Abstract:The 2025 European Resuscitation Council (ERC) guidelines introduce updated recommendations for adult Basic Life Support (BLS) and Advanced Life Support (ALS), with a strong focus on early recognition, high-quality cardiopulmonary resuscitation (CPR), timely defibrillation, and physiologically guided resuscitation. This article summarizes the most relevant changes and practical implications for healthcare professionals and bystander.
Abstract:Pain assessments are essential for the diagnosis and treatment planning of pain disorders. Guided by the biopsychosocial model, they evaluate physical, psychological, and social factors that contribute to pain chronification. Unimodal assessments, typically performed by pain specialists, are often the first step in specialized pain care. If risk factors for chronification or established chronic pain are identified, an interdisciplinary multimodal assessment (IMA) involving physicians, psychologists, and physiotherapists is recommended. The IMA combines medical, functional, and psychological evaluation with an interdisciplinary case conference to develop an individualized treatment plan. Depending on the findings, recommendations may include outpatient, day-clinic, inpatient, rehabilitative, psychosomatic, or psychiatric treatment. More recently, ambulatory interdisciplinary multimodal assessments (A-IMA) have been introduced for patients in the early stages of pain chronification. Early identification of risk factors and timely interdisciplinary intervention may help prevent the progression of chronic pain.
Abstract:Interdisciplinary multimodal pain therapy (IMPT) is the gold standard for patients with refractory chronic pain. However, long-term treatment success varies considerably. While evidence for factors of success is scarce, this narrative review outlines key strategies to improve the long-term effectiveness of IMPT across all treatment phases, exemplified in a model patient with fibromyalgia. A comprehensive interdisciplinary assessment is essential to identify medical, psychological, functional, and social barriers to recovery while fostering patient engagement and shared decision-making. During therapy, patient education, individualized goal setting, and strengthening self-efficacy are crucial to promoting lasting behavioral change. In particular, early planning of discharge modalities may facilitate treatment adherence in an ambulatory setting. Discharge reports with concrete interdisciplinary recommendations enhance long-term success. Moreover, digital health applications and self-help groups may reinforce learned strategies and improve adherence. A structured booster session several months after IMPT is recommended to assess treatment success, review treatment goals, reinforce coping strategies, and strengthen motivation through peer support and interdisciplinary guidance. Overall, sustainable success after IMPT depends on careful patient assessment, continuous patient activation, individual approaches with concrete goals, seamless transition to outpatient care, and a structured long-term follow-up. These measures may improve patients' ability to manage chronic pain in everyday life.
Abstract:Children are particularly vulnerable to heat-related illnesses, yet specific diagnostic and treatment guidelines are lacking. In light of climate change and rising temperatures, there is an urgent need to adapt pediatric emergency care. This article highlights risks and symptoms and provides practical recommendations for managing heat-related emergencies in children.
Abstract:During general anesthesia, patients cannot experience pain - only nociception. Opioids do not serve as intraoperative analgesics; their role is to blunt autonomic stress responses and reduce the requirements for other anesthetic agents. The concept of balanced anesthesia was developed to minimize the side effects of mono-anesthesia, not to treat intraoperative pain. Opioid-free and opioid-sparing strategies confirm that intraoperative opioids are effective but not indispensable. Framing their use as pain relief is a persistent myth that may promote harmful overprescribing.
Abstract:Postoperative delirium (POD) and perioperative neurocognitive disorders (PND) are among the most common and clinically relevant complications following surgical procedures. Older and vulnerable patients are particularly affected, with reported delirium incidences ranging from 20% to 50%, depending on patient risk profile, surgical procedure, and screening methodology. Beyond increased morbidity and mortality, postoperative neurocognitive complications are associated with functional decline, reduced quality of life, prolonged hospital stays, and substantial healthcare costs.The evidence base for the prevention, early detection, and management of perioperative neurocognitive disorders includes preoperative risk stratification, structured delirium screening, EEG-guided anesthesia, and multimodal perioperative care pathways. These measures are supported by contemporary international recommendations, including the European Society of Anaesthesiology and Intensive Care (ESAIC) guideline on postoperative delirium in adult patients. Despite the growing body of evidence, the successful implementation of these strategies into routine clinical practice remains challenging.This CME article summarizes the current evidence regarding the assessment, prevention, and follow-up of perioperative neurocognitive disorders and discusses the Safe Brain Initiative (SBI) together with its Patient-Centered Precision Care - (PC)2 - framework as an example of a structured implementation strategy for evidence-based perioperative care. Three clinical case studies illustrate the practical application of guideline-based recommendations throughout the perioperative pathway. Statements supported by published evidence are clearly distinguished from working hypotheses and implementation concepts whose effectiveness remains the subject of ongoing scientific investigation.
Abstract:In current anaesthetic practice, monitoring remains largely focused on cardiorespiratory parameters, while the brain, the primary target organ of anaesthesia, is insufficiently monitored. EEG-based neuromonitoring enables direct, continuous, and non-invasive evaluation of the cerebral effects of anaesthetics, yet its clinical application is often limited to numerical indices derived from proprietary algorithms. This simplification of a complex biosignal is prone to artifacts, delays, and systematic bias, particularly in elderly and frail patients.We argue that index-guided anaesthesia alone may fail to detect clinically relevant states such as burst suppression, even when values remain within recommended ranges. Age-related EEG changes, including reduced alpha activity and increased susceptibility to suppression, can result in falsely reassuring index values despite excessive anaesthetic depth. Importantly, both the occurrence and duration of burst suppression are associated with postoperative delirium and adverse cognitive outcomes.Visual interpretation of raw EEG and spectral patterns provides essential additional information, enabling individualized anaesthetic titration and avoiding overdosage. However, implementation is limited by insufficient training. Structured educational concepts, such as the Safe Brain Initiative EEG Bootcamp, are therefore critical to meaningfully integrate EEG-based monitoring into routine practice and advancing precision, patient-centred neuroprotective anaesthesia.
Abstract:Preoperative fasting is among the most routine measures in perioperative medicine. While fasting from solid food remains well justified, current evidence suggests that prolonged fluid fasting - particularly for clear liquids - places an unnecessary burden on patients without proven benefit and may be associated with unfavorable clinical outcomes. This review examines preoperative fluid fasting within the context of the Safe Brain Initiative (SBI) and the concept of Patient-centered Precision Care - (PC)2. Using data from a multicenter registry analysis (n = 15837 patients), adherence to recommended fluid fasting intervals was shown to be associated with a lower incidence of postoperative delirium and a shorter hospital length of stay. At the same time, substantial implementation challenges are addressed transparently: despite considerable efforts, the median duration of fluid fasting remained 5 hours, and nearly 60% of patients fasted for more than 4 hours. A differentiated discussion of various fluid fasting regimens - from the conventional 2-hour rule to more liberal approaches such as "Sip-til-send" - is integrated into the (PC)2 framework. For a more detailed discussion of current guideline recommendations and their practical implementation, readers are referred to the 2026 international consensus statement (DOI: 10.1111/anae.70130).
Zusammenfassung Dexamethason ist ein hochpotentes, langwirksames synthetisches Glukokortikoid ohne mineralokortikoide Aktivität. Perioperativ wird es routinemäßig zur PONV-Prophylaxe eingesetzt, vielfach aber auch wegen einer vermeintlich relevanten Reduktion von postoperativen Schmerzen und einer damit einhergehenden Reduktion des Opioidbedarfs. Zusammenführung substanzbezogener Grundlagen, klinisch relevanter Applikationsformen, gebräuchlicher Dosierungen, Kontraindikationen, unerwünschter Wirkungen und Leitlinienempfehlungen. Parenterale Präparate enthalten typischerweise Dexamethason-21-dihydrogenphosphat, die relative antiinflammatorische Potenz liegt etwa 30-fach über der von Cortisol. Während höhere Dosierungen keinen proportionalen Zusatznutzen zu zeigen scheinen, dominieren in der Literatur intravenöse Einzeldosen von 4–8 mg. In diesen Dosierungen gilt Dexamethason als sicher. Insbesondere finden sich keine erhöhten Raten an postoperativen Wundinfektionen oder verzögerter Wundheilung, jedoch ein leichter transitorischer Anstieg des Blutzuckerspiegels. Spezielle Risiken bestehen insbesondere bei hämatologischen Neoplasien durch das Tumorlysesyndrom sowie in der endokrinologischen Diagnostik infolge einer Suppression der Hypothalamus-Hypophysen-Nebennierenrinden-Achse. Aktuelle Leitlinien verorten Dexamethason zunehmend als Bestandteil balancierter Analgesiekonzepte, teils mit Wiederholungsdosen im Rahmen von ERAS-Protokollen. Bei sorgfältiger Nutzen-Risiko-Abwägung kann Dexamethason einen kleinen, aber konsistenten Beitrag zur postoperativen Analgesie im Rahmen eines balancierten Analgesiekonzeptes leisten.
