Post-dural puncture headache (PDPH) is a frequent yet often underestimated complication of neuraxial anesthesia. The presumed mechanism involves cerebrospinal fluid loss due to accidental dural perforation, leading to intracranial hypotension and a secondary compensatory vasodilation. Meningeal irritation and neuroinflammatory processes also contribute to the complex pathophysiology. The main symptom is a severe orthostatic headache with pain exacerbation in an upright posture. This can be accompanied by neck stiffness, tinnitus, visual and other neurological disorders. Patient-specific risk factors are young age, female sex and a positive history of headaches and anesthesia-related factors include puncture needle size and design. The epidural blood patch (EBP) is the current gold standard for treatment. The occasionally considerable patient suffering and optimization of the outcomes necessitate a critical analysis of the treatment options.

Importance Video laryngoscopy is increasingly used in routine tracheal intubation in the operating room, but evidence regarding its clinical outcomes remains inconclusive. In particular, the role of hyperangulated video laryngoscopes as first-choice devices has not been studied sufficiently. Objective To determine whether video laryngoscopy—regardless of blade geometry or manufacturer—provides superior first-pass success compared with direct laryngoscopy (DL) during routine tracheal intubations. Design, Setting, and Participants This 3-arm randomized clinical trial (Conventional vs Video-Assisted Laryngoscopy for Perioperative Endotracheal Intubation [COVALENT]) was conducted at 6 academic or intermediate care centers in Germany and Austria between March 28, 2022, and February 17, 2025. Adults undergoing surgery under general anesthesia with the need for tracheal intubation were included in the trial. Adults undergoing surgery under any other form of anesthesia, those requiring nasal or planned fiberoptic intubation, and pregnant patients were excluded. Patients were sampled consecutively until trial staff capacity limits were met for any given day. Devices from different manufacturers were allowed to maximize generalizability. All data analyses followed a modified intention-to-treat approach. Intervention Tracheal intubation as part of general anesthesia induction preceding surgery. Patients were randomly assigned (1:1:1) to DL, video laryngoscopy with Macintosh blade (VLM), or video laryngoscopy with a hyperangulated blade (VLH). All interventions were performed by the anesthesiologists assigned to their respective cases. Main Outcomes and Measure The primary outcome was first-pass intubation success rate. After the laryngoscope and tracheal tube were inserted into the patient’s oral cavity, retrieval of either marked a failed intubation attempt. Successful intubation was defined as positive capnography. Differences between success rates were tested applying the z test for unpooled variance and reported as absolute differences with corresponding 95% CIs. Results Of the 2532 patients (1426 males [56.3%]; mean [SD] age, 59.7 [15.4] years) randomly assigned to DL (n = 848), VLM (n = 841), or VLH (n = 843), 2423 (95.7%) were included in a modified intention-to-treat analysis. Both video laryngoscopy modalities were superior to DL regarding first-pass success (VLM: 82.9%, VLH: 87.6%, and DL: 78.2%; all P < .001). Unadjusted absolute risk differences for first-pass intubation success were 4.66 (95% CI, 4.45-4.78) percentage points for DL vs VLM, 9.34 (95% CI, 9.22-9.46) percentage points for DL vs VLH, and 4.68 (95% CI, 4.57-4.79) percentage points for VLM vs VLH. VLM and VLH compared with DL had faster intubation success after a failed first attempt (mean [SD] time to positive capnography, 146.6 [103.6] and 147.5 [98.9] seconds vs 170.3 [100.4] seconds; P = .008). There were fewer complications of lip or dental injuries or blood on the blade for VLH compared with VLM and DL (10.9% [11 of 101] vs 23.2% [32 of 138] and 24.1% [42 of 174]). Conclusions and Relevance This randomized clinical trial of DL vs VLM and VLH found that video laryngoscopy significantly improved first-pass success during intubation in the operating room compared with DL. The findings support the use of video laryngoscopy as a new standard of care for routine airway management. Trial Registration ClinicalTrials.gov Identifier: NCT05228288 .

PURPOSE OF REVIEW:Perioperative anemia is common in surgical patients and is associated with increased morbidity, mortality, prolonged hospitalization, and higher rates of allogeneic red blood cell transfusion. Iron deficiency, either absolute or functional, represents the leading underlying cause. RECENT FINDINGS:Recent advances in patient blood management emphasize early diagnosis and targeted treatment of anemia, with iron supplementation as a cornerstone intervention. This review summarizes current evidence on mechanisms, indications, and clinical outcomes of perioperative iron therapy, with a focus on oral and intravenous formulations across the perioperative pathway. Intravenous iron is particularly effective in the preoperative setting, especially when time to surgery is limited or inflammation is present, leading to increased hemoglobin levels and reduced transfusion requirements. Oral iron remains an option in mild cases when sufficient time is available. Postoperative iron supplementation may support recovery from anemia, although evidence for patient-centered outcomes remains limited. SUMMARY:Perioperative iron therapy is an essential, evidence-based strategy to optimize hemoglobin levels, reduce transfusion needs, and improve surgical outcomes.

BACKGROUND Anaesthesia is central to obstetric care, yet contemporary data on clinical practices, particularly concerning general anaesthesia (GA) for caesarean section (CS), remain scarce. Given evolving guidelines and technologies, an updated understanding of real-world anaesthetic management is needed. OBJECTIVE Our aim was to evaluate current anaesthetic practices in obstetric care in Germany, focusing on the use of GA for CS, perioperative management, and adherence to guideline recommendations. DESIGN Nationwide, anonymised, cross-sectional questionnaire survey. SETTING The questionnaire targeted both experienced obstetric anaesthesiologists and other anaesthesiologists regularly working in obstetric anaesthesia in German hospitals. PARTICIPANTS We analysed 567 completed questionnaires from anaesthesiologists actively involved in obstetric care, representing 171 geographic locations and institutions covering approximately half of all annual births in Germany. MAIN OUTCOME MEASURES Contraindications for neuraxial procedures, estimated GA rates, perioperative management strategies, and conformity with guidelines. RESULTS The survey yielded 29 984 individual responses. Neuraxial anaesthesia was strongly preferred over GA (Likert score 4.8/5), with a median GA rate of 5 [5 to 10]%. Postoperative nausea and vomiting prophylaxis was provided by 89.4% of respondents. Platelet thresholds for neuraxial anaesthesia were more liberal than in previous surveys, with reliance on individual risk-benefit assessment instead of fixed numerical thresholds. For GA induction, propofol has largely replaced thiopental, but suxamethonium remains the favoured neuromuscular blocking agent (71.7%). Balanced anaesthesia with sevoflurane predominated (84%), while nitrous oxide use has declined sharply (2.1%). Gaps in guideline adherence were noted regarding the timing of antibiotic prophylaxis, the use of active warming and intraoperative red blood cell salvage. Compared with international practice, postoperative analgesia was mainly opioid-based, with regional techniques underused (23%). CONCLUSIONS Despite progress towards guideline adherence, substantial gaps persist between recommendations and clinical practice in German obstetric anaesthesia. Improvement opportunities include better implementation of evidence-based perioperative strategies and greater use of regional analgesic techniques postoperatively.

BACKGROUND:Anaesthesia is central to obstetric care, yet contemporary data on clinical practices, particularly concerning general anaesthesia (GA) for caesarean section (CS), remain scarce. Given evolving guidelines and technologies, an updated understanding of real-world anaesthetic management is needed. OBJECTIVE:Our aim was to evaluate current anaesthetic practices in obstetric care in Germany, focusing on the use of GA for CS, perioperative management, and adherence to guideline recommendations. DESIGN:Nationwide, anonymised, cross-sectional questionnaire survey. SETTING:The questionnaire targeted both experienced obstetric anaesthesiologists and other anaesthesiologists regularly working in obstetric anaesthesia in German hospitals. PARTICIPANTS:We analysed 567 completed questionnaires from anaesthesiologists actively involved in obstetric care, representing 171 geographic locations and institutions covering approximately half of all annual births in Germany. MAIN OUTCOME MEASURES:Contraindications for neuraxial procedures, estimated GA rates, perioperative management strategies, and conformity with guidelines. RESULTS:The survey yielded 29 984 individual responses. Neuraxial anaesthesia was strongly preferred over GA (Likert score 4.8/5), with a median GA rate of 5 [5 to 10]%. Postoperative nausea and vomiting prophylaxis was provided by 89.4% of respondents. Platelet thresholds for neuraxial anaesthesia were more liberal than in previous surveys, with reliance on individual risk-benefit assessment instead of fixed numerical thresholds. For GA induction, propofol has largely replaced thiopental, but suxamethonium remains the favoured neuromuscular blocking agent (71.7%). Balanced anaesthesia with sevoflurane predominated (84%), while nitrous oxide use has declined sharply (2.1%). Gaps in guideline adherence were noted regarding the timing of antibiotic prophylaxis, the use of active warming and intraoperative red blood cell salvage. Compared with international practice, postoperative analgesia was mainly opioid-based, with regional techniques underused (23%). CONCLUSIONS:Despite progress towards guideline adherence, substantial gaps persist between recommendations and clinical practice in German obstetric anaesthesia. Improvement opportunities include better implementation of evidence-based perioperative strategies and greater use of regional analgesic techniques postoperatively.

Background: Blood transfusion practices have evolved significantly in order to enhance patient care. The optimal strategies for administering red blood cell (RBC) transfusions is becoming rather clear; however, a comprehensive understanding of patients requiring transfusions of other blood components remains inadequate, leading to variability in clinical practice and outcomes. Here we examine surgical patients that could benefit from perioperative risk stratification. Study Design and Methods: We analyzed subgroups of a prospective, multicenter follow-up study and identified three distinct transfusion profiles across surgical disciplines: low (n = 1,035,588, 92.0%), moderate (n = 81,243, 7.2%), and high (n = 8413, 0.7%). These profiles are characterized by varying requirements for RBC, plasma, and platelet units. Results: While most patients were clustered in the low transfusion profile, blood component use only increased significantly in the high transfusion profile. Notably, patients in the high transfusion profile benefited from Patient Blood Management (PBM) interventions with a reduction of the predefined composite endpoint of in-hospital mortality and postoperative complications (ischemic stroke, myocardial infarction, pneumonia, sepsis and acute renal failure with renal replacement therapy) from 28.2% to 26.0% and an OR of 0.90 (95% CI 0.80-1.00, p = 0.048) compared to the moderate transfusion profile. Conversely, the low transfusion profile encompassed patients with minimal transfusion needs, presenting opportunities to refine resource allocation and risk stratification. Discussion: These findings underscore the potential for improving patient outcomes and indicate that implementing targeted PBM interventions can reduce the risk of adverse events and mortality. This study advances the field by identifying specific transfusion profiles that can guide future research and clinical practices towards more personalized and efficient blood management in perioperative care.

Importance:Video laryngoscopy is increasingly used in routine tracheal intubation in the operating room, but evidence regarding its clinical outcomes remains inconclusive. In particular, the role of hyperangulated video laryngoscopes as first-choice devices has not been studied sufficiently. Objective:To determine whether video laryngoscopy-regardless of blade geometry or manufacturer-provides superior first-pass success compared with direct laryngoscopy (DL) during routine tracheal intubations. Design, Setting, and Participants:This 3-arm randomized clinical trial (Conventional vs Video-Assisted Laryngoscopy for Perioperative Endotracheal Intubation [COVALENT]) was conducted at 6 academic or intermediate care centers in Germany and Austria between March 28, 2022, and February 17, 2025. Adults undergoing surgery under general anesthesia with the need for tracheal intubation were included in the trial. Adults undergoing surgery under any other form of anesthesia, those requiring nasal or planned fiberoptic intubation, and pregnant patients were excluded. Patients were sampled consecutively until trial staff capacity limits were met for any given day. Devices from different manufacturers were allowed to maximize generalizability. All data analyses followed a modified intention-to-treat approach. Intervention:Tracheal intubation as part of general anesthesia induction preceding surgery. Patients were randomly assigned (1:1:1) to DL, video laryngoscopy with Macintosh blade (VLM), or video laryngoscopy with a hyperangulated blade (VLH). All interventions were performed by the anesthesiologists assigned to their respective cases. Main Outcomes and Measure:The primary outcome was first-pass intubation success rate. After the laryngoscope and tracheal tube were inserted into the patient's oral cavity, retrieval of either marked a failed intubation attempt. Successful intubation was defined as positive capnography. Differences between success rates were tested applying the z test for unpooled variance and reported as absolute differences with corresponding 95% CIs. Results:Of the 2532 patients (1426 males [56.3%]; mean [SD] age, 59.7 [15.4] years) randomly assigned to DL (n = 848), VLM (n = 841), or VLH (n = 843), 2423 (95.7%) were included in a modified intention-to-treat analysis. Both video laryngoscopy modalities were superior to DL regarding first-pass success (VLM: 82.9%, VLH: 87.6%, and DL: 78.2%; all P < .001). Unadjusted absolute risk differences for first-pass intubation success were 4.66 (95% CI, 4.45-4.78) percentage points for DL vs VLM, 9.34 (95% CI, 9.22-9.46) percentage points for DL vs VLH, and 4.68 (95% CI, 4.57-4.79) percentage points for VLM vs VLH. VLM and VLH compared with DL had faster intubation success after a failed first attempt (mean [SD] time to positive capnography, 146.6 [103.6] and 147.5 [98.9] seconds vs 170.3 [100.4] seconds; P = .008). There were fewer complications of lip or dental injuries or blood on the blade for VLH compared with VLM and DL (10.9% [11 of 101] vs 23.2% [32 of 138] and 24.1% [42 of 174]). Conclusions and Relevance:This randomized clinical trial of DL vs VLM and VLH found that video laryngoscopy significantly improved first-pass success during intubation in the operating room compared with DL. The findings support the use of video laryngoscopy as a new standard of care for routine airway management. Trial Registration:ClinicalTrials.gov Identifier: NCT05228288.

The American Society of Anaesthesiologists Physical Status (ASA-PS) classification system is the most widely used tool for estimating perioperative risk. Despite its widespread application, the ASA-PS is based solely on the subjective assessment of the patient’s clinical condition and comorbidities, which leads to considerable inter-rater variability. The aim of this study was to investigate interprofessional differences in ASA-PS scoring between surgeons and anaesthesiologists. This prospective observational study involved patients who were scheduled for elective or emergency surgery. The patients were independently evaluated using the ASA-PS classification by treating anaesthesiologists and surgeons with varying levels of experience. Following data collection, an interdisciplinary board comprising senior anaesthesiologists and surgeons retrospectively assigned reference ASA-PS scores. Inter-rater agreement was analysed using Cohen’s kappa (κ). In total, 684 were included in the study. Surgeons assigned lower ASA-PS classes more frequently, with 16.81

Der Postpunktionskopfschmerz („post-dural puncture headache“, PDPH) ist eine häufige, aber oft unterschätzte Komplikation neuroaxialer Anästhesieverfahren. Mutmaßlich ursächlich ist ein Liquorverlust infolge akzidentieller Duraperforation mit resultierender intrakranieller Hypotension und kompensatorischer Vasodilatation. Meningeale Reizung und neuroinflammatorische Prozesse tragen zur Pathophysiologie bei. Hauptsymptom ist ausgeprägter orthostatischer Kopfschmerz, mit Schmerzexazerbation in aufrechter Körperposition, ggf. begleitet von Nackenverspannung, Tinnitus, visuellen und weiteren neurologischen Störungen. Patientenspezifische Risikofaktoren sind junges Alter, weibliches Geschlecht und positive Kopfschmerzanamnese; zu den anästhesieassoziierten Faktoren zählen Größe und Schliff der verwendeten Punktionsnadel. Der epidurale Blut-Patch (EBP) stellt therapeutisch den Goldstandard dar. Der mitunter starke Leidensdruck der Patienten und die Optimierung des Outcome erfordern die kritische Auseinandersetzung mit den Therapieoptionen.

Continuous monitoring of vital parameters using wearable devices offers potential benefits in palliative care, such as early detection of clinical deterioration and improving symptom management. However, evidence supporting their feasibility and utility in hospitalized palliative care patients remains scarce. This prospective pilot study aimed to evaluate the feasibility of continuous vital sign monitoring in hospitalized palliative care patients using wrist-worn and chest-wall devices. The study was conducted from October 2023 to November 2024 and included hospitalized patients at a university hospital. Eligible participants were required to provide written informed consent. Patients were monitored for up to 30 days or until discharge or death. Data acquisition focused on the quantity and quality of recorded parameters, including heart rate, respiratory rate, and oxygen saturation, as well as advanced hemodynamic variables. Challenges in recruitment, device performance, and data reliability were assessed. A total of 275 patients were screened, with 263 excluded for not meeting eligibility criteria. Of the nine patients who provided written informed consent, two withdrew consent before study interventions, leaving seven participants. Among these, one patient completed the maximum study duration, three were discharged to outpatient care, and three died during hospitalization. Wrist-worn devices yielded valid data for 61.5

BACKGROUND:Large language models (LLMs) are increasingly used in the medical field and have the potential to reduce workload and improve treatment procedures in clinical practice. This study evaluates the capabilities of LLMs to answer common questions related to patient blood management (PBM) and compares their performance to the expertise of clinicians from two university hospitals. METHODS:To evaluate the performance of ChatGPT-3.5, ChatGPT-4o, and Google Gemini in answering PBM-related questions, we used a representative sample of 40 questions (30 single-choice and 10 frequently asked patient questions) and compared their responses to those of clinicians. The accuracy and interrater reliability of the answers were analyzed. RESULTS:For PBM knowledge-based questions, the proportion of correct answers was 96.4% (95% CI: 93.6-98.0%) for ChatGPT-4o, 81.3% (95% CI: 77.0-85.7%) for ChatGPT-3.5, and 84.0% (95% CI: 79.4-87.7%) for Google Gemini. Clinicians (N.=82) provided correct answers to 76.5% (95% CI: 74.7-78.1%) of the questions. For frequently asked patient questions, the proportion of correct answers was 100% for ChatGPT-4o, 95.5% (95% CI: 91.4-99.6%) for ChatGPT-3.5 and 91.7% (95% CI: 86.0-97.4%) for Google Gemini. Clinicians provided correct answers to 62.0% (95% CI: 58.7-65.3%) of the questions. Across the categories -anemia management, iron supplementation, cell salvage, principles of PBM, and blood transfusion- ChatGPT-4o achieved the highest scores, providing the most correct answers. CONCLUSIONS:LLMs show strong potential for delivering accurate and comprehensive responses to common PBM-related questions. However, it remains essential for clinicians and patients to verify responses, particularly in critical situations.

BACKGROUND:Liquid fasting durations often exceed current recommendations, resulting in patient discomfort. OBJECTIVE:To investigate the feasibility of three preoperative liquid fasting protocols in patients with low risk of aspiration in preparation for a future large-scale trial, with a particular focus on patient-centred benefits. DESIGN:Prospective, randomised, controlled, pilot trial. SETTING:Secondary care; single academic centre in Germany. PATIENTS:One hundred and seventy-four adult surgical patients with low risk of aspiration. INTERVENTION:Patients were randomised either to 'control group' (usual care, 2 h liquid fasting protocol), 'conservative intervention' (patients received assistance in adhering to a 2 h liquid fasting protocol) or 'liberal intervention' (patients could drink until they were called to the operating room). MAIN OUTCOME MEASURES:Piloting process endpoints and performance endpoints were assessed. The primary outcome was patient-reported thirst before anaesthesia induction categorised as none, moderate, or severe. RESULTS:No patient dropped out or was lost to follow-up. Blinding was successful in 98.3%. The conservative and liberal interventions reduced the median [interquartile range or IQR] fluid fasting time from 5.38 h [3.67 to 9.53 h] in the control group to 3.00 h [2.23 to 4.25 h], P  < 0.001, and 1.97 h [1.20 to 3.02 h], P  < 0.001, respectively. Both conservative and liberal intervention significantly reduced the risk of preoperative thirst compared with the control group, presented as odds ratio (OR) and 95% confidence intervals (CI); conservative intervention OR 0.41 (CI, 0.20 to 0.82), P  = 0.013; liberal intervention: OR 0.21 (CI, 0.10 to 0.43), P  < 0.001. In the liberal intervention group, postoperative thirst, OR 0.32 (CI, 0.13 to 0.75), P  = 0.009, and preoperative headache, OR 0.24 (CI, 0.07 to 0.66), P  = 0.009, were significantly reduced compared with those in the control group. No adverse events were reported. CONCLUSIONS:The trial design proved feasible. Liberal fluid intake reduced thirst and headache. The trial was not powered to provide definitive conclusions on safety. TRIAL REGISTRATION:The clinical investigation plan can be accessed at ClinicalTrials.gov identifier NCT06253052. Deidentified individual participant data, the data dictionary, and statistical code can be accessed upon reasonable request from the corresponding author.

Background: Hemoglobin (Hb) is a crucial parameter in perioperative care due to its essential role for oxygen transport and tissue oxygenation. Accurate Hb monitoring allows for timely interventions to address perioperative anemia and, thus, prevent morbidity and mortality. Traditional Hb measurements rely on invasive blood sampling, which significantly contributes to iatrogenic anemia and poses discomfort and increased infection risks. The advent of non-invasive devices like Masimo’s Rad-67™, which measures Hb using pulse CO-oximetry (SpHb), offers a promising alternative. This study evaluates the accuracy of SpHb compared to clinical standard blood gas analysis (BGA) in perioperative patients. Methods: This retrospective study analyzed 335 paired Hb measurements with an interval <15 min between SpHb and BGA in the operating theater and post-anesthesia care unit of a university hospital. Patients experiencing hemodynamic instability, acute bleeding, or critical care were excluded. Statistical analysis included Bland–Altman plots and Pearson correlation coefficients (PCCs) to assess the agreement between SpHb and BGA. Potential confounders, e.g., patient age, skin temperature, sex, perfusion index (PI), and atrial fibrillation, were also analyzed. Results: The bias of the SpHb compared to BGA according to Bland–Altman was 0.00 g/dL, with limits of agreement ranging from −2.70 to 2.45 g/dL. A strong correlation was observed (r = 0.79). Overall, 57.6% of the paired measurements showed a deviation between the two methods of ≤±1 g/dL; however, this applied to only 33.3% of the anemic patients. Modified Clark’s Error Grid analysis showed 85.4% of values fell within clinically acceptable limits. Sex was found to have a statistically significant, but not clinically relevant, effect on accuracy (p = 0.02). Conclusions: The Rad-67TM demonstrates reasonable accuracy for non-invasive SpHb, but exhibits significant discrepancies in anemic patients with overestimating low values. While it offers potential for reducing iatrogenic blood loss, SpHb so far should not replace BGA in critical clinical decision-making.

Wearables and Internet of Things (IoT) technologies are increasingly incorporated into healthcare, including perioperative settings. These devices offer continuous non-invasive monitoring of vital signs, patient position, and mobilization. Nonetheless, there is currently little information about tolerance and acceptance of wearables in postoperative patients. We therefore assessed opinions and user experience in postoperative patients who used three popular fitness trackers during their entire hospital stay. Specifically, we evaluate the Apple Watch 7, Garmin Fenix 6 Pro, and Withings ScanWatch. We used an investigator-designed patient questionnaire with 11 questions to quantify patient experience and opinions regarding inpatient and home monitoring. Secondarily, we evaluated compliance and the incidence of associated adverse events during daily patient visits. Data were analyzed using descriptive statistics and non-parametric tests. The majority of the answers to the questions (82.1%) were rated positively defined as Likert-Scale Scores 4 or 5 by the 33 analyzed patients, ranging between 72.7 and 97.0% agreement rate. Specific questions related to data sharing for research and overall user experience received high agreement rates (97.0 and 84.8%, respectively). Women reported slightly higher satisfaction with device comfort, as compared to men (LS-Score 4.8 vs. 4.0). No significant differences were found based on the device model or length of hospitalization. The use of wearable devices in healthcare is rated positively by postoperative inpatients, paving the way for future implementation of these devices in healthcare. However, besides validating the measurement accuracy and demonstrating clinical benefits, several regulatory hurdles must be overcome before implementing wearables in routine clinical care.

Als Risikofaktor für erhöhte Morbidität und Mortalität sowie als einer der stärksten Prädiktoren für die Gabe von Erythrozytenkonzentraten (EK) (Gombotz et al., Transfusion 47:1468–1480, 2007; Carson et al., N Engl J Med 377:1261–1272, 2017), sollte eine präoperative Anämie frühzeitig erkannt und behandelt werden. Patient Blood Management (PBM) ist ein interdisziplinäres Konzept. Ziel ist die Erhöhung der Patientensicherheit durch Reduktion von vermeidbaren Fremdbluttransfusionen. PBM beruht auf 3 Säulen: 1) umfassendes Anämiemanagement, 2) Minimierung iatrogener Blutverluste und 3) Etablierung des rationalen Umgangs mit Fremdblutkonserven. Der individuelle Transfusionsbedarf sollte hausintern, eingriffsspezifisch erhoben werden. Bei erhöhter Transfusionswahrscheinlichkeit sollte auf eine präoperative Anämie hin untersucht und gegebenenfalls behandelt werden. Die maschinelle Autotransfusion kann den Bedarf an Fremdbluttransfusionen senken. Bei Hb-Werten von 7–8 g/dl sind die individuellen Kompensationsmechanismen der Patienten entscheidend und es ist daher auf Zeichen der anämischen Hypoxie als Transfusionstrigger zu achten.

Introduction Fitness trackers can provide continuous monitoring of vital signs and thus have the potential to become a complementary, mobile and effective tool for early detection of patient deterioration and post-operative complications. Methods To evaluate potential implementations in acute care setting, we included 36 patients after moderate to major surgery in a recent randomised pilot trial to compare the performance of vital sign monitoring by three different fitness trackers (Apple Watch 7, Garmin Fenix 6pro and Withings ScanWatch) with established standard clinical monitors in post-anaesthesia care units and monitoring wards. Results During a cumulative period of 56 days, a total of 53,197 heart rate (HR) measurements, as well as 12,219 measurements of the peripheral blood oxygen saturation (SpO2) and 28,954 respiratory rate (RR) measurements were collected by fitness trackers. Under real-world conditions, HR monitoring was accurate and reliable across all benchmarked devices (r = [0.95;0.98], p < 0.001; Bias = [−0.74 bpm;−0.01 bpm]; MAPE∼2%). However, the performance of SpO2 (r = [0.21;0.68]; p < 0.001; Bias = [−0.46%;−2.29%]; root-mean-square error = [2.82%;4.1%]) monitoring was substantially inferior. RR measurements could not be obtained for two of the devices, therefore exclusively the accuracy of the Garmin tracker could be evaluated (r = 0.28, p < 0.001; Bias = −1.46/min). Moreover, the time resolution of the vital sign measurements highly depends on the tracking device, ranging from 0.7 to 117.94 data points per hour. Conclusion According to the results of the present study, tracker devices are generally reliable and accurate for HR monitoring, whereas SpO2 and RR measurements should be interpreted carefully, considering the clinical context of the respective patients.

Correction to: Postpartale HämorrhagieAnästhesiol Intensivmed Notfallmed Schmerzther 2023; 58(10): 583-597DOI: 10.1055/a-2043-4451

Blood oxygen saturation is an important clinical parameter, especially in postoperative hospitalized patients, monitored in clinical practice by arterial blood gas (ABG) and/or pulse oximetry that both are not suitable for a long-term continuous monitoring of patients during the entire hospital stay, or beyond. Technological advances developed recently for consumer-grade fitness trackers could-at least in theory-help to fill in this gap, but benchmarks on the applicability and accuracy of these technologies in hospitalized patients are currently lacking. We therefore conducted at the postanaesthesia care unit under controlled settings a prospective clinical trial with 201 patients, comparing in total >1,000 oxygen blood saturation measurements by fitness trackers of three brands with the ABG gold standard and with pulse oximetry. Our results suggest that, despite of an overall still tolerable measuring accuracy, comparatively high dropout rates severely limit the possibilities of employing fitness trackers, particularly during the immediate postoperative period of hospitalized patients.