victim during the course of one's professional carrier are high. Effective measures to support second victims are peer support programs within medical institutions, which also benefit economically from the implementation of these programs. Supporting second victims is also beneficial to future patients and finally healthcare systems as a whole.

[Recommended actions: Reinforcing clinicians' resilience and supporting second victims during the COVID-19 pandemic to maintain capacity in the healthcare system]. / Handlungsempfehlung: Stärkung der Resilienz von Behandelnden und Umgang mit Second Victims im Rahmen der COVID-19-Pandemie zur Sicherung der Leistungsfähigkeit des Gesundheitswesens.

The term second victim describes a person involved in patient care who, due to an extraordinary patient care situation, also becomes traumatized. This phenomenon is largely unknown to the general public, although it is widespread, and is being exacerbated by the COVID-19 pandemic. Pronounced psychological strain among clinicians entails the risk of increasing pressure on the healthcare system even further. The ensuing threat to the safety of both patients and staff needs to be taken seriously. The second victim phenomenon is extensively researched and requires a two-pronged strategy. Second victims need fast, personal and confidential support within a comprehensive, easily accessible, stratified system and reinforcing clinicians' resilience is crucial. Leadership and appropriate crisis communication can sustainably support clinicians' resilience, and thus their ability to function effectively in the long term. Consequently, management can make both a short-term as well as a sustainable contribution to patient safety and therefore increasing the chances of survival for many patients during and after the COVID-19 pandemic.

[What Surgeons Should Know about Risk Management]. / Risikomanagement in der Chirurgie ­ was muss der Chirurg wissen?

Background: The fact that medical treatment is associated with errors has long been recognized. Based on the principle of "first do no harm", numerous efforts have since been made to prevent such errors or limit their impact. However, recent statistics show that these measures do not sufficiently prevent grave mistakes with serious consequences. Preventable mistakes such as wrong patient or wrong site surgery still frequently occur in error statistics. Methods: Based on insight from research on human error, in due consideration of recent legislative regulations in Germany, the authors give an overview of the clinical risk management tools needed to identify risks in surgery, analyse their causes, and determine adequate measures to manage those risks depending on their relevance. The use and limitations of critical incident reporting systems (CIRS), safety checklists and crisis resource management (CRM) are highlighted. Also the rationale for IT systems to support the risk management process is addressed. Results/Conclusion: No single tool of risk management can be effective as a standalone instrument, but unfolds its effect only when embedded in a superordinate risk management system, which integrates tailor-made elements to increase patient safety into the workflows of each organisation. Competence in choosing adequate tools, effective IT systems to support the risk management process as well as leadership and commitment to constructive handling of human error are crucial components to establish a safety culture in surgery.

[Perioperative administration of beta-blockers. Critical appraisal of recent meta-analyses]. / Nutzen der perioperativen beta-Blockade. Kritische Bewertung aktueller Metaanalysen.

BACKGROUND: The perioperative administration of beta blockers is a controversial issue. Numerous trials failed to show any significant benefit or disadvantage because of low event rates and insufficient statistical power. METHODS: In July 2005 McGory et al. and Devereaux et al. separately published 2 meta-analyses, raising the question of the perioperative administration of beta blockers for patients undergoing non-cardiac surgery. In February 2006, Schouten et al. published an additional meta-analysis concerning the same question. This evidence is supplemented by the publication of Lindenauer et al. in 2005. These trials will be critically appraised in this review. RESULTS: McGory et al. concluded from their data that the perioperative administration of beta blockers significantly reduced cardiovascular mortality. However, this conclusion is clearly not valid because of methodological deficits of the meta-analysis. In addition, the publications by Devereaux et al. and Schouten et al. did not support the results of the analysis by McGory et al. CONCLUSIONS: There is still no clear evidence to prove a significant benefit for the unselected perioperative use of beta blockers in patients undergoing non-cardiac surgery. While high-risk patients and those undergoing major surgical procedures seem to profit, low-risk patients may be more harmed than helped by this intervention. The fact that 3 meta-analyses raising the same question produced substantially different results, underlines the importance of critically appraising each meta-analysis.

[Aprotinin in cardiac surgery: more risks than usefulness?]. / Aprotinin in der Kardiochirurgie: Mehr Risiko als Nutzen?

Antifibrinolytic therapy with the serine protease inhibitor Aprotinin or the lysine analogues epsilon-aminocapronic acid or tranexamic acid is a therapeutic measure to reduce perioperative blood loss during cardiac surgery. In an international, prospective, non-randomised phase 4 observation study, Mangano et al. investigated the effectiveness and side-effects of Aprotinin, epsilon-aminocapronic acid and tranexamic acid in comparison to no antifibrinolytic therapy in a total of 4,374 patients who underwent cardiac surgery with extracorporeal circulation. In the opinion of Mangano et al. the results of this study question the safety and effectiveness of Aprotinin for reduction of perioperative blood loss by cardiac surgery patients. Despite a critical review of the study and results reported by Mangano et al., the authors of the present paper come to the conclusion that, in view of the availability of more reasonably priced alternatives in Germany, it appears to be sensible to give preference to tranexamic acid instead of aprotinin.