Luckscheiter A, Fischer M, Zink W
Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Deutschland.
Klinik für Anästhesiologie, Operative Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinik am Eichert Göppingen, Göppingen, Deutschland.
Anaesthesist. 2018 Jan;67(1):9-17. doi: 10.1007/s00101-017-0386-1. Epub 2017 Dec 5.
In 2015 practice management guidelines on prehospital emergency anesthesia in adults were published in Germany. The aim of the present study was to evaluate whether emergency physicians follow these guidelines in daily practice and to assess their level of experience with the use of anesthetic agents.
In an online survey the way of induction of preclinical anesthesia (including preoxygenation time and applied monitoring techniques) was assessed with the help of virtual scenarios based on the guidelines. Furthermore, the individual level of experience with specific anesthetic agents was estimated by the total number of anesthetic procedures performed with these drugs (0, 1-10, 11-25, 26-50, 51-100, and >100 procedures).
A total of 155 emergency physicians answered the online survey. Except for cardiac patients and for the preoxygenation time, we found a high accordance between specific algorithms proposed in the guidelines and emergency physicians' clinical practice. Furthermore, the median level of experience with rocuronium and succinylcholine was significantly higher compared to vecuronium. With respect to induction agents the highest level of experience was found for propofol and thiopental, the lowest for the combination of ketamine/propofol and midazolam. Generally, compared to non-anesthetists, emergency physicians had significantly higher levels of experience with the use of these anesthetic agents (except for etomidate and vecuronium). Over 94% used a 4-lead electrocardiogram (ECG), pulse oxymetry, non-invasive blood pressure and quantitative capnography for monitoring. The availability of succinylcholine was 91%, rocuronium 55%, vecuronium 29% and sugammadex 9%.
The results of this survey demonstrate that clinical practice of emergency physicians is in high accordance with the recommendations named in the guidelines for prehospital emergency anesthesia in adults (except for cardiac patients and time of preoxygenation). With respect to the lower levels of experience of non-anesthetists in the use of anesthetic drugs, specific training concepts may help to further improve the quality of preclinical emergency care.
2015年德国发布了成人院前急诊麻醉的实践管理指南。本研究的目的是评估急诊医生在日常实践中是否遵循这些指南，并评估他们使用麻醉剂的经验水平。
在一项在线调查中，借助基于指南的虚拟场景评估临床前麻醉的诱导方式（包括预充氧时间和应用的监测技术）。此外，通过使用这些药物进行的麻醉手术总数（0、1 - 10、11 - 25、26 - 50、51 - 100以及>100例手术）来估计个体对特定麻醉剂的经验水平。
共有155名急诊医生回答了在线调查。除了心脏病患者和预充氧时间外，我们发现指南中提出的特定算法与急诊医生的临床实践高度一致。此外，与维库溴铵相比，罗库溴铵和琥珀酰胆碱的经验中位数显著更高。关于诱导剂，丙泊酚和硫喷妥钠的经验水平最高，氯胺酮/丙泊酚和咪达唑仑组合的经验水平最低。总体而言，与非麻醉医生相比，急诊医生使用这些麻醉剂的经验水平显著更高（除依托咪酯和维库溴铵外）。超过94%的人使用四导联心电图（ECG）、脉搏血氧饱和度测定、无创血压和定量二氧化碳监测。琥珀酰胆碱的可用性为91%，罗库溴铵为55%，维库溴铵为29%，舒更葡糖为9%。
本次调查结果表明，急诊医生的临床实践与成人院前急诊麻醉指南中提出的建议高度一致（心脏病患者和预充氧时间除外）。鉴于非麻醉医生在使用麻醉药物方面经验水平较低，特定的培训理念可能有助于进一步提高临床前急诊护理的质量。
