With advancements in sedation techniques,painless gastrointestinal endoscopy has expanded from a diagnostic role to surgeries. This study aims to explore strategies for enhancing patient satisfaction, improving safety, and reducing complications. Tailoring preoperative assessments beyond American Society of Anesthesiologists classification is crucial, especially for the elderly and pediatric populations. Integration of scales and point-of-care testing (POCT) provides a precise baseline evaluations. Optimizing anesthetic strategies through improved drug selection and enhanced perioperative monitoring follows accurate patient evaluations. While post-procedural follow-up is essential, existing studies in this area are limited. This article outlines current painless gastrointestinal endoscopy technology, emphasizing POCT establishment, personalized monitoring, and optimized anesthesia strategies for a positive impact on patient outcomes.
Hinweise
Le Xu and Yanhong Li contributed equally to this work.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Abkürzungen
ASA
American Society of Anesthesiologists
BIS
Bispectral index
BNP
Brain natriuretic peptide
ERCP
Endoscopic retrograde cholangiopancreatography
GI
Gastrointestinal
IVCD
Inferior vena cava diameter
NT
N-terminal
PetCO2
End-tidal carbon dioxide
POCT
Point-of-care testing
RCRI
Revised Cardiac Risk Index
1 Introduction
In the past decade, the number of patients undergoing gastrointestinal (GI) endoscopy in China exceeded 20 million. However, the proportion of painless painless gastrointestinal endoscopy and treatment technology was only 48.3%, which is much lower than other countries [1]. This is mainly due to the shortage of anesthesiologists, the lack of relevant knowledge among the public, insufficient understanding of complications, and economic reasons [1]. Recently, with the popularization of painless gastrointestinal endoscopy technology, it is not only used for screening and early diagnosis of gastrointestinal diseases. The development of many endoscopic surgeries is also worth attention, such as endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP). Patients with morbid obesity, achalasia, superficial gastrointestinal carcinoma, and non-neoplastic mucosal lesions can also undergo regular endoscopic treatments. Some common procedures include endoscopic submucosal dissection, endoscopic sleeve gastrectomy, and peroral endoscopic myotomy . The development of these endoscopic surgeries has also presented challenges for perioperative anesthesia management [2]. In clinical practice, we not only need to prevent anesthesia-related complications such as hypoxemia and aspiration, but anesthesiologists should also be highly vigilant about complications caused by endoscopic surgeries, such as venous air embolism, pneumomediastinum, pneumothorax, subcutaneous emphysema, bleeding, and visceral perforation.
Bowel preparation is an essential step in performing colonoscopy and therapeutic interventions. However, it can lead to electrolyte imbalances in patients, potentially resulting in cardiovascular complications. Therefore, for high-risk populations such as the elderly and those with concomitant cardiovascular diseases, a more precise evaluation of their electrolyte status and volume is imperative. This approach aims to tailor interventions based on individual patient profiles, with the goal of reducing perioperative complications in these patients.
Anzeige
In the following parts, we aim to discuss how to reduce the incidence of perioperative complications by improving preoperative evaluation, enhancing perioperative monitoring, and optimizing anesthesia strategies.The main points of the summary are presented in the form of a mind map in Fig. 1.
Fig. 1
Optimizing perioperative anesthesia strategies for safety and high-quality
×
2 Preoperative evaluation
Adequate preoperative evaluation remains an important step in optimizing patient status, improving patient outcomes, and enhancing comfort. Currently, there are no unified preoperative assessment standards for painless gastrointestinal endoscopic examination and treatment internationally, nor have reasonable and comprehensive standardized processes has been established. Both the American Society of Anesthesiologists (ASA) classification [3] and the 2021 Korean Endoscopic Sedation Guidelines [4] use ASA classification to assess the level of sedation risk, and most domestic hospitals also use ASA classification as the primary assessment basis. Although the ASA classification is widely applicable and related to perioperative cardiopulmonary adverse events, it is difficult to perform individualized assessments. The prevention of diverse complications associated with distinct gastrointestinal endoscopies necessitates the establishment of a relatively comprehensive assessment system. This involves relying on a variety of already implemented risk assessment tools. Regarding potential airway and cardiac risks during gastrointestinal endoscopic procedures, guidance can be sought from the decision tree formulated by Pardo et al. [5]. The determination of whether endotracheal intubation is necessary for airway protection during gastrointestinal endoscopy depends on specific clinical and procedural characteristics, encompassing body mass index, risk of hypoxemia, aspiration risk, procedural location, time, and duration of the procedure. Algorithms designed for decision-making encourage airway protection for a score greater than or equal to 4. In evaluating potential cardiac risks in patients, it is crucial to employ the Revised Cardiac Risk Index (RCRI) to assess perioperative cardiac-related risks. Moreover, for patients with evident cardiac risk factors, enhancing screening with cardiac biomarkers is recommended. Meta-analyses suggest that incorporating assessments of N-terminal (Nt) brain natriuretic peptide (BNP) and NT-proBNP can further improve the predictive accuracy for major cardiac adverse events. In certain instances, the use of biomarkers alone may demonstrate superior discriminative performance compared to RCRI. Therefore, for elderly patients with a history of cardiac conditions, both RCRI assessment and cardiac biomarker screening are indispensable [6]. A notable complication of significance is upper gastrointestinal bleeding. It is advisable to utilize the Glasgow Blatchford Bleeding Score for the stratification of risk in upper gastrointestinal bleeding, thereby aiding in the prediction of a combination of clinical interventions and mortality rates [7]. Pediatric patients have a different disease spectrum, complexity, and severity than adults, and the ASA classification lacks specificity in preoperative assessment of children. The revised pediatric American Society of Anesthesiologists Physical Status classification system [8] and the simplified Pediatric Risk Assessment system validated both internally and externally can predict perioperative mortality in non-cardiac surgical pediatric patients within a 30-day timeframe [9]. Hence, it is advisable to augment the assessment process for pediatric patients undergoing gastrointestinal endoscopy [10]. Constructing a personalized and precise monitoring system entails a focused preoperative assessment centered on prevalent complications during the perioperative phase of gastrointestinal endoscopy. Tailored evaluations are imperative for specific patient demographics, such as pediatric and geriatric populations. By amalgamating processes and scales delineated in the aforementioned assessment references, a comprehensive framework can be devised. The ultimate goal is to formulate a quantifiable tool reminiscent of the American College of Surgeons National Surgical Quality Improvement Program calculator. However, the successful development of this assessment methodology necessitates thorough validation using a substantial sample size to affirm its correlation with complication occurrences and scoring.
Reducing the incidence and mortality of anesthesia-related complications, is an important issue in the further development of painless gastrointestinal endoscopy diagnostic and therapeutic technology. Therefore, establishing a precision evaluation system is an important step in reducing perioperative adverse events and improving comfort.
3 Perioperative precise monitoring
3.1 End-tidal carbon dioxide monitoring
Ensuring patient safety during the perioperative period hinges on maintaining a delicate balance between oxygen supply and demand. Oxygen supply is determined by factors such as cardiac output, hemoglobin levels, and arterial oxygen saturation. Continuous monitoring of electrocardiogram, oxygen saturation, and blood pressure is essential. Perioperative angina and changes in body temperature can increase oxygen consumption, thus temperature monitoring is also crucial. In China, patients undergoing painless gastroscopy receive routine SpO2 monitoring, but the monitoring rates for blood pressure, electrocardiogram, and end-tidal carbon dioxide (PetCO2) are 79.3%, 76.5%, and 13.9%, respectively [1]. PetCO2 monitoring has been proven effective in detecting respiratory depression before transient hypoxemia occurs. By comparing PetCO2 with transcutaneous arterial CO2, the occurrence of hypoxia during endoscopic procedures can be detected earlier in PetCO2. Studies have demonstrated that the incidence of hypoxemia in patients receiving PetCO2 monitoring is significantly lower than in those receiving standard monitoring [11]. Nasal cannula oxygen is widely used in clinical practice but does not allow real-time PetCO2 monitoring [12]. The new type of endoscopic mask not only permits PetCO2 monitoring and improves minimum oxygen saturation, but also benefits patients with obesity or difficult airways as it is connected to the oral pharyngeal airway [13]. Therefore, in predicting and preventing hypoxia complications, end-respiratory carbon dioxide is of great significance, but the prevalence rate is not high.
Anzeige
3.2 Sedation depth monitoring
Determining the appropriate level of targeted sedation relies heavily on a comprehensive preprocedural evaluation of the patient and the specific procedure planned. For individuals with normal physiological conditions, moderate sedation and analgesia are generally suitable. In this state, patients demonstrate purposeful responses to verbal or tactile stimuli, with unaffected airway and spontaneous respiration, and maintained cardiovascular function. Advancing into deep sedation and analgesia diminishes responsiveness to stimuli, potentially requiring interventions for airway and respiration. It’s crucial to note that purposeful response doesn’t equate to withdrawal from noxious stimuli. In general anesthesia, there’s no response to noxious stimuli, often necessitating support for airway maintenance, ventilation, and possibly cardiovascular support. Therefore, for patients undergoing general anesthesia intubation, quantifying anesthesia depth explicitly holds instructive significance for airway management. Moreover, continuous monitoring of bispectral index (BIS) during deep sedation in endoscopic retrograde cholangiopancreatography can detect respiratory depression early and prevent it in patients [14]. BIS values were not associated with hypoxic events, but there was a clear downward trend prior to hypoxic events. Therefore, BIS monitoring should only be used as an adjunct to suggest that the patient may be hypoxic.
3.3 POCT ultrasound examination
The point-of-care testing (POCT), including bedside laboratories and ultrasound examination with patient’s frailty score, establishes accurate and fast preoperative evaluation systems, to improve clinical pathways and enhances patient anesthesia safety and quality. It has undergone technological development, and its use is widespread in clinical laboratories to assure a reduction in turn-around time and rapid patient management in some clinical settings where it is important to make quick decisions. Assessment of the risk of aspiration of GI content is a critical part of patients evaluation. A US registry study, including nearly 5 million outpatients undergoing GI endoscopy, reports 1.1% aspiration pneumonia within 30 days after the procedure. Risk factors were: a previous history of pneumonia, stroke, dysphagia and congestive heart failure. The risk increases to 3.4% regarding ERCP and 4.8% in case of upper GI bleeding [5]. In high-risk patients for reflux aspiration such as severe and/or documented gastroesophageal reflux disease, occurring during fasting or more than once a week, resistant to proton pump inhibitors or responsible for severe lesions such as Barrett’s esophagus, appropriately prolonging the fasting time and placing gastrointestinal decompression are recommended by the Chinese guidelines [15]. However, routine fasting alone cannot guarantee complete gastric emptying or eliminate differences in gastric acid pH. In a study of elective surgery patients who underwent gastric ultrasound examination, approximately 6% of patients still had a large amount of gastric fluid and 1.7% had solid contents despite fasting [16]. Although the use of acid-suppressing agents, histamine receptor antagonists, and proton pump inhibitors can alter the pH and volume of gastric contents [17], no studies have demonstrated that prophylactic use of drugs can improve patient clinical outcomes. Prior to anesthesia induction, gastric ultrasound examination is more effective than fasting alone in ensuring complete gastric emptying. If solid gastric contents are present, the necessity of endoscopy, sedation depth, and the need for tracheal intubation must be considered.
Bedside gastric ultrasound is highly sensitive and specific to detect or rule out a full stomach in clinical scenarios in which the presence of gastric content is uncertain. Although gastric ultrasound can help us understand in advance how well a patient is holding food in the stomach, there is no good monitoring method for reflux aspiration. coughing during endoscopy is considered to be related to postoperative aspiration pneumonia [18].
Measuring the inferior vena cava diameter (IVCD) by ultrasound before surgery, with an IVCDmax < 1.25, is a better predictor of hypotension and a noninvasive and convenient way to assess blood volume. When IVCDmax < 1.25, intravenous fluid supplementation or oral multidimensional carbohydrate regimens can help maintain circulatory stability and reduce postoperative nausea and vomiting, but they do not decrease the incidence of hypotension [19, 20].
3.4 POCT bedside laboratory
Due to routine gastrointestinal preparation and water fasting before painless gastroscopy, patients often experience hypokalemia, hypoglycemia, hypovolemia, enhanced stress response, hypocalcemia, and other complications, which may increase the incidence of cardiovascular events in elderly patients, including myocardial ischemia and infarction, malignant arrhythmia, and sudden death. These complications are also associated with perioperative muscle weakness, fatigue, and other symptoms [21]. The use of certain special drugs, such as proton pump inhibitor related hypomagnesemia, is closely related to perioperative arrhythmia [22]. Therefore, it is significant to establish a bedside laboratory for gastroscopy mainly based on blood gas analysis to assess the patient’s internal environment, including electrolytes, blood sugar, acid-base balance, and other conditions, in order to provide timely warning, recognition, and prevention of related complications. In addition, for unexpected events such as newly appeared nausea and vomiting, electrolyte disorders after enema use, insufficient preoperative blood volume, failure to comply with the requirements of water and food restriction, or unauthorized discontinuation of relevant medications, emergency gastrointestinal endoscopy may be performed on patients with severe cardiovascular and pulmonary diseases. Before the procedure, the bedside laboratory system should be used to evaluate the internal environment and cardiovascular function, volume, pressure, and morphology, and to perform continuous, real-time monitoring and dynamic assessment without increasing the cost. Therefore, the significance of a painless gastroscopy preoperative risk assessment system that is universally applicable and effective lies in the rapid reassessment before the procedure, the establishment of a bedside laboratory evaluation system based on blood gas analysis and assisted by ultrasound examination, and further detailed inquiry of medical history and physical examination.
Accurate monitoring should be continuously performed for the occurrence of complications, capturing information in real time, in order to improve patient prognosis. Joint monitoring should be conducted using bedside ultrasound, blood gas analysis, and other methods, transitioning from focusing on electrocardiography, SpO2, blood pressure, heart rate, to monitoring tissue ion balance and acid-base equilibrium changes. Therefore, for patients undergoing painless endoscopic diagnosis and treatment, maintaining a balance between oxygen supply and demand, electrolyte and acid-base balance, and reducing respiratory and circulatory system adverse events, establishing an immediate and continuous monitoring system that combines electrocardiography, SpO2, blood pressure, and heart rate with bedside laboratory testing is a new approach for clinical monitoring of new technologies.
4 Optimizing anesthesia management strategies for painless gastrointestinal endoscopy
4.1 Optimization strategies for the use of anesthetic drugs
As the application of gastrointestinal endoscopy continues to expand, anesthesia methods involved in these procedures have become increasingly diverse. In addition to local anesthesia with lidocaine, tetracaine hydrochloride jelly, and benzocaine throat spray, various options are available for patients, ranging from conscious analgesia and mild sedation to deep sedation and tracheal intubation, with different drug combinations. Benzodiazepines and opioids are widely used in clinical practice. However, midazolam, due to its relatively long half-life, is associated with prolonged postoperative sedation and drowsiness in elderly patients and should be avoided [23]. Administering an adequate dose of opioids with a rapid onset can significantly reduce stress responses during the examination. Short-acting drugs such as remifentanil have been shown to be effective and safe for gastric polyp resection [24], although postoperative respiratory depression and urinary retention should be taken into consideration. Administering a continuous low-dose propofol infusion and reducing the speed of drug administration [4], can also help prevent hypoxemia. Etomidate has a potent sedative effect and is more conducive to maintaining circulatory stability than propofol. However, studies have shown that using etomidate alone leads to a higher incidence of respiratory system complications and requires more adjunctive medications. Long-term systemic complications, such as adrenal suppression, should not be disregarded [25].
Research has demonstrated that the physicochemical properties of a propofol and etomidate mixture remain unchanged, and when administered in a volume ratio of 2:1, they can maintain stable respiration and hemodynamics in patients, while effectively reducing the incidence of hypoxemia, muscle spasms, injection pain, limb movement, coughing, swallowing, postoperative nausea, and vomiting [26]. However, further investigation is required regarding painless gastrointestinal endoscopy in elderly patients. Ciprofol similar to propofol in terms of induction and recovery time, has been proven to be effective and safe in painless gastroscopy and fiberoptic bronchoscopy, reducing injection pain. Nonetheless, its cardiovascular inhibitory effect is not significantly different from propofol, and its impact on the respiratory and circulatory systems in elderly and debilitated patients needs further exploration [27, 28]. Based on Hung et al.’s meta-analysis, incorporating intravenous lidocaine into propofol sedation not only diminishes postoperative pain, lowers the risk of vomiting, and reduces the occurrence of involuntary movements but also, in subgroup analysis, exclusively intravenous lidocaine decreases the required propofol dosage during gastrointestinal endoscopy. This enhancement in endoscopist satisfaction is coupled with a shortened recovery time. Importantly, whether administered intravenously or locally, lidocaine has no discernible impact on oxygen saturation decline, arterial hypotension rates, or surgical duration [29]. Futhermore, in the randomized controlled trial conducted by Hu et al., it was observed that the use of intravenous lidocaine can reduce intraoperative hypoxia, emergency airway management events, and the duration of painless gastroscopy in elderly patients [30]. Conversely, another study focusing on painless gastroscopy in children aged 1 to 6 revealed that a small dose of intravenous lidocaine combined with chloral hydrate sedation had no significant impact on hemodynamic status, endoscopist satisfaction, or recovery time. Therefore, the effects of lidocaine vary across different populations [31].
Anzeige
4.2 Optimization strategies for anesthesia complications
Based on the findings of a demographic survey, there exists a higher correlation between the use of anesthesia in gastrointestinal endoscopy and the incidence of complications [32]. Gastrointestinal endoscopy-related complications primarily encompass cardiovascular, pulmonary, and endoscopy-associated digestive complications. Within adverse events during upper gastrointestinal endoscopy, 60% are attributed to cardiovascular events, with an incidence rate ranging from 1/170 to 1/10,000 in large-scale national studies [33]. Using a threshold of less than 90 mmHg as low blood pressure, a meta-analysis suggests that low blood pressure is common during the propofol sedation process in colonoscopy, with 36% of procedures associated with hypotensive episodes. Prolonged propofol sedation, increased propofol dosage, and longer durations of low blood pressure are positively correlated [34]. Benzodiazepine medications manifest a subtle vasodilatory effect, exerting minimal influence on blood pressure [35]. However, in conjunction with opioid drugs, they may synergistically induce a significant reduction in blood pressure, particularly in hypovolemic patients. Propofol demonstrates a similar effect, especially in individuals with diminished blood volume. Bradycardia, irrespective of its etiology, can also precipitate hypotension. Given the multifactorial nature of perioperative hypotension, therapeutic interventions should target underlying pathogenic mechanisms. This may encompass dose reduction of vasodilatory anesthetics, utilization of vasopressor agents to counteract vasodilation, administration of positive inotropic agents to augment blood flow, use of atropine to increase heart rate, or treatment of intravascular volume depletion with crystalloids, colloids, or blood products [36]. For patients undergoing painless gastrointestinal endoscopy, primary factors include prolonged water fasting and insufficient volume due to bowel cleansing solutions. Therefore, early and adequate volume resuscitation remains paramount.
Hypoxemia is another prevalent complication, with randomized controlled trials and systematic reviews of patients undergoing gastrointestinal endoscopy reporting incidence rates of 6%–11% [33]. Given that sedative medications can contribute to hypoxemia, caution is advised when using sedatives in elderly patients. Studies suggest that even lower doses of midazolam may induce hypoxemia in older individuals, emphasizing the need for prudent use of sedatives in the elderly population. Preferably with a benzodiazepine reversal agent (e.g., Flumazenil) before the opioid reversal (e.g., Naloxone), while providing continuous supplemental oxygen, either with a face mask [37]. Patient airway protection should be maintained with either a chin-lift or jaw-thrust maneuver or using an airway, laryngeal mask or even an endotracheal tube [12, 38, 39].
Nausea and vomiting are common complications after painless diagnosis and treatment. In addition to high-risk factors such as young women, non-smokers, a history of postoperative nausea and vomiting, motion sickness, and the use of opioids, mechanical stimulation of the digestive mucosa during endoscopy, insufficient suction after insufflation, and pharyngeal irritation are closely associated with postoperative nausea and vomiting. For moderate to high-risk patients, drugs such as butyrophenones, corticosteroids, anticholinergics, 5-HT3 receptor antagonists, and neurokinin-1 antagonists have some therapeutic effects on nausea and vomiting [40], as well as shortening the fasting time or administering low-concentration carbohydrates orally 2 h before surgery [41, 42]. As previously mentioned, studies have also confirmed that correcting electrolyte disorders and intravenous fluid supplementation have certain effects in reducing postoperative nausea and vomiting.
4.3 Optimization strategies of anesthesia for special populations
With the increasing prevalence of painless gastrointestinal endoscopy, there is currently no established clinical pathway for evaluating and examining both the general population and special populations who are not absolutely contraindicated, including elderly and debilitated patients, children, patients with acute myocardial infarction, COVID-19 infection, upper gastrointestinal bleeding, and other conditions, both internationally and domestically. Therefore, we propose the establishment of a painless gastrointestinal endoscopy evaluation system. Based on the ASA grading evaluation, a rapid evaluation system is adopted for patients with different risk factors, including bedside blood gas analysis and ultrasound, to improve the ability to diagnose and treat complications, and pay more attention to tissue metabolism and functional changes. The monitoring system should ensure effectiveness, timeliness, and comprehensive information capture. For patients with fullness, repeated vomiting, or hematemesis, bedside rapid gastric ultrasound scanning should be performed; for elderly and patients with heart failure, bedside cardiac ultrasound evaluation should be performed; for emergency bleeding shock or patients with obvious diarrhea after using enema, bedside blood volume assessment and blood gas analysis should be performed. The incidence and mortality of COVID-19 in elderly patients with cardiovascular diseases are high. Acute cardiovascular complications may include myocardial injury, acute coronary syndrome, heart failure, arrhythmia, autonomic dysfunction, and thromboembolism. There may be interactions between perioperative cardiac risks and persistent respiratory symptoms, hypoxia, pulmonary dysfunction, or occult thromboembolism. Additionally, although respiratory symptoms of COVID-19 may disappear or even be asymptomatic, potential lung infections, even pulmonary consolidation, are often overlooked. Studies have shown that patients who underwent surgery within 7 weeks after COVID-19 diagnosis had a higher incidence of postoperative pulmonary complications [43]. Therefore, bedside rapid assessment of cardiac and pulmonary ultrasound before painless diagnosis and treatment may help detect potential lesions.
Anzeige
Simultaneously, establishing emergency plans for unexpected events, such as timely awakening of patients with gastric retention or airway protection for patients with expected massive bleeding, can enable precise management of painless gastrointestinal endoscopy perioperative care. Furthermore, increasing the training of non-anesthesiologist staff such as anesthesia nurses, optimizing anesthesia drugs, and implementing fast-track models can reduce perioperative complications and provide new technical solutions to ensure the safety and comfort of painless gastrointestinal endoscopy patients. These measures can improve the popularity of painless diagnosis and treatment.
5 Conclusions
Currently, preoperative assessment for painless gastrointestinal endoscopy still relies primarily on ASA classification. It is crucial to emphasize and establish an individualized assessment system for complications. The use of POCT technology and optimized anesthesia strategies can effectively prevent and reduce the occurrence of perioperative complications, improve patient outcomes, and promote the development of comfortable medical care.
Acknowledgements
Not applicable.
Declarations
Ethics approval and consent to participate
Not applicable.
Anzeige
Consent for publication
All authors of the manuscript have read and agreed to publish.
Competing interests
The authors declare no conflicts of interest.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.
Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.
Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.
Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.
Update AINS
Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.
