[POSSIBLE REACTION TO SUTURE MATERIALS].

INTRODUCTION: The use of sutures is a common practice in plastic surgical procedures. The potential risk of developing an allergic reaction to suture materials exists. To the best of the authors' knowledge, this is the first case reported in the literature of such a reaction in aesthetic breast surgery. The aim of this review is to raise the awareness of possible allergic and infective or inflammatory reactions to the suture material and to expand the knowledge of the management and interventions which are critical for patient safety and satisfaction. More research is needed to study this challenging topic.

Comparison of an automated respiratory systolic variation test with dynamic preload indicators to predict fluid responsiveness after major surgery.

BACKGROUND: Predicting the response of cardiac output to volume administration remains an ongoing clinical challenge. The objective of our study was to compare the ability to predict volume responsiveness of various functional measures of cardiac preload. These included pulse pressure variation (PPV), stroke volume variation (SVV), and the recently launched automated respiratory systolic variation test (RSVT) in patients after major surgery. METHODS: In this prospective study, 24 mechanically ventilated patients after major surgery were enrolled. Three consecutive volume loading steps consisting of 300 ml 6% hydroxyethylstarch 130/0.4 were performed and cardiac index (CI) was assessed by transpulmonary thermodilution. Volume responsiveness was considered as positive if CI increased by >10%. RESULTS: In total 72 volume loading steps were analysed, of which 41 showed a positive volume response. Receiver operating characteristic (ROC) curve analysis revealed an area under the curve (AUC) of 0.70 for PPV, 0.72 for SVV and 0.77 for RSVT. Areas under the curves of all variables did not differ significantly from each other (P>0.05). Suggested cut-off values were 9.9% for SVV, 10.1% for PPV, and 19.7° for RSVT as calculated by the Youden Index. CONCLUSION: In predicting fluid responsiveness the new automated RSVT appears to be as accurate as established dynamic indicators of preload PPV and SVV in patients after major surgery. The automated RSVT is clinically easy to use and may be useful in guiding fluid therapy in ventilated patients.

Changes in sevoflurane plasma concentration with delivery through the oxygenator during on-pump cardiac surgery.

BACKGROUND: It is unclear what factors affect the uptake of sevoflurane administered through the membrane oxygenator during cardiopulmonary bypass (CPB) and whether this can be monitored via the oxygenator exhaust gas. METHODS: Stable delivery of sevoflurane was administered to 30 elective cardiac surgery patients at 1.8 vol% (inspiratory) via the anaesthetic circuit and ventilator. During CPB, sevoflurane was administered in the oxygenator fresh gas supply (Compactflo Evolution™; Sorin Group, Milano, Italy). Sevoflurane plasma concentration (SPC) was measured using gas chromatography. Changes were correlated with bispectral index (BIS), patient temperature, haematocrit, plasma albumin concentration, oxygenator fresh gas flow, and the sevoflurane concentration in the oxygenator exhaust at predefined time points. RESULTS: The mean SPC pre-bypass was 54.9 µg ml(-1) [95% confidence interval (CI): 50.6-59.1]. SPC decreased to 43.2 µg ml(-1) (95% CI: 40.3-46.1; P<0.001) after initiation of CPB, and was lower still during rewarming and weaning from bypass, 39.4 µg ml(-1) (95% CI: 36.6-42.3; P<0.001). BIS did not exceed a value of 55. SPCs were higher during hypothermia (P<0.001) and with an increase in oxygenator fresh gas flow (P=0.015), and lower with haemodilution (P=0.027). No correlation was found between SPC and the concentration of sevoflurane in the oxygenator exhaust gas (r=-0.04; 95% CI: -0.18 to 0.09; P=0.53). CONCLUSIONS: The uptake of sevoflurane delivered via the membrane oxygenator during CPB seems to be affected by hypothermia, haemodilution, and changes in the oxygenator fresh gas supply flow. Measuring the concentration of sevoflurane in the exhaust from the oxygenator is not useful for monitoring sevoflurane administration during bypass.

[Pharmacogenetics. Clinical relevance in anesthsiology]. / Pharmakogenetik. Klinische Bedeutung in der Anästhesiologie.

BACKGROUND: Pharmacogenetics deals with hereditary factors which influence the pharmacodynamics and pharmacokinetics of drugs leading to individual diverse reactions. Also in anesthesiology differences in the pharmacogenetics of patients can lead to relevant alterations in the pharmacodynamics of drugs. AIM: This article provides a summary of polymorphisms relevant to commonly used anesthetic agents and the clinical relevance in patients treated with these compounds. It describes the possibilities, the problems and limits of pharmacogenetic diagnostics and therapy and explains how this follows the target of individualized medicine. MATERIAL AND METHODS: This article describes in detail the alterations in pharmacodynamics and pharmakokinetics relevant for anesthesia and their clinical significance. Based on the results of current studies, an overview of the most important drugs in anesthesiology with significant polymorphisms is given. These include opioids, muscle relaxants, volatile anesthetic agents, non-steroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, antiemetics and cardiovascular drugs as well as platelet aggregation inhibitors, anticoagulants and the so-called new oral anticoagulants. RESULTS: Genetic alterations can lead to substantial modifications in the effectiveness of drugs. Genetic alterations of opioid receptors and the enzyme cytochrome P450 (CYP) 2D6 can result in a failure of analgesia after administration of opioids. Alterations in plasma cholinesterase activity are associated with a prolonged effectiveness of muscle relaxants. Polymorphisms in ryanodine receptors can contribute to the development of the feared MH in patients after administration of volatile anesthetics or succinylcholine. CONCLUSION: The study results presented here emphasize that these days knowledge on pharmacogenetics should not be missing in modern induction of anesthesia. In the future a blood sample could enable physicians to identify pharmacologically relevant markers. And these could guide the decision on the prescription of drugs and their appropriate dose, in order to achieve the lowest risk of side effects and the highest effectiveness of the active substance.

Reinforcement learning for patient-specific optimal stenting of intracranial aneurysms.

Developing new capabilities to predict the risk of intracranial aneurysm rupture and to improve treatment outcomes in the follow-up of endovascular repair is of tremendous medical and societal interest, both to support decision-making and assessment of treatment options by medical doctors, and to improve the life quality and expectancy of patients. This study aims at identifying and characterizing novel flow-deviator stent devices through a high-fidelity computational framework that combines state-of-the-art numerical methods to accurately describe the mechanical exchanges between the blood flow, the aneurysm, and the flow-deviator and deep reinforcement learning algorithms to identify a new stent concepts enabling patient-specific treatment via accurate adjustment of the functional parameters in the implanted state.

Effects of one-lung ventilation on thermodilution-derived assessment of cardiac output.

BACKGROUND: Cardiac output (CO) monitoring can be useful in high-risk patients during one-lung ventilation (OLV), but it is unclear whether thermodilution-derived CO monitoring is valid during OLV. Therefore, we compared pulmonary artery (CO(PATD)) and transcardiopulmonary thermodilution (CO(TPTD)) with an experimental reference in a porcine model. METHODS: CO(PATD) and CO(TPTD) were measured in 23 pigs during double-lung ventilation (DLV) and 15 min after the onset of OLV, during conditions of normovolaemia and after haemorrhage. An ultrasonic flow probe placed around the pulmonary artery (CO(PAFP)) was used for reference. RESULTS: The range of CO in these experiments was 1.5-3 litre min(-1). Normovolaemia: during DLV and conditions of normovolaemia, the mean (95% limits of agreement) bias for CO(PATD) compared with CO(PAFP) was -0.05 (-0.92 and 0.83) litre min(-1), and 0.58 (-0.40 and 1.55) litre min(-1) for CO(TPTD). During OLV, the bias for CO(PATD) remained unchanged at 0.08 (-0.51 and 0.66) litre min(-1), P=0.15, and the bias for CO(TPTD) increased significantly to 0.85 (0.05 and 1.64) litre min(-1), P=0.047. Hypovolaemia: during DLV, the bias for CO(PATD) compared with CO(PAFP) was 0.22 (-0.20 and 0.66) litre min(-1) and for CO(TPTD) was 0.60 (0.12 and 1.10) litre min(-1). There was no significant change of bias during OLV for CO(PATD) [0.30 (-0.10 and 0.70) (litre min(-1)), P=0.25] or bias CO(TPTD) [0.72 (0.21 and 1.22) (litre min(-1)), P=0.14]. Trending ability during OLV, quantified by the mean of angles θ, showed good values for both CO(PATD) (θ=11.2°) and CO(TPTD) (θ=1.3°). CONCLUSIONS: CO(TPTD) is, to some extent, affected by OLV, whereas CO(PATD) is unchanged. Nonetheless, both methods provide an acceptable estimation of CO and particularly of relative changes of CO during OLV.

Successful weaning from extracorporal circulation using a pumpless extracorporal lung assist device in a patient with intraoperative hypercapnic lung failure during aortic valve replacement.

We present a case of a 59-year-old female suffering from massive pulmonary edema with consecutive hypercapnic lung failure immediately following elective aortic valve replacement. Due to severe restrictive ventilation disorder, mechanical ventilation was inadequate. A pumpless lung assist (PECLA, iLA, Novalung®, Talheim, Germany)--a device for extracorporeal carbon dioxide elimination--was used for successful weaning from extracorporeal circulation (ECC). Within 24 hours respiratory function had normalized and the patient could be extubated. The further clinical course and follow-up at 3 months remained uneventful. This report describes the first intraoperative use of the PECLA device in a cardiac surgery patient to promote weaning from ECC.

Knee joint transplantation combined with surgical angiogenesis in rabbits--a new experimental model.

PURPOSE: We have previously described a means to maintain bone allotransplant viability, without long-term immune modulation, replacing allogenic bone vasculature with autogenous vessels. A rabbit model for whole knee joint transplantation was developed and tested using the same methodology, initially as an autotransplant. MATERIALS/METHODS: Knee joints of eight New Zealand White rabbits were elevated on a popliteal vessel pedicle to evaluate limb viability in a nonsurvival study. Ten additional joints were elevated and replaced orthotopically in a fashion identical to allotransplantation, obviating only microsurgical repairs and immunosuppression. A superficial inferior epigastric facial (SIEF) flap and a saphenous arteriovenous (AV) bundle were introduced into the femur and tibia respectively, generating a neoangiogenic bone circulation. In allogenic transplantation, this step maintains viability after cessation of immunosuppression. Sixteen weeks later, X-rays, microangiography, histology, histomorphometry, and biomechanical analysis were performed. RESULTS: Limb viability was preserved in the initial eight animals. Both soft tissue and bone healing occurred in 10 orthotopic transplants. Surgical angiogenesis from the SIEF flap and AV bundle was always present. Bone and joint viability was maintained, with demonstrable new bone formation. Bone strength was less than the opposite side. Arthrosis and joint contractures were frequent. CONCLUSION: We have developed a rabbit knee joint model and evaluation methods suitable for subsequent studies of whole joint allotransplantation.

First experiences with simultaneous skeletal and soft tissue reconstruction of noma-related facial defects.

Noma victims suffer from a three-dimensional facial soft-tissue loss. Some may also develop complex viscerocranial defects, due to acute osteitis, chronic exposure, or arrested skeletal growth. Reconstruction has mainly focused on soft tissue so far, whereas skeletal restoration was mostly avoided. After successful microvascular soft tissue free flap reconstruction, we now included skeletal restoration and mandibular ankylosis release into the initial step of complex noma surgery. One free rib graft and parascapular flap, one microvascular osteomyocutaneous flap from the subscapular system, and two sequential chimeric free flaps including vascularized bone were used as the initial steps for facial reconstruction. Ankylosis release could spare the temporomandibular joint. Complex noma reconstruction should include skeletal restoration. Avascular bone is acceptable in cases with complete vascularized graft coverage. Microsurgical chimeric flaps are preferable as they can reduce the number and complexity of secondary operations and provide viable, infection-resistant bone supporting facial growth.

[Severe muscular dystrophy and pregnancy: interdisciplinary challenge]. / Schwere Muskeldystrophie und Schwangerschaft: Interdisziplinäre Herausforderung.

The muscular dystrophies are degenerative muscle diseases characterized by progressive muscle weakness. The vast majority of women suffering from muscle diseases develop a deterioration of symptoms during pregnancy. Cardiac and respiratory complications are observed in pregnant women with muscular dystrophy especially in the second and third trimester. The successful perioperative therapy of a 32-year-old pregnant tetraplegic woman with a severe limb-girdle type muscular dystrophy who underwent elective Caesarean section is reported. According to the literature epidural and spinal anesthesia are both possible for perioperative anesthetic management in women with limb-girdle dystrophies. Due to the excellent controllability of intrathecal hyperbaric bupivacaine it was decided to use spinal anesthesia and non-invasive positive pressure ventilation was planned in case of impairment of respiratory function. In summary limb-girdle muscular dysthrophies should be managed on an individual basis and spinal anesthesia can be safely used to avoid intubation.

[When the resting membrane potential becomes restless. Acute hyperkalemia in the perioperative phase]. / Wenn das Ruhemembranpotenzial aus der Ruhe kommt. Akute Hyperkaliämie in der perioperativen Phase.

Acute hyperkalemia is a life-threatening event and often occurs abruptly and without warning in the perioperative field. Risk factors are found on multiple levels as they can derive from a patients pre-existing condition or result from the surgical intervention or management of anesthesia. The therapy of hyperkalemia depends on the dimensions of electrolyte disturbance and a distinction can be made between therapeutic measures with a rapid and those with a long-term effect.

[Intraoperative electrophysiological monitoring with evoked potentials]. / Intraoperatives elektrophysiologisches Monitoring mit evozierten Potenzialen.

During the last 30 years intraoperative electrophysiological monitoring (IOEM) has gained increasing importance in monitoring the function of neuronal structures and the intraoperative detection of impending new neurological deficits. The use of IOEM could reduce the incidence of postoperative neurological deficits after various surgical procedures. Motor evoked potentials (MEP) seem to be superior to other methods for many indications regarding monitoring of the central nervous system. During the application of IOEM general anesthesia should be provided by total intravenous anesthesia with propofol with an emphasis on a continuous high opioid dosage. When intraoperative MEP or electromyography guidance is planned, muscle relaxation must be either completely omitted or maintained in a titrated dose range in a steady state. The IOEM can be performed by surgeons, neurologists and neurophysiologists or increasingly more by anesthesiologists. However, to guarantee a safe application and interpretation, sufficient knowledge of the effects of the surgical procedure and pharmacological and physiological influences on the neurophysiological findings are indispensable.

[Undergraduate teaching of anaesthesiology : a nationwide survey in Germany]. / Universitäre Lehre der Anästhesiologie : Bestandsaufnahme in Deutschland.

BACKGROUND: In 2003 anaesthesiology was implemented as a compulsory speciality of undergraduate teaching in Germany due to the revised regulations of medical education. Besides the preexisting subject of emergency medicine an obligatory course in anaesthesiology was introduced. Thus anaesthesiology has gained considerable importance in all medical faculties. To gain insight into the current status of undergraduate medical education in the university departments of anaesthesiology a nationwide survey at all university departments in Germany was initiated. METHODS: In cooperation with the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) a standardized questionnaire was developed and sent to 36 departments of anaesthesiology of all German medical faculties. Questions concerned the structure of the respective curriculum, learning goals, teaching, assessment and evaluation methods as well as facultative courses. RESULTS: Of the 36 university departments of anaesthesiology, 35 returned the questionnaire. In 66% undergraduate education in anaesthesiology is part of the fourth or fifth year of medical training. In 91% of the faculties lectures were accompanied by teaching in small student groups. A simulator-based training is integrated either in anaesthesiology and/or in emergency medicine in 91% of the departments of anaesthesiology. In 69% of the departments contents of anaesthesia, critical care medicine, emergency medicine and pain management are an integral part of undergraduate teaching in anaesthesiology. The primary learning goals are directed towards general anaesthesia and there is less focus on topics of preoperative or postoperative care, such as preoperative risk evaluation, postoperative pain management and regional anaesthesia. Besides a multiple choice test (91%) oral (63%) and/or practical examinations (71%) are used as assessment tools. In 71% of the medical faculties the respective departments of anaesthesiology are leading and organising skills laboratories. In student evaluations anaesthesiology achieved best ranking in 66% of the medical faculties compared to other specialties. The possibility to take an elective course in anaesthesiology exists in 74% of the faculties. Half of these faculties organize this elective as a longitudinal course for one complete semester, the other half as a full time course over mostly 1 or 2 weeks. At present E-learning plays a minor role. CONCLUSIONS: This survey provides detailed information about the current status of undergraduate teaching of the university departments of anaesthesiology in Germany. The study shows a remarkable consistency of structure, contents and methods of education in anaesthesiology throughout all university departments of anaesthesiology. This information is the basis for triggering synergistic effects, for improving educational standards in anaesthesiology and for introducing a platform for developing modern learning media, e.g. through the scientific society DGAI.

Respiratory systolic variation test in acutely impaired cardiac function for predicting volume responsiveness in pigs.

BACKGROUND: Predicting the response of cardiac output (CO) to volume administration remains difficult, in particular in patients with acutely compromised cardiac function, where, even small amounts of i.v. fluids can lead to volume overload. We compared the ability to predict volume responsiveness of different functional haemodynamic parameters, such as pulse pressure variation (PPV), stroke volume variation (SVV), the static preload parameter right atrial pressure (RAP), and global end-diastolic volume (GEDV) with the recently proposed respiratory systolic variation test (RSVT) in acutely impaired cardiac function. METHODS: In 13 mechanically ventilated pigs, cardiac function was acutely reduced by continuous application of verapamil to reach a decrease in peak change of left ventricular pressure over time (dP/dt) of 50%. After withdrawal of 20 ml kg(-1) BW blood to establish hypovolaemia, four volume loading steps of 7 ml kg(-1) BW using the shed blood and 6% hydroxyethylstarch 130/0.4 were performed. Volume responsiveness was considered as positive, if CO increased more than 10%. RESULTS: Receiver operating characteristic curve analysis revealed an area under the curve (AUC) of 0.88 for the RSVT, 0.84 for PPV, 0.82 for SVV, 0.78 for RAP, and 0.77 for GEDV. CONCLUSIONS: Functional parameters of cardiac preload, including the RSVT, allow prediction of fluid responsiveness in an experimental model of acutely impaired cardiac function.

Prefabricated supraclavicular flap as a salvage procedure for a failed microvascular hypopharyngeal defect closure in a tetraplegic patient.

Delayed hypopharyngeal perforations in tetraplegics are a rare but potentially life-threatening complication of anterior cervical spine instrumentation. To date, no established treatment regimen exists for these situations. A patient with traumatic tetraplegia sub-C4 was admitted to the hospital 14 days after anterior spinal fusion with an infected hypopharyngeal perforation. After hardware removal, the spine was restabilized with a composite free osteomusculocutaneous fibula with the flexor hallucis longus muscle closing the mucosal defect. However, it was lost because of external venous compression. After 54 days, definitive reconstruction was achieved with a delayed supraclavicular artery flap. Follow-up endoscopy showed a closed and mucosalized defect. Composite free flaps are intriguing for complex hypopharyngeal and spine defects; however, they can undergo fatal external compression due to postoperative swelling in this area. Supraclavicular flaps might serve as a rescue alternative, offering unimpaired neck mobility that is crucial for tetraplegics, adequate tenuity for the hypopharynx, and reliable blood supply without large vessels in the field.

The role of fabricated chimeric free flaps in reconstruction of devastating hand and forearm injuries.

Devastating hand and forearm injuries almost exclusively need free flap transfer if reconstruction is attempted. Early active and passive motion is only possible with aggressive, early, and comprehensive reconstruction. Despite recent advances in compound flaps, in selected cases it might be wise to harvest several smaller flaps and microsurgically combine them to one "chain-linked" flap "system." Four microsurgically fabricated chimeric free flaps were used in four patients for complex hand and forearm injuries. The combinations were sensate anterolateral thigh (ALT) flap plus sensate extended lateral arm flap (2x), ALT plus free fibula, and ALT plus functional musculocutaneous gracilis muscle. All flaps survived completely. Functional rehabilitation was possible immediately after flap transfer. There were no donor-site complications except two widened scars. The microsurgical fabrication of chimeric free flaps, as well established in head and neck reconstruction, can be successfully adapted to massive hand injuries as well. Individual placement of selected tissue components, early comprehensive reconstruction, and reduction of the number of operations are beneficial in cases that need more than one free flap.

[Further education in anesthesiology. Implementation at the University Hospital Hamburg-Eppendorf]. / Weiterbildung in der Anästhesiologie. Umsetzung am Universitätsklinikum Hamburg-Eppendorf.

Due to the lack of physicians and the changing demands of junior staff more attractive curricula are needed in anesthesiology in Germany. In the German Society of Anesthesiology and Intensive Care Medicine as well as the Association of German Anesthesiologists discussions on the optimization of training have a long tradition. The following article gives a description of the concept and the practical approach to the training curricular at the University Hospital Hamburg-Eppendorf and is designed to stimulate discussion on possible concepts for training in anesthesiology.

Surgical angiogenesis: a new approach to maintain osseous viability in xenotransplantation.

BACKGROUND: Large segmental osseous defects are challenging clinical problems. Current reconstructive methods, using non-viable allografts, vascularized autografts or prostheses have significant rates of serious complications and failure. These include infection, stress fracture and non-union (frozen structural allogenic bone); loosening and implant failure (prosthetic replacement); limited availability, poor match of size and shape and donor site morbidity (vascularized autograft bone). In the future, microvascular transplantation of living allogenic or xenogenic bone could solve some of these issues, combining the advantages of living bone autografts (capability of primary osseous healing, remodeling, and fracture resistance) with the ability to match size and shape, provide immediate stability and avoid donor site morbidity. Xenotransplants would be particularly attractive, as they could be readily available, if long-term bone survival could be achieved without unacceptable morbidity. Here, we present a preliminary study to evaluate a new and unique method to maintain xenogenic bone circulation without need for long-term immune modulation that depends upon generation of a neo-angiogenic circulation within the transplanted bone from recipient-derived vessels. Thus, only short-term immunosuppression would be required to achieve bone survival. METHODS: One hundred and forty-one hamster femora were microsurgically transplanted to rats, restoring nutrient vessel circulation with standard microvascular anastomoses. At the same time, a host-derived arteriovenous bundle (AVB) was placed within the medullary canal. Two independent variables were evaluated: use of tacrolimus/cyclophosmamid immunosuppression (IS) and patency of the implanted AVB. Rats were therefore randomized to four groups; group 1-no IS + patent AVB; group 2-no IS + ligated AVB; group 3-IS + patent AVB; group 4-IS + ligated AVB. Rats were sacrificed after 1 or 2 weeks. We evaluated bone blood flow (microsphere entrapment), neoangiogenesis (microangiography and quantification of capillary density), bone necrosis rate (osteocyte counts) and nutrient pedicle rejection (microsurgical anastomotic patency). Statistical Analysis was performed with two-way ANOVA with Bonferroni adjustment. Differences were considered significant when P < 0.05. RESULTS: Capillary density was significantly increased with a patent intramedullary AVB (groups 1/3) compared to groups with ligated AVBs (groups 3/4). Capillary sprouting was predominantly restricted to the endosteal layer. Most nutrient pedicles (78.7%) stayed patent in groups with IS (groups 3 and 4). Consequently, bone blood flow was significantly higher in groups 3 and 4 compared to groups 1 and 2. Similarly, a patent AV bundle improved flow in group 1 when compared to group 2. The bone necrosis rate was not influenced by the presence of patent AVBs but was significantly reduced in groups 3 and 4. CONCLUSIONS: Surgical angiogenesis occurs when patent arteriovenous bundles are placed in the medullary canal of xenogenic bone and leads to increased bone blood flow. Bone viability was not significantly influenced by neoangiogenesis. Although capillary sprouting was restricted to the endosteal layer in this short term study, more complete cortical revascularization might be observed in a long-term study. Such a study should further evaluate whether these new vessels supply sufficient blood flow to maintain long-term bone viability and allow remodeling.

[Co-editors and editors with Jewish origins of the first German journals for anaesthesia. Their fate under National Socialism and an attempt at a biographical appreciation]. / Mitarbeiter und Herausgeber mit jüdischer Herkunft der ersten deutschen Anästhesiezeitschriften. Ihr Schicksal im Nationalsozialismus und der Versuch einer biografischen Würdigung.

The decision to publish the journals Der Schmerz and Narkose und Anaesthesie in 1928 was an important step towards the professionalization of anaesthesiology in Germany. The appearance of both journals, which for economic reasons merged into Schmerz - Narkose - Anaesthesie 1 year later, was initiated and vehemently supported by Jewish physicians. As editors and co-editors they were deeply involved with the editorial tasks of the journals for years from the early beginnings. When the National Socialistic Party took over the government in Germany many of the Jewish colleagues were forced to quit their editorial tasks, were eliminated and replaced by "Arians", they were persecuted and often arrested, forced to emigrate or decided to commit suicide due to inhumane personal circumstances. It is our intention to recall the biography and the terrible fate of the nearly unknown Jewish members of the editorial board of the first German anaesthesia journals. Moreover the biographic sketches promote a continuous discussion about the victims of an inhumane and barbarous ideology.