[Characteristics of the fetal and infant respiratory system : What the pediatric anesthetist should know]. / Besonderheiten des fetalen und kindlichen Atmungssystems : Was der/die (Kinder­)Anästhesist*in wissen sollte.

Respiratory complications are the most frequent incidents in pediatric anesthesia after cardiac events. The pediatric respiratory physiology and airway anatomy are responsible for the particular respiratory vulnerability in this stage of life. This article explains the aspects of pulmonary embryogenesis relevant for anesthesia and their impact on the respiration of preterm infants and neonates. The respiratory distress syndrome and bronchopulmonary dysplasia are highlighted as well as the predisposition to apnea of preterm infants and neonates. Due to the anatomical characteristics, the low size ratios and the significantly shorter apnea tolerance, airway management in children frequently represents a challenge. This article gives useful assistance and provides an overview of formulas for calculating the appropriate tube size and depth of insertion. Finally, the pathophysiology and adequate treatment of laryngospasm are explained.

Amniotic fluid embolism: A comparison of two classification systems in a retrospective 8-year analysis from two tertiary hospitals.

OBJECTIVE: Amniotic fluid embolism (AFE) is a rare life-threatening complication in obstetrics, but the diagnosis lacks a consensual definition. The objective of this study was to compare two different AFE classification systems by analysing the AFE cases from two university hospitals. MATERIAL AND METHODS: In this retrospective study, all patients with a strong suspicion of AFE between 2014 and 2021 at two university hospitals, LMU Women's University Hospital Munich, and Women's University Hospital Basel, were included. Patient records were checked for the ICD-10 code O88.1 (AFE). Diagnoses were confirmed through clinical findings and/or autopsy. The presence of the diagnostic criteria of the Society of Maternal foetal Medicine (SMFM) and the AFE Foundation (AFEF) and of a new framework by Ponzio-Klijanienko et al. from Paris, France, were checked and compared using Chi-square-test. RESULTS: Within our study period, 38,934 women delivered in the two hospitals. Six patients had a strong suspicion of AFE (0.015%). Only three of six patients (50%) presented with all the four diagnostic criteria of the SMFM/AFEF framework. All six patients met the criteria of the modified "Paris AFE framework". CONCLUSION: Using the "Paris AFE framework" based exclusively on clinical criteria can help clinicians to diagnose AFE, anticipate the life-threatening condition of the patient and prepare immediately for best clinical care.

[Fetal and pediatric cardiovascular physiology : Things you should know as an (pediatric) anesthesiologist]. / Fetale und kindliche Herz-Kreislauf-Physiologie : Was der/die (Kinder­)Anästhesist*in wissen sollte.

Immediately after birth the physiology of the cardiovascular system of the neonate undergoes some significant changes. The first breaths in life and the inflation of the lungs lead to a considerable drop in pulmonary arterial resistance. This results in the closure of the foramen ovale and ductus arteriosus; however, during the first weeks of life a sharp rise in pulmonary vascular resistance caused by hypoxia, hypercapnia and excessive positive pressure ventilation can lead to the reopening of the ductus arteriosus. This may result in subsequent strain of the left heart. In order to anticipate the reopening of the ductus arteriosus, it is recommended to measure the saturation of peripheral oxygen not only preductal (right hand), but also postductal (feet).An excessive volume therapy should be avoided as the neonatal myocardium is hallmarked by low cardiac compliance, reduced contractility and reduced ventricular filling.Until now there is still no uniform definition of hypotension in pediatric patients. Blood pressure values that are measured in awake children or are derived from the 50% age percentile values can thus only be used as approximate values. In all cases it is mandatory to recognize and consistently treat hypotension during pediatric anesthesia in order to prevent postoperative organ damage, particularly of the brain.The transcranial measurement of cerebral regional oxygen saturation (c­rSO2) by means of near-infrared spectroscopy (NIRS) provides valuable information about regional tissue oxygenation of the brain. This enables conclusions about the state of the multifactorial cerebral perfusion to be drawn. In this way monitoring of the hypoxia sensitive cerebral tissue can be accomplished and should be used in premature infants and neonates. When measuring a baseline in awake patients, a 20% drop of c­rSO2 from this baseline should be challenged and treated if necessary.

[Anesthesia for electroconvulsive therapy]. / Anästhesie zur Elektrokrampftherapie.

Electroconvulsive therapy (ECT) is an important component in the treatment of depression and schizophrenia in Germany. For this intervention patients undergo short-term general anesthesia and muscle relaxation. Before anesthesia can be carried out patients are subject to a comprehensive examination. For general anesthesia all established hypnotics can be used, but differences with respect to the success of the ECT have been described. Short-acting or reversible relaxants should be preferentially used. The risks of general anesthesia during ECT are estimated to be low but a transient hemodynamic instability of patients can occur. Treatment can be performed as an inpatient but also as an outpatient procedure.

[Pregnant patients wirsth major trauma in the resuscitation room : Special (patho)physiological and therapeutic aspects]. / Polytraumatisierte Schwangere im Schockraum : Spezielle (patho­)physiologische und therapeutische Aspekte.

BACKGROUND: Severely injured pregnant women are rarely encountered even in major trauma centers; at the same time high expectations are set for the best possible outcome of mother and child. OBJECTIVE: Summary of the main pathophysiological aspects of pregnancy and essential therapeutic implications for emergency room treatment from the perspective of anesthetists. METHODOLOGY: Selective literature analysis with a focus on primary physiological literature and the synthesis of pregnancy-adapted recommendations of related guidelines. RESULTS: The essential physiological adaptations to pregnancy and their implications for acute care are presented. CONCLUSION: Teamwork, structured decision making as well as airway management and goal-oriented hemodynamic treatment are the foundations for a good outcome of mother and child.

[Anesthesia and pain management during pregnancy]. / Anästhesie und Schmerztherapie während der Schwangerschaft.

During the perioperative and postoperative care of pregnant women it is prudent to pay close attention to the changed physiology of these patients. The main principles of care are the preservation of maternal and fetal homeostasis as well as avoidance of any substances with toxic effects on the fetus. In order to provide pregnant patients with good quality care, all relevant disciplines should be involved as early as possible. Modern anesthetic drugs can be used as they seem to be without teratogenic effects. Adequate perioperative surveillance and assessment of the fetus is also important.The mainstay of pain management during pregnancy is the World Health Organization (WHO) pain ladder. It is of the utmost importance to use only substances without teratogenic or fetotoxic properties. Considering non-opioid drugs, the use of paracetamol is a viable option, whereas non-steroidal anti-inflammatory drugs (NSAID) should only be used with rigorous restrictions. Tramadol is a first-line drug when using opioids with low potency, whereas morphine can be used as an opioid with a higher potency after careful consideration of the risk-benefit ratio. If possible anticonvulsives should not be used as an adjunct in pain management during pregnancy. The use of thoroughly investigated antidepressants seems to be a better alternative. Apart from drug therapy it is important to use all available conservative pain treatment options.

[Perioperative evaluation and treatment of cardiovascular risk patients for noncardiac surgery : Guidelines of the European Society of Cardiology/European Society of Anaesthesiology 2014]. / Perioperative Beurteilung und Behandlung kardiovaskulärer Risikopatienten für nichtherzchirurgische Eingriffe : Leitlinien 2014 der European Society of Cardiology/European Society of Anaesthesiology.

In late summer 2014, the joint working group of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) presented new guidelines for the evaluation and treatment of cardiovascular risk patients undergoing noncardiac surgery. In addition to the preoperative collation of patient and intervention-specific risks, the guidelines deal with anaesthesiological and cardiological aspects of the perioperative management of patients with diseases of the heart and common comorbidities. This article summarizes the essential aspects of the guidelines in a clearly arranged form.