Background Malignant hyperthermia (MH) is a rare, life-threatening pharmacogenetic reaction to volatile anaesthetics or succinylcholine. Because of its low incidence and the need for rapid intervention, clinical management remains challenging. The Mainz MH emergency kit was developed to improve procedural safety by providing standardised materials and an integrated step-by-step checklist. Methods In a randomised controlled simulation study including 57 anaesthesiologists, the impact of the Mainz MH emergency kit on performance in the management of an MH crisis was evaluated. Performance was assessed using a weighted score based on the German S1 guideline "Therapy of Malignant Hyperthermia." Additionally, both the time prior to first dantrolene administration and the accuracy of individual therapeutic steps were analyzed. Results The intervention group achieved a mean score of 85 points compared with 72 points in the control group (p < 0.001). Practical and technical measures such as dantrolene preparation, use of a particle filter, and placement of a separate intravenous line were performed significantly more often in the intervention group. The mean time prior to the first dantrolene administration was approximately 11 minutes in both groups (p = 0.82). Conclusion The Mainz MH emergency kit significantly improved performance in the ma-nagement of malignant hyperthermia. Standardised material provision and structured cognitive aids facilitate the implementation of guideline-based therapy and help reduce technical errors.
Background Anaesthesiology and intensive care medicine are among the most resource-intensive clinical disciplines and contribute significantly to the healthcare sector's ecological footprint. Despite growing scientific and professional interest, to date, there have been only a few data surveys on the implementation of sustainable measures in German anaesthesiology. The aim of this study was to investigate the extent to which sustainable procedures are already being applied in clinical anaesthesiological practice. Methods An anonymous online survey was conducted between March and April 2025 among members of the German Society for Anaesthesiology and Intensive Care Medicine (DGAI) and the Professional Association of German Anaesthetists (BDA). All questionnaires recorded by the system were included in the analysis, regardless of their degree of completeness. Respondents were allowed to skip individual questions. Of the survey's original 60 questions, 23 were selected to test the hypothesis that sustainable practices are increasingly being adopted in anaesthesiology but have not yet been implemented across the board. Structural barriers and supportive re-sources for the implementation of sustainability measures were also analysed. In addition, the implementation of sustainability measures was analysed in detail using two exploratory stratification approaches. Stratification proceeded, on the one hand, according to the level of care and, on the other hand, according to the physicians hierarchical status. Results A total of 1,239 questionnaires were analysed. Participants demonstrated a high level of environmental awareness (79.8 % agreement) and a sense of responsibility (78.3 % agreement) but reported that they had an insufficient level of knowledge (39.7 % agreement). Volatile anaesthetics continue to be used across the board by 87 % of respondents, with 78 % stating that they do not use desflurane. Of the participants, 68.3 % reported the absence of a 'green team'. A lack of financial resources, procurement guidelines and hygiene regulations were identified as barriers to the implementation of sustainability measures. The participants expressed a desire for institutional support, knowledge transfer, interdisciplinary networking and investment in sustainable technologies. Stratification according to the level of care provided by the healthcare facility showed that energy-saving measures are implemented more consistently in the outpatient sector than in the inpatient sector. Differences were also evident on hierarchical levels, with junior doctors more frequently implementing measures to reduce the ecological footprint. Conclusion There is an intrinsic motivation regarding sustainability among survey participants in the field of anaesthesiology and intensive care medicine. Volatile anaesthetics continue to be used routinely to maintain general anaesthesia. Although the use of desflurane is low, this proportion remains relevant from an environmental perspective. Structural and organisational barriers are identified as significant obstacles to widespread implementation. In this regard, there are some differences discernible between the outpatient and inpatient sectors.
Melioidosis is a rare but potentially life-threatening infection in Europe caused by Burkholderia pseudomallei and should be considered early in the differential diagnosis of travelers returning from tropical endemic regions. We report the case of a 66-year-old man with diabetes mellitus who, after travelling to southwestern Thailand, presented with fever, malaise, respiratory compromise, incipient renal failure, and multiple bilateral pulmonary infiltrates. Early blood culture sampling at first presentation was pivotal for diagnosis. Gram-negative bacilli were recovered from positive blood cultures, initially identified as Burkholderia thailandensis and subsequently confirmed as B. pseudomallei. The combination of travel history, barefoot exposure in mangrove areas, and preexisting diabetes led to an early clinical suspicion of acute bacteremic melioidosis. Following initial empirical antimicrobial treatment, therapy was adjusted according to guideline-based recommendations to ceftazidime with the addition of cotrimoxazole. Interdisciplinary intensive care management, including high-flow oxygen/noninva-sive ventilation, nutritional support, and close monitoring, allowed stabilisation without invasive mechanical ventilation or vasopressor therapy. The patient was transferred to the general ward after 9 days; intravenous therapy was continued in the outpatient setting and followed by oral eradication therapy. This case highlights the importance of early blood culture diagnostics, structured travel and exposure history, specialised microbiological infrastructure, and close collaboration between infectious diseases, microbiology, and intensive care specialists. In non-endemic countries, melioidosis should be consistently considered likely to affect travelers who present with pneumonia, sepsis, or visceral organ involvement upon their return from tropical regions.
Six years after the previous edition, the S1 guideline "Obstetric Analgesia and Anaesthesia" (AWMF 001-038) is now available in a completely revised and substantially expanded version. The 2026 revision replaces the 2020 version, which was still methodologically rooted in the tradition of American Practice Guidelines; the new edition is based exclusively on the expert consensus of 27 contributors and relies on evidence up to July 2025. The revised edition comprises 157 recommendations and 14 entirely new chapters. New content includes chapters on managing language barriers in the delivery room, ultrasound guidance for neuraxial blocks, inadequate labour epidural analgesia, insufficient efficacy of neuraxial regional anaesthesia for Caesarean delivery, uterotonics, placenta accreta spectrum (PAS), cell salvage (intraoperative autotransfusion), amniotic fluid embolism, ERAS concepts after Caesarean delivery, peripartum iron-deficiency anaemia, anaesthetic management for termination of pregnancy and palliative birth, peripartum echocardiography, and training, simulation, and staffing. In addition the guideline also includes several clinically significant reversals: vasopressors should now be administered prophylactically-rather than only therapeutically-during Caesarean delivery under spinal anaesthesia. Lo-cal anaesthetics should be given in unchanged dosage to parturients with obesity, contradicting the 2020 recommendation for dose reduction. The routinely applied left lateral tilt during Caesarean delivery is no longer generally recommended. Volatile anaesthetics now carry a strong recommendation for general anaesthesia in Caesarean delivery. The platelet threshold value for neuraxial procedures has been lowered from >= 80,000 to >= 70,000/& micro;l. The outcome indicator "conversion rate <= 5 %" for general anaesthesia during Caesarean delivery has been abolished, as it might encourage to abstain from conversion in cases of inadequate intraoperative analgesia. This brief summary of the S1 guideline outlines the key changes chapter by chapter and highlights the changes relating to actions of immediate clinical relevance.
A 58-year-old patient with Fournier's gangrene developed severe rhabdomyolysis while receiving linezolid for treatment of an infection caused by Enterococcus faecium (resistant to van-comycin). The rhabdomyolysis was characterised by a significant increase in serum creatine kinase (CK i.s.). After ruling out other causes and discontinuing linezolid therapy, CK i.s. normalised rapidly. This case suggests that linezolid may trigger rhabdomyolysis. It highlights the importance of early diagnosis, close monitoring of CK i.s., and consistent discontinuation of potentially causative medications. Additionally, haemoadsorption may be considered to lower serum myoglobin and creatine kinase i.s.. This case provides the basis for a literature review of the causes and treatment options for rhabdomyolysis.
