Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Die Anaesthesiologie
Erschienen in: Der Anaesthesist 8/2012

01.08.2012 | Regionalanästhesie

Ultraschallgesteuerte periphere Regionalanästhesie

Applikationsort und Dosierung des Lokalanästhetikums

verfasst von: Dr. G. Gorsewski, A. Dinse-Lambracht, I. Tugtekin, A. Gauss

Erschienen in: Die Anaesthesiologie | Ausgabe 8/2012

Einloggen, um Zugang zu erhalten

Zusammenfassung

Durch die Einführung des Ultraschalls in die Regionalanästhesie wurde in den letzten Jahren deutlich, dass es in der Vergangenheit wahrscheinlich erheblich häufiger als bisher angenommen zu sog. intraneuralen Punktionen bzw. Injektionen (d. h. Penetration des Epineuriums) gekommen ist. Allerdings führte dies nur selten zu bleibenden neurologischen Schäden. Die sonographische Darstellung der Nerven hat gezeigt, dass die „intraneurale Injektion“ als Oberbegriff zu betrachten ist, der unter Berücksichtigung der Morphologie der Nerven einer detaillierteren Beschreibung bedarf. Es wurde deutlich, dass der Stichkanal bei einer intraneuralen Punktion meist an den Nervenfaszikeln vorbei (intraneural-perifaszikulär) und selten durch sie hindurch (intraneural-transfaszikulär) verlief, wobei die Nadelspitze entsprechend selten im Faszikel selbst (intraneural-intrafaszikulär) zu liegen kam. Bei intraneural-extrafaszikulärer Lage kann derzeit davon ausgegangen werden, dass es wahrscheinlich zu keinen bleibenden Nervenschädigungen kommt. Werden Faszikel geschädigt, sind klinisch apparente Nervenschäden nicht auszuschließen. In einer Reihe von Studien zur Bestimmung des minimalen effektiven anästhetischen Volumens, in denen bewusst eine intraneurale Injektion vermieden wurde, konnte aber belegt werden, dass auch bei gezielter zirkumferenzieller Applikation des Lokalanästhetikums mithilfe des Ultraschalls (d. h. bei ringförmiger Verteilung um die äußerste erkennbare Nervenhülle) eine erhebliche Volumenreduktion des Lokalanästhetikums möglich ist. Diese erscheint gegenüber einer Einzelpunktinjektion außerhalb des Epineuriums (extraneurale Injektion ohne garantierte Verteilung des Lokalanästhetikums um den Nerv herum) vorteilhaft. Da die intraneural-intrafaszikuläre Applikation des Lokalanästhetikums das Risiko von z. T. lebensqualitätseinschränkenden Nervenschäden in sich birgt, sollten die Möglichkeiten des Ultraschalls im Hinblick auf die Vermeidung von intraneuralen Punktionen genutzt werden.
Literatur
1.
Abrahams MS, Aziz MF, Fu RF et al (2009) Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth 102:408–417PubMedCrossRef
2.
Altermatt FR, Cummings TJ, Auten KM et al (2010) Ultrasonographic appearance of intraneural injections in the porcine model. Reg Anesth Pain Med 35:203–206PubMedCrossRef
3.
Barrington MJ, Snyder GL (2011) Neurologic complications of regional anesthesia. Curr Opin Anaesthesiol 24:554–560PubMedCrossRef
4.
Barrington MJ, Watts SA, Gledhill SR et al (2009) Preliminary results of the Australasian Regional Anaesthesia Collaboration: a prospective audit of more than 7000 peripheral nerve and plexus blocks for neurologic and other complications. Reg Anesth Pain Med 34:534–541PubMedCrossRef
5.
Barrington MJ, Wong DM, Slater B et al (2012) Ultrasound-guided regional anesthesia: how much practice do novices require before achieving competency in ultrasound needle visualization using a cadaver model. Reg Anesth Pain Med 37:334–339PubMed
6.
Bigeleisen PE (2006) Nerve puncture and apparent intraneural injection during ultrasound-guided axillary block does not invariably result in neurologic injury. Anesthesiology 105:779–783PubMedCrossRef
7.
Bigeleisen PE, Moayeri N, Groen GJ (2009) Extraneural versus intraneural stimulation thresholds during ultrasound-guided supraclavicular block. Anesthesiology 110:1235–1243PubMedCrossRef
8.
Bloc S, Ecoffey C, Dhonneur G (2008) Controlling needle tip progression during ultrasound-guided regional anesthesia using the hydrolocalization technique. Reg Anesth Pain Med 33:382–383PubMed
9.
Brull R, Macfarlane AJ, Parrington SJ et al (2011) Is circumferential injection advantageous for ultrasound-guided popliteal sciatic nerve block?: a proof-of-concept study. Reg Anesth Pain Med 36:266–270PubMedCrossRef
10.
Brull R, Mccartney CJ, Chan VW et al (2007) Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg 104:965–974PubMedCrossRef
11.
Casati A, Baciarello M, Di Cianni S et al (2007) Effects of ultrasound guidance on the minimum effective anaesthetic volume required to block the femoral nerve. Br J Anaesth 98:823–827PubMedCrossRef
12.
Chan VW, Brull R, Mccartney CJ et al (2007) An ultrasonographic and histological study of intraneural injection and electrical stimulation in pigs. Anesth Analg 104:1281–1284PubMedCrossRef
13.
Chin KJ, Perlas A, Chan VW et al (2008) Needle visualization in ultrasound-guided regional anesthesia: challenges and solutions. Reg Anesth Pain Med 33:532–544PubMed
14.
Cohen JM, Gray AT (2010) Functional deficits after intraneural injection during interscalene block. Reg Anesth Pain Med 35:397–399PubMedCrossRef
15.
Crile GW (1897) Anesthesia of nerve roots with cocaine. Cleveland Med J 2:355
16.
Danelli G, Ghisi D, Fanelli A et al (2009) The effects of ultrasound guidance and neurostimulation on the minimum effective anesthetic volume of mepivacaine 1.5% required to block the sciatic nerve using the subgluteal approach. Anesth Analg 109:1674–1678PubMedCrossRef
17.
18.
Dufour E, Cymerman A, Nourry G et al (2010) An ultrasonographic assessment of nerve stimulation-guided median nerve block at the elbow: a local anesthetic spread, nerve size, and clinical efficacy study. Anesth Analg 111:561–567PubMedCrossRef
19.
Eichenberger U, Stockli S, Marhofer P et al (2009) Minimal local anesthetic volume for peripheral nerve block: a new ultrasound-guided, nerve dimension-based method. Reg Anesth Pain Med 34:242–246PubMedCrossRef
20.
Eifert B, Hahnel J, Kustermann J (1994) Axillary blockade of the brachial plexus. A prospective study of blockade success using electric nerve stimulation. Anaesthesist 43:780–785PubMedCrossRef
21.
Franco CD, Vieira ZE (2000) 1,001 subclavian perivascular brachial plexus blocks: success with a nerve stimulator. Reg Anesth Pain Med 25:41–46PubMed
22.
Fredrickson MJ, Smith KR, Wong AC (2010) Importance of volume and concentration for ropivacaine interscalene block in preventing recovery room pain and minimizing motor block after shoulder surgery. Anesthesiology 112:1374–1381PubMedCrossRef
23.
Fuzier R, Fourcade O, Pianezza A et al (2006) A comparison between double-injection axillary brachial plexus block and midhumeral block for emergency upper limb surgery. Anesth Analg 102:1856–1858PubMedCrossRef
24.
Gautier P, Vandepitte C, Ramquet C et al (2011) The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block. Anesth Analg 113:951–955PubMed
25.
Gray AT (2006) Ultrasound-guided regional anesthesia: current state of the art. Anesthesiology 104:368–373PubMedCrossRef
26.
Greenblatt GM, Denson JS (1962) Needle nerve stimulatorlocator: nerve blocks with a new instrument for locating nerves. Anesth Analg 41:599–602PubMedCrossRef
27.
Gupta PK, Pace NL, Hopkins PM (2010) Effect of body mass index on the ED50 volume of bupivacaine 0,5% for supraclavicular brachial plexus block. Br J Anaesth 104:490–495PubMedCrossRef
28.
Hadzic A, Dilberovic F, Shah S et al (2004) Combination of intraneural injection and high injection pressure leads to fascicular injury and neurologic deficits in dogs. Reg Anesth Pain Med 29:417–423PubMed
29.
Hara K, Sakura S, Yokokawa N et al (2012) Incidence and effects of unintentional intraneural injection during ultrasound-guided subgluteal sciatic nerve block. Reg Anesth Pain Med 37:289–293PubMed
30.
Hirschel G (1911) Die Anästhesierung des Plexus bei Operationen an der oberen Extremität. Munch Med Wochenschr 29:1555–1556
31.
Horlocker TT, Kufner RP, Bishop AT et al (1999) The risk of persistent paresthesia is not increased with repeated axillary block. Anesth Analg 88:382–387PubMed
32.
Janzen PR, Vipond AJ, Bush DJ et al (2001) A comparison of 1% prilocaine with 0.5% ropivacaine for outpatient-based surgery under axillary brachial plexus block. Anesth Analg 93:187–191PubMedCrossRef
33.
Kapral S, Krafft P, Eibenberger K et al (1994) Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg 78:507–513PubMedCrossRef
34.
Kapur E, Vuckovic I, Dilberovic F et al (2007) Neurologic and histologic outcome after intraneural injections of lidocaine in canine sciatic nerves. Acta Anaesthesiol Scand 51:101–107PubMedCrossRef
35.
Kefalianakis F, Döffert J, Hillmann R et al (2011) DGAI-zertifizierte Seminarreihe Anästhesie Fokussierte Sonografie Modul 3: Neurosonografie. Anaesthesiol Intensivmed Notfallmed Schmerzther 46:760–765CrossRef
36.
Koscielniak-Nielsen ZJ (2008) Ultrasound-guided peripheral nerve blocks: what are the benefits? Acta Anaesthesiol Scand 52:727–737PubMedCrossRef
37.
Kulenkampff D (1911) Die Anästhesierung des Plexus brachialis. Zentralbl Chir 38:1337–1340
38.
Latzke D, Marhofer P, Zeitlinger M et al (2010) Minimal local anaesthetic volumes for sciatic nerve block: evaluation of ED 99 in volunteers. Br J Anaesth 104:239–244PubMedCrossRef
39.
Läwen A (1911) Über Leitungsanästhesie an der unteren Extremität, mit Bemerkungen über die Technik von Injektionen an den Nervus ischiadicus bei Behandlung der Ischias. Dtsch Z Chir 111:252–268CrossRef
40.
Lewalter J, Schläger G, Zimmer G (1911) Deutsches Kinderlied und Kinderspiel: in Kassel aus Kindermund in Wort und Weise gesammelt. Vietor, Kassel, Vers 470, S 154
41.
Liu SS, Ngeow JE, Yadeau JT (2009) Ultrasound-guided regional anesthesia and analgesia: a qualitative systematic review. Reg Anesth Pain Med 34:47–59PubMedCrossRef
42.
Liu SS, Yadeau JT, Shaw PM et al (2011) Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound-guided interscalene and supraclavicular nerve blocks. Anaesthesia 66:168–174PubMedCrossRef
43.
Lupu CM, Kiehl TR, Chan VW et al (2010) Nerve expansion seen on ultrasound predicts histologic but not functional nerve injury after intraneural injection in pigs. Reg Anesth Pain Med 35:132–139PubMedCrossRef
44.
Macdonald KS, Sites BD (2010) Electron microscopy evaluation of block needle-related trauma to the tibial nerve. Acta Anaesthesiol Scand 54:426–429PubMedCrossRef
45.
Macfarlane AJ, Bhatia A, Brull R (2011) Needle to nerve proximity: what do the animal studies tell us? Reg Anesth Pain Med 36:290–302PubMedCrossRef
46.
Maruyama M (1997) Long-tapered double needle used to reduce needle stick nerve injury. Reg Anesth 22:157–160PubMedCrossRef
47.
McNaught A, Shastri U, Carmichael N et al (2011) Ultrasound reduces the minimum effective local anaesthetic volume compared with peripheral nerve stimulation for interscalene block. Br J Anaesth 106:124–130PubMedCrossRef
48.
Meier G, Büttner J (2010) Allgemeine Aspekte peripherer Nervenblockaden der Extremitäten, Kap. 9. In: van Aken H, Wulf H (Hrsg) Lokalanästhesie, Regionalanästhesie, regionale Schmerztherapie, 3. Aufl. Thieme, Stuttgart, S 275
49.
Moayeri N, Bigeleisen PE, Groen GJ (2008) Quantitative architecture of the brachial plexus and surrounding compartments, and their possible significance for plexus blocks. Anesthesiology 108:299–304PubMedCrossRef
50.
Moayeri N, Groen GJ (2009) Differences in quantitative architecture of sciatic nerve may explain differences in potential vulnerability to nerve injury, onset time, and minimum effective anesthetic volume. Anesthesiology 111:1128–1134PubMedCrossRef
51.
Moore D (1953) Regional anesthesia. Thomas, Springfield, S 241
52.
Morau D, Levy F, Bringuier S et al (2010) Ultrasound-guided evaluation of the local anesthetic spread parameters required for a rapid surgical popliteal sciatic nerve block. Reg Anesth Pain Med 35:559–564PubMedCrossRef
53.
Neal JM (2010) Ultrasound-guided regional anesthesia and patient safety: an evidence-based analysis. Reg Anesth Pain Med 35:59–67CrossRef
54.
O’Donnell BD, Iohom G (2009) An estimation of the minimum effective anesthetic volume of 2% lidocaine in ultrasound-guided axillary brachial plexus block. Anesthesiology 111:25–29CrossRef
55.
Orebaugh SL, Mcfadden K, Skorupan H et al (2010) Subepineurial injection in ultrasound-guided interscalene needle tip placement. Reg Anesth Pain Med 35:450–454PubMedCrossRef
56.
Perlas A, Lobo G, Lo N et al (2009) Ultrasound-guided supraclavicular block: outcome of 510 consecutive cases. Reg Anesth Pain Med 34:171–176PubMedCrossRef
57.
Perlas A, Niazi A, Mccartney C et al (2006) The sensitivity of motor response to nerve stimulation and paresthesia for nerve localization as evaluated by ultrasound. Reg Anesth Pain Med 31:445–450PubMed
58.
Perthes G (1912) Über die Leitungsanästhesie unter Zuhilfenahme elektrischer Reizung. Munch Med Wochenschr 59:2545–2548
59.
Reiss W, Kurapati S, Shariat A et al (2010) Nerve injury complicating ultrasound/electrostimulation-guided supraclavicular brachial plexus block. Reg Anesth Pain Med 35:400–401PubMedCrossRef
60.
Renes SH, Van Geffen GJ, Rettig HC et al (2010) Minimum effective volume of local anesthetic for shoulder analgesia by ultrasound-guided block at root C7 with assessment of pulmonary function. Reg Anesth Pain Med 35:529–534PubMedCrossRef
61.
Rice AS, Mcmahon SB (1992) Peripheral nerve injury caused by injection needles used in regional anaesthesia: influence of bevel configuration, studied in a rat model. Br J Anaesth 69:433–438PubMedCrossRef
62.
Robards C, Hadzic A, Somasundaram L et al (2009) Intraneural injection with low-current stimulation during popliteal sciatic nerve block. Anesth Analg 109:673–677PubMedCrossRef
63.
Rodriguez J, Barcena M, Taboada-Muniz M et al (2004) A comparison of single versus multiple injections on the extent of anesthesia with coracoid infraclavicular brachial plexus block. Anesth Analg 99:1225–1230PubMedCrossRef
64.
Rodriguez J, Taboada M, Blanco M et al (2008) Intraneural catheterization of the sciatic nerve in humans: a pilot study. Reg Anesth Pain Med 33:285–290PubMed
65.
Sala Blanch X, Lopez AM, Carazo J et al (2009) Intraneural injection during nerve stimulator-guided sciatic nerve block at the popliteal fossa. Br J Anaesth 102:855–861CrossRef
66.
Sala-Blanch X, Lopez AM, Pomes J et al (2011) No clinical or electrophysiologic evidence of nerve injury after intraneural injection during sciatic popliteal block. Anesthesiology 115:589–595PubMedCrossRef
67.
Sala-Blanch X, Pomes J, Matute P et al (2004) Intraneural injection during anterior approach for sciatic nerve block. Anesthesiology 101:1027–1030PubMedCrossRef
68.
Sala-Blanch X, Ribalta T, Rivas E et al (2009) Structural injury to the human sciatic nerve after intraneural needle insertion. Reg Anesth Pain Med 34:201–205PubMedCrossRef
69.
Sala-Blanch X, Vandepitte C, Laur JJ et al (2011) A practical review of perineural versus intraneural injections: a call for standard nomenclature. Int Anesthesiol Clin 49:1–12PubMedCrossRef
70.
Schafhalter-Zoppoth I, Zeitz ID, Gray AT (2004) Inadvertent femoral nerve impalement and intraneural injection visualized by ultrasound. Anesth Analg 99:627–628PubMedCrossRef
71.
Selander D, Brattsand R, Lundborg G et al (1979) Local anesthetics: importance of mode of application, concentration and adrenaline for the appearance of nerve lesions. An experimental study of axonal degeneration and barrier damage after intrafascicular injection or topical application of bupivacaine (Marcain). Acta Anaesthesiol Scand 23:127–136PubMedCrossRef
72.
Selander D, Dhuner KG, Lundborg G (1977) Peripheral nerve injury due to injection needles used for regional anesthesia. An experimental study of the acute effects of needle point trauma. Acta Anaesthesiol Scand 21:182–188PubMedCrossRef
73.
Selander D, Edshage S, Wolff T (1979) Paresthesiae or no paresthesiae? Nerve lesions after axillary blocks. Acta Anaesthesiol Scand 23:27–33PubMedCrossRef
74.
Sites BD, Chan VW, Neal JM et al (2010) The American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy Joint Committee recommendations for education and training in ultrasound-guided regional anesthesia. Reg Anesth Pain Med 35:74–80CrossRef
75.
Sites BD, Spence BC, Gallagher JD et al (2007) Characterizing novice behavior associated with learning ultrasound-guided peripheral regional anesthesia. Reg Anesth Pain Med 32:107–115PubMed
76.
Stan TC, Krantz MA, Solomon DL et al (1995) The incidence of neurovascular complications following axillary brachial plexus block using a transarterial approach. A prospective study of 1,000 consecutive patients. Reg Anesth 20:486–492PubMed
77.
Steinfeldt T, Graf J, Schneider J et al (2011) Histological consequences of needle-nerve contact following nerve stimulation in a pig model. Anesthesiol Res Pract 2011:591851PubMed
78.
Steinfeldt T, Nimphius W, Werner T et al (2010) Nerve injury by needle nerve perforation in regional anaesthesia: does size matter? Br J Anaesth 104:245–253PubMedCrossRef
79.
Steinfeldt T, Nimphius W, Wurps M et al (2010) Nerve perforation with pencil point or short bevelled needles: histological outcome. Acta Anaesthesiol Scand 54:993–999PubMedCrossRef
80.
Steinfeldt T, Poeschl S, Nimphius W et al (2011) Forced needle advancement during needle-nerve contact in a porcine model: histological outcome. Anesth Analg 113:417–420PubMedCrossRef
81.
Steinfeldt T, Werner T, Nimphius W et al (2011) Histological analysis after peripheral nerve puncture with pencil-point or Tuohy needletip. Anesth Analg 112:465–470PubMedCrossRef
82.
Tran QH de, Dugani S, Correa JA et al (2011) Minimum effective volume of lidocaine for ultrasound-guided supraclavicular block. Reg Anesth Pain Med 36:466–469
83.
Tran QH de, Dugani S, Dyachenko A et al (2011) Minimum effective volume of lidocaine for ultrasound-guided infraclavicular block. Reg Anesth Pain Med 36:190–194CrossRef
84.
Tran QH de, Dugani S, Pham K et al (2011) A randomized comparison between subepineural and conventional ultrasound-guided popliteal sciatic nerve block. Reg Anesth Pain Med 36:548–552
85.
Tsai TP, Vuckovic I, Dilberovic F et al (2008) Intensity of the stimulating current may not be a reliable indicator of intraneural needle placement. Reg Anesth Pain Med 33:207–210PubMed
86.
Vester-Andersen T, Broby-Johansen U, Bro-Rasmussen F (1986) Perivascular axillary block VI: the distribution of gelatine solution injected into the axillary neurovascular sheath of cadavers. Acta Anaesthesiol Scand 30:18–22PubMedCrossRef
87.
Vester-Andersen T, Christiansen C, Sorensen M et al (1983) Perivascular axillary block II: influence of injected volume of local anaesthetic on neural blockade. Acta Anaesthesiol Scand 27:95–98PubMedCrossRef
88.
Vester-Andersen T, Husum B, Lindeburg T et al (1984) Perivascular axillary block IV: blockade following 40, 50 or 60 ml of mepivacaine 1% with adrenaline. Acta Anaesthesiol Scand 28:99–105PubMedCrossRef
89.
Vloka JD, Hadzic A, April E et al (2001) The division of the sciatic nerve in the popliteal fossa: anatomical implications for popliteal nerve blockade. Anesth Analg 92:215–217PubMedCrossRef
90.
Vloka JD, Hadzic A, Lesser JB et al (1997) A common epineural sheath for the nerves in the popliteal fossa and its possible implications for sciatic nerve block. Anesth Analg 84:387–390PubMed
91.
92.
Zink W, Graf BM (2007) Lokalanästhetikatoxizität – Relevanz empfohlener Maximaldosen? Anaesth Intensivmed 48:182–205
Metadaten
Titel
Ultraschallgesteuerte periphere Regionalanästhesie
Applikationsort und Dosierung des Lokalanästhetikums
verfasst von
Dr. G. Gorsewski
A. Dinse-Lambracht
I. Tugtekin
A. Gauss
Publikationsdatum
01.08.2012
Verlag
Springer-Verlag
Erschienen in
Die Anaesthesiologie / Ausgabe 8/2012
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI
https://doi.org/10.1007/s00101-012-2045-x

Weitere Artikel der Ausgabe 8/2012

Der Anaesthesist 8/2012 Zur Ausgabe

Editorial

Duale Antiplättchentherapie und operative Medizin

Einführung zum Thema

Primum non nocere

Kasuistiken

Entfernung eines Periduralkatheters unter dualer Antiplättchentherapie nach akutem Koronarsyndrom

Intensivmedizin

Ernährungstherapie bei Schädel-Hirn-Trauma

Notfallmedizin

Gerinnungsmanagement beim kreislaufinstabilen Polytraumapatienten

Editorial

Wenn Kasuistiken fehlende Evidenz ersetzen müssen

Neu im Fachgebiet AINS

11.04.2024 | Rückenschmerzen | Nachrichten

Diclofenac-Gel versus Ibuprofen bei akuten Rückenschmerzen

10.04.2024 | Postoperative Schmerztherapie | Nachrichten

Chronische Schmerzen nach Op. oft mit neuropathischer Komponente

08.04.2024 | Andrologie | Nachrichten

Wie toxische Männlichkeit der Gesundheit von Männern schadet

04.04.2024 | DGP 2024 | Kongressbericht | Nachrichten

Neue NIV-Leitlinie mit Anleitung zur Beatmungseinstellung vorgestellt
weitere anzeigen

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren