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AbstractTo evaluate learning motivation barriers in infection control and feedback competences, we conducted a national online survey in Germany. Among 767 healthcare workers, overconfidence effects could be detected independent from age, gender, profession, education, and hospital-size. The identified effects may impair learning motivation relevant for supervisors and educators in infection control.

Stereotactically guided procedures are performed for an ever extending range of conditions. They present a unique anesthetic challenge. In our institution, a standardized anesthetic protocol for total intravenous anesthesia (TIVA) augmented by electrophysiologic monitoring with BIS or AEP monitors was introduced. We conducted a retrospective study of 21 patients (ASA status 2-3) presenting for stereotactically guided procedures who were anesthetized according to the protocol. Median duration of anesthesia was 260 minutes (222 to 325 min); on average 3.0 (1.0 to 4.2) adjustments to the TIVA-protocol were made per patient. Highest and lowest mean arterial blood pressures in relation to baselines were 100 (87.5 to 109.8) and 68.7 (64.0 to 72.6), respectively. Likewise highest and lowest heart rates recorded were 106.7 (98.5 to 119.0) and 75.0 (68.2 to 83.3). After discontinuation of TIVA, spontaneous breathing returned after 5.0 minutes (4.0 to 8.0 min), extubation was possible after 6.0 minutes (5.0 to 10.0 min) and patients were ready for discharge to the ward after 15.0 minutes (12.0 to 18.0 min). There were no cases of postoperative nausea or vomiting. We found that manually controlled TIVA, augmented by electrophysiologic monitoring, facilitated maintenance of an appropriate depth of anesthesia with stable hemodynamics and excellent recovery times.

Purpose: To assess the analgesic efficacy and functional outcome of postoperative epidural infusion of ropivacaine combined with sufentanil in a randomized, controlled trial. Methods: Thirty-two ASA I–III patients undergoing elective total hip replacement (THR) were included. Lumbar epidural block using 0.75% ropivacaine was combined with either propofol sedation or general anesthesia for surgery. On arrival in the recovery room, the epidural infusion was commenced at a rate in mL calculated as follows: (height in cm −100) × 0.1. Eleven patients received an epidural infusion of ropivacaine 0.1 % with 0.5 μg·mL−1sufentanil (Group R+S0.5), ten patients ropivacaine 0.1% with 0.75 μg·mL−1sufentanil (Group R+S0.75), and 11 patients ropivacaine 0.1% with 1 μg·mL−1sufentanil (Group R+S1) over a postoperative study period of 44 hr. All patients had access to iv piritramide via a patient-controlled analgesia (PCA) device. Postel-Merle-d’Aubigné scoring system (PMA score) was assessed preoperatively, three weeks after surgery, and three months after surgery by an orthopedic surgeon blinded to study group. Results: Motor block was negligible in all three groups. After eight hours of epidural infusion, sensory block had regressed completely in all patients. There was no significant difference with regard to visual analogue scale (VAS) scores (at rest:P= 0.55, on movement:P= 0.63), consumption of rescue medication (P= 0.99), patient satisfaction (P= 0.22), and the incidence of adverse events. All treatment regimens provided effective postoperative analgesia with only a minimal use of supplemental opioid PCA. There was no difference between groups regarding orthopedic PMA score (pain:P= 0.24, mobility:P= 0.65, and ability to walk:P= 0.44). Conclusion: Ropivacaine 0.1% with 0.5 μg·mL−1sufentanil for postoperative analgesia after THR provides efficient pain relief and, compared with 0.75 and 1 μg·mL−1sufentanil, reduces sufentanil consumption without compromise in patient satisfaction, VAS scores, and functional outcome.