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ZusammenfassungDie Ösophagusatresie (ÖA) ist eine angeborene Kontinuitätsunterbrechung der Speiseröhre mit oder ohne Fistel zur Trachea (Tracheoösophageale Fistel, TÖF). Je nach Abstand zwischen den beiden Ösophagusenden unterscheidet man eine „kurzstreckige“ von einer „langstreckigen“ Form. Bis zu 50% der Neugeborenen weisen weitere Anomalien auf. Eine pränatale Diagnose der ÖA gelingt in 32–63% der Fälle. Die interdisziplinäre Betreuung dieser Kinder hat sich in den letzten Jahren gewandelt. In der folgenden Arbeit wird die aktuelle S2K-Leitlinie der Deutschen Gesellschaft für Kinderchirurgie zur Behandlung der ÖA mit unterer TÖF, die etwa 90% aller Fälle ausmacht, zusammengefasst. Hierzu gehören das präoperative Management sowie operative und anästhesiologische Aspekte (u. a. Thorakoskopie vs. Thorakotomie, präoperative Tracheobronchoskopie, intraoperative Hyperkapnie und Azidose). Ferner wird das postoperative Management insbesondere von relevanten Komplikationen wie der Anastomosenstenose beschrieben. Trotz Fortschritten in der Behandlung der ÖA ist die Langzeitmorbidität mit Motilitätsstörungen des Ösophagus, gastroösophagealer Refluxkrankheit, rezidivierenden Infektionen der oberen und unteren Atemwege, Tracheomalazie, mangelhaftem Gedeihen sowie orthopädischen Problemen nach Thorakotomie weiterhin hoch. Zum Erreichen einer guten Lebensqualität ist daher eine gute interdisziplinäre Nachsorge wichtig.

Background/AimsBiliary leakage (BL) is a major cause of postoperative morbidity after liver resection. Aim of our study was to analyse surgical parameters and postoperative morbidity with special emphasis on BL, after launching a minimally invasive liver resection program.MethodsA prospectively maintained medical database of patients who required a liver resection was used for analysis.ResultsA total of n=156 patients were divided into a group of n=47 patients (30.1%) receiving laparoscopic (LLR) and n=109 patients (69.9%) undergoing open liver resections (OLR). Patient age (OLR: 59.4 ± 16.0 vs. LLR: 57.9 ± 14.2 years) and male to female ratio (OLR: 63/46 vs. LLR: 25/22) were comparable. We performed n=75 (68.8%) major OLR and n=31 (66.0%) major LLR. Operation time was OLR 342.8 ± 110.5 min vs. LLR 287.3 ± 132.6 min (p=0.014) and the average blood loss was OLR 523.5 ± 428.6 ml vs. LLR 355.5 ± 459.2 ml. Morbidity and mortality was observed in n= 29 (18.6 %) and n= 7 (4.5 %) patients, respectively. The overall biliary leakage (BL) rate was 5.1% (n= 8). Majority of BL were detected in OLR with biliodigestive anastomosis (BDA) (n=2 (11.0%)) followed by OLR without BDA (n=6 (6.5%)). No BL were detected in patients with LLR. Hospital stay was significantly prolonged after OLR in patients with BL (38.4 ± 20.1 vs. 17.4 ± 11.1 days, p< 0.001).ConclusionIn line with previous reports, the introduction of different transection techniques in laparoscopic liver resections did not increase morbidity and BL-rate.

ZusammenfassungDas pädiatrische Emergence Delir rückt aufgrund der Debatte um Neurotoxizität von Anästhetika bei kleinen Kindern erneut in den Fokus. Die 2017 von der Europäischen Gesellschaft für Anästhesiologie (ESA) publizierte Leitlinie zu Prävention und Therapie kann eine sinnvolle Unterstützung der klinischen Tätigkeit sein. Insbesondere die zügige und konsequente Behandlung von Schmerzen bei kleinen Kindern und die konsequente Diagnose eines pädED mittels validierter Skale ermöglicht es- dank der Verbreitung von patient data management systemen- in Zukunft eine reelle Inzidenz des pädEDs anzugeben. In der Prävention des pädED liegt der Schwerpunkt auf der Reduktion der präoperativen Angst der Kinder, egal, ob dies durch ein auf das Kind fokussierte Kinderanästhesieteam zusammen mit den Eltern, Musik, Clowns, smartphones/tablets oder eine medikamentöse Prämedikation erzielt wird. Medikamentöse pädED-Prophylaxe durch perioperative Anwendung von alpha-2-Agonisten und die Verwendung von Propofol als Ausleitungsbolus oder TIVA erscheint gleichzeitg sinnvoll. Postoperativ ermöglicht eine ruhige Aufwachumgebung ein entspanntes delirfreies Aufwachen. Postanästhesiologische Visiten mit strukturiertem Erfassen von Veränderungen des kindlichen Verhaltens respektive schriftliche Fragebögen werden in Zukunft Auskunft über das pädED auf den Normalstationen geben. Strukturierte Nachbefragungen im Verlauf werden auch die Erfassung postoperativen unerwünschten Verhaltensänderungen und deren möglichen Zusammenhang zum pädED ermöglichen.

Inspired by the Choosing Wisely initiative, a group of pediatric anesthesiologists representing the German Working Group on Paediatric Anaesthesia (WAKKA) coined and agreed upon 10 concise positive ("dos") or negative ("don'ts") evidence-based recommendations. (i) In infants and children with robust indications for surgical, interventional, or diagnostic procedures, anesthesia or sedation should not be avoided or delayed due to the potential neurotoxicity associated with the exposure to anesthetics. (ii) In children without relevant preexisting illnesses (ie, ASA status I/II) who are scheduled for elective minor or medium-risk surgical procedures, no routine blood tests should be performed. (iii) Parental presence during the induction of anesthesia should be an option for children whenever possible. (iv) Perioperative fasting should be safe and child-friendly with shorter real fasting times and more liberal postoperative drinking and enteral feeding. (v) Perioperative fluid therapy should be safe and effective with physiologically composed balanced electrolyte solutions to maintain a normal extracellular fluid volume; addition of 1%-2.5% glucose to avoid lipolysis, hypoglycemia, and hyperglycemia, and colloids as needed to maintain a normal blood volume. (vi) To achieve safe and successful airway management, the locally accepted airway algorithm and continued teaching and training of basic and alternative techniques of ventilation and endotracheal intubation are required. (vii) Ultrasound and imaging systems (eg, transillumination) should be available for achieving central venous access and challenging peripheral venous and arterial access. (viii) Perioperative disturbances of the patient's homeostasis, such as hypotension, hypocapnia, hypothermia, hypoglycemia, hyponatremia, and severe anemia, should not be ignored and should be prevented or treated immediately. (ix) Pediatric patients with an elevated perioperative risk, eg, preterm and term neonates, infants, and critically ill children, should be treated at institutions where all caregivers have sufficient expertise and continuous clinical exposure to such patients. (x) A strategy for preventing postoperative vomiting, emergence delirium, and acute pain should be a part of every anesthetic procedure.

The laryngeal tube suction II (LTS II) is a supraglottic airway device (SAD) with a gastric drainage tube and enhanced seal properties as compared with other SADs. Therefore, its use has been proposed in situations with an elevated risk of aspiration.To compare the safety and efficacy of airway management and controlled mechanical ventilation when using either an LTS II or an endotracheal tube for laparoscopic radical prostatectomy.Randomised, controlled, blinded and single-centre study.Academic tertiary care centre in Leipzig from April 2014 to May 2015.It was planned to include 100 patients but the study was stopped after 50 patients following an interim analysis. These 50 patients were randomised to either the LTS II group or the endotracheal tube group. All male patients aged more than 18 years for elective laparoscopic radical prostatectomy were eligible. Exclusion criteria included a BMI more than 30, American Society of Anesthesiologists class III or greater, a history of gastroesophageal reflux or other factors known to increase the risk of aspiration and a known difficult airway.All patients received general anaesthesia. Airway management was with either a LTS II or an endotracheal tube, according to the randomisation.The primary endpoint was successful insertion of the particular airway device during anaesthesia for laparoscopic radical prostatectomy.In 15 of the 28 patients randomised to LTS II, the device had to be removed and an endotracheal tube inserted, mainly because of an airway leak (n = 10) or swelling of the tongue (n = 3). Ventilation was successful in all patients (n = 22) randomised to endotracheal tube. Quality of ventilation was rated better in the endotracheal tube group.Our data suggest that LTS II should not be the preferred method of airway management in patients undergoing laparoscopic radical prostatectomy.DRKS00008985 (German Clinical Trials Register).

Kindernotfalle sind im Bereich der praklinischen Notfallmedizin seltene Ereignisse und u. a. deshalb fur Notarzte und Rettungsdienstkrafte oft mit Stress und Unsicherheit verbunden. Es existiert eine Vielzahl verschiedener kognitiver Hilfsmittel (Bucher, Apps, Lineale, gewichtsadaptierte Taschensysteme etc.), um im padiatrischen Notfall die adaquate Versorgung sicherzustellen. Insbesondere die richtige Grosenauswahl der Ausrustung und die Dosierung der Notfallmedikamente sind bei Kindern individuell sehr unterschiedlich und abhangig von Kenngrosen wie der Korperlange und dem Korpergewicht. Kognitive Hilfsmittel beinhalten deshalb oftmals die Moglichkeit der Langenmessung, von der wiederum auf das Gewicht als Leitwert zur Dosisberechnung von Medikamenten ruckgeschlossen werden kann. Zwar konnen diese Hilfsmittel die Fehldosierung und -behandlung von Kindern im Notfall verhindern helfen, ihr unkritischer und nicht im Vorfeld trainierter Einsatz birgt aber auch die Gefahr der falschen Anwendung. Diese Empfehlung bietet einen Uberblick uber die allgemeinen Anforderungen und Probleme verschiedener Arten kognitiver Hilfsmittel und soll dazu beitragen, die Rahmenbedingungen und die rationale Basis fur den Einsatz und die Weiterentwicklung kognitiver Hilfsmittel in der Notfallmedizin zu verbessern.

The growing number of medical procedures performed in children that require cooperation of patients, lack of movement, anxiolysis or/and analgesia triggers the increased need for procedural sedation. This document presents the consensus statement of the European Society for Paediatric Anaesthesiology about the principles connected with the safe management of procedural sedation and analgesia (PSA) by anaesthesiologists for elective procedures in children. It does not aim to provide a legal statement on how and by whom PSA should be performed. The document highlights that any staff taking part in sedation of children must be appropriately trained with the required competencies and must be able to demonstrate regularly that they have maintained their knowledge, skills and clinical experience. The main goal of creating this document was to reflect the opinions of the community of the paediatric anaesthesiologists in Europe regarding how PSA for paediatric patients should be organized to make it safe.

Ubergewicht und Adipositas sind in der Kinderanasthesie zunehmend relevant. In der vorliegenden Arbeit wurde untersucht, inwiefern ubergewichtige Kinder und Jugendliche Atemwegskomplikationen wahrend einer Allgemeinanasthesie aufweisen und welche Bedeutung die Thematik in der lokalen Population hat. Von Oktober 2008 bis August 2009 wurden am Universitatsklinikum Leipzig ambulante und stationare Patienten wahrend eines Elektiveingriffs (2–18 Jahre, ASA I–III, Kinderchirurgie und Hals-Nasen-Ohren-Heilkunde, insgesamt 504 Patienten) betrachtet. Mithilfe spezieller Erfassungsbogen wurden folgende Parameter ermittelt: der Mallampati-Score, schwierige Maskenventilation und Intubation, die Verwendung eines Atemwegshilfsmittels, der Cormack-Lehane-Score und die Anzahl der Intubationsversuche; des Weiteren die Inzidenz von Atemwegsobstruktionen (Broncho- und Laryngospasmen) und Husten als Zeichen der Atemwegsirritation und Sauerstoffsattigungsabfalle >10 % des Ausgangswerts. Es zeigte sich ein signifikant hoherer Mallampati-Score und ein signifikant haufigeres Auftreten von Husten (p < 0,05). Die weiteren Parameter blieben ohne statistisch relevanten Unterschied. Die Inzidenz von Sauerstoffsattigungsabfallen war 9,5 % bei den Ubergewichtigen und 6,3 % bei den Normalgewichtigen und die Inzidenz von Atemwegsobstruktionen betrug 4,1 % bzw. 2,7 %. Die Inzidenz von respiratorischen Komplikationen ist in der vorliegenden Studie insgesamt gering. Ursache dafur konnen der geringe Anteil von morbid adiposen Kindern und das hohere Alter der ubergewichtigen Kinder im Vergleich zu anderen Studien sein.

Die Moglichkeiten des Monitorings der Hamodynamik und zerebralen Perfusion sind in der Kinderanasthesie aufgrund der geringen technischen Vielfalt eingeschrankt. Dieses Monitoring sollte jedoch vor dem Hintergrund des potenziellen Schadens einer langanhaltenden Hypotension und zerebralen Minderperfusion zum Einsatz kommen. So steht derzeit fur die breite Anwendung die nicht invasive Blutdruckmessung und fur Risikopatienten v. a. die Nahinfrarot-Spektroskopie zur Verfugung. Die fruhzeitige Messung des Blutdrucks und die Beachtung der Grenzen standen in der Vergangenheit in der Kinderanasthesie im Hintergrund. Das ist aufgrund der aktuellen Datenlage nicht mehr state of the art.

This consensus- based S1 Guideline for perioperative infusion therapy in children is focused on safety and efficacy. The objective is to maintain or re-establish the child's normal physiological state (normovolemia, normal tissue perfusion, normal metabolic function, normal acid- base- electrolyte status). Therefore, the perioperative fasting times should be as short as possible to prevent patient discomfort, dehydration, and ketoacidosis. A physiologically composed balanced isotonic electrolyte solution (BS) with 1-2.5% glucose is recommended for the intraoperative background infusion to maintain normal glucose concentrations and to avoid hyponatremia, hyperchloremia, and lipolysis. Additional BS without glucose can be used in patients with circulatory instability until the desired effect is achieved. The additional use of colloids (albumin, gelatin, hydroxyethyl starch) is recommended to recover normovolemia and to avoid fluid overload when crystalloids alone are not sufficient and blood products are not indicated. Monitoring should be extended in cases with major surgery, and autotransfusion maneuvers should be performed to assess fluid responsiveness.

To test the compensatory role of endothelin-1 when acute blood loss is superimposed on anaesthesia, by characterizing the effect of systemic endothelin receptor subtype A (ET(A)) blockade on the haemodynamic and hormonal responses to haemorrhage in dogs anaesthetized with xenon/remifentanil (X/R) or isoflurane/remifentanil (I/R).Prospective experimental randomized controlled study.Six female Beagle dogs, 13.4 +/- 1.3 kg.Animals were anaesthetized with remifentanil 0.5 microg kg(-1) minute(-1) plus either 0.8% isoflurane (I/R) or 63% xenon (X/R), with and without (Control) the systemic intravenous endothelin receptor subtype A antagonist atrasentan (four groups, n = 6 each). After 60 minutes of baseline anaesthesia, the dogs were bled (20 mL kg(-1)) over 5 minutes and hypovolemia was maintained for 1 hour. Continuous haemodynamic monitoring was performed via femoral and pulmonary artery catheters; vasoactive hormones were measured before and after haemorrhage.In Controls, systemic vascular resistance (SVR), vasopressin and catecholamine plasma concentrations were higher with X/R than with I/R anaesthesia at pre-haemorrhage baseline. The peak increase after haemorrhage was higher during X/R than during I/R anaesthesia (SVR 7420 +/- 867 versus 5423 +/- 547 dyne seconds cm(-5); vasopressin 104 +/- 23 versus 44 +/- 6 pg mL(-1); epinephrine 2956 +/- 310 versus 177 +/- 99 pg mL(-1); norepinephrine 862 +/- 117 versus 195 +/- 33 pg mL(-1), p0.05). Haemorrhage reduced central venous pressure from 3 +/- 1 to 1 +/- 1 cm H(2)O (I/R, ns) and from 8 +/- 1 to 5 +/- 1 cm H(2)O (X/R, p0.05), but did not reduce mean arterial pressure, nor cardiac output. Atrasentan did not alter the haemodynamic and hormonal response to haemorrhage during either anaesthetic protocol.Selective ET(A) receptor blockade with atrasentan did not impair the haemodynamic and hormonal compensation of acute haemorrhage during X/R or I/R anaesthesia in dogs.

The incidence of overweight and obesity in children and adolescents who need an anesthesia is increasing. These children have a higher risk for perioperative complications. The review discusses definition and causes of obesity in children, gives information about relevant pathophysiological changes, and focuses anesthesiological management and complications.

The increase in intra-abdominal pressure may be followed by a renal, gut, respiratory and cardial dysfunction and an increase in intra-cranial pressure. The review focuses risk factors and pathophysiological consequences of intra-abdominal hypertension and of abdominal compartment syndrome. Patients with intra-abdominal hypertension and abdominal compartment syndrome are critical ill and need special anesthesiological care due to risk of pulmonary aspiration, hemodynamic disturbances and difficult mechanical ventilation.

In congenital hyperinsulinism (CHI), the identification and precise localization of a focal lesion is essential for successful surgery.Our objective was to evaluate the predictive value and accuracy of integrated [18F]fluoro-L-DOPA ([18F]FDOPA) positron emission tomography (PET)-computed tomography (CT) for the surgical therapy of CHI.This was an observational study.The study was performed in the Department of Pediatric Surgery at a university hospital.From February 2005 to September 2007, 10 children with the clinical signs of CHI and an increased radiotracer uptake in a circumscribed area of the pancreas in the [18F]FDOPA PET-CT were evaluated.Guided by the [18F]FDOPA PET-CT report, all children underwent partial pancreatic resection, in two cases twice.Correlation of the anatomical findings at surgery with the report of the [18F]FDOPA PET-CT, and the results of surgery and clinical outcome were determined.In nine children the intraoperative situation corresponded exactly to the description of the [18F]FDOPA PET-CT. A limited resection of the pancreas was curative in eight cases at the first surgery, in one case at the second intervention. We observed no diabetes mellitus or exocrine insufficiency in the follow up so far. In one child, hypoglycemia persisted even after two partial resections of the pancreatic head. Histological analysis finally revealed an atypical intermediate form of CHI.The integrated [18F]FDOPA PET-CT is accurate to localize the lesion in focal CHI and is a valuable tool to guide the surgeon in limited pancreatic resection.

Cardiopulmonary resuscitation of a child is a rare, emotionally affective, challenging and potentially frightful event. Current guidelines have been largely simplified to facilitate teaching and retention, to encourage bystander resuscitation, and to improve the quality of resuscitation by healthcare professionals. This article is a practical approach to the current european guidelines (ERC), including basic and advanced life support algorithms, as well as recommendations on the post-resuscitation periode and parental presence.

Regional anesthesia has many advantages as intraoperative and more important as postoperative analgesia in pediatric anesthesia. There are special requirements for a sufficient acute pain management in preterms, newborns and small infants. This review focuses these special features regarding to local anesthetics and supplements, caudal and spinal anesthesia, and peripheral blockades.

Das Management des Atemwegs bei Neugeborenen, Sauglingen, Kleinkindern und Kindern kann aufgrund anatomischer und physiologischer Besonderheiten schwierig sein. Durch spezielle Lagerung wird dem im Vergleich zu Erwachsenen grosen Hinterkopf, dem kurzen Hals und dem Larynxhochstand Rechung getragen. Bei jeder Form von Beatmung ist die physiologisch hohe Atemfrequenz, die auf einem erhohten Sauerstoffbedarf und einer erhohten Kohlendioxidproduktion beruht, zu berucksichtigen. Zur Sicherung des Atemweges stehen verschiedene Hilfsmittel zur Verfugung. So kann die Maskenbeatmung durch den Einsatz eines Wendl-Tubus optimiert werden. Fur viele Indikationen kann zur Narkose die klassische Larynxmaske als schonendes Verfahren auch bei bestehendem Atemwegsinfekt empfohlen werden. Bei einigen Operationen und im Fall des nicht nuchternen Kindes ist die endotracheale Intubation notwendig. Hierbei muss auf die richtige Grose des Tubus und dessen Fixierungstiefe geachtet werden. Ist eine konventionelle Intubation aufgrund der Anamnese oder z. B. eines kraniofazialen Syndroms erschwert, sollte eine primar fiberoptische Intubation durchgefuhrt werden.

Background The objective of this study was to determine whether endothelin-A receptor blockade (ETAB) impairs hemodynamic and hormonal regulation compared with controls and angiotensin II receptor blockade (AT1B) during hypotensive hemorrhage in dogs under isoflurane-nitrous oxide anesthesia. Methods Six dogs were studied in four protocols: (1) control experiments (controls); (2) ETA blockade using ABT-627 (ETAB); (3) AT1 blockade using losartan (AT1B); and (4) combined AT1B and ETAB (AT1B + ETAB). After a 30-min awake period, isoflurane-nitrous oxide anesthesia was established (1.3 minimum anesthetic concentration). After 60 min of anesthesia, 20 ml blood/kg body weight was withdrawn within 5 min, and the dogs were observed for another hour. Thereafter, the blood was retransfused, and the dogs were observed for a final hour. Results Anesthesia: Cardiac output decreased in all protocols, whereas mean arterial pressure decreased more in AT1B and AT1B + ETAB than in controls and ETAB. Hemorrhage: After 60 min, cardiac output had decreased less in controls than in all other protocols. Mean arterial pressure decreased more during ETAB than in controls, but most severely during AT1B and AT1B + ETAB. Angiotensin II increased further only in controls and ETAB, whereas vasopressin and catecholamines increased similarly in all protocols. Retransfusion: Mean arterial pressure remained below controls in all protocols but was lowest when the AT1 receptor was blocked. Cardiac output fully recovered in all but the ETAB protocol. Conclusions ETAB impairs long-term hemodynamic regulation after hemorrhage and retransfusion during anesthesia despite an activation of vasoconstrictive hormones. This suggests that endothelins have a role in long-term cardiovascular regulation. AT1B impairs both short- and long-term blood pressure regulation during anesthesia and after hemorrhage.

The pharmacokinetics of opioids are impaired in patients with liver and renal failure. Fentanyl, sufentanil, and alfentanil are metabolized in the liver. The extrahepatic metabolism by renal enzymes is gaining more importance in patients with severe liver disease. Pharmacokinetic effects of single doses of fentanyl and sufentanil are not affected in liver and renal failure; however, continuous infusion of fentanyl may result in accumulation and prolonged opioid effects. Plasma clearance and elimination of alfentanil are reduced in patients with liver failure and its clinical use can therefore not be recommended. A reduction in alfentanil dosing is not necessary in patients with renal failure. Remifentanil is the opioid of choice in patients with liver and renal failure. The clearance of morphine is reduced in liver failure. In renal failure an accumulation of morphine metabolites has been demonstrated, and thus, application of morphine is not recommended in patients with liver and renal failure. A reduction in piritramide dosing is necessary in patients with liver failure.

Background: This study investigates whether long-term treatment with an angiotensin converting enzyme inhibitor (ACEI) impairs the hemodynamic regulation during the early phase of spinal anaesthesia. Methods: Forty-two patients undergoing minor surgery were studied. Twenty-one patients were long-term treated (ACEI group), while the other patients served as controls (nonACEI group). All patients received a balanced electrolyte solution(6 ml kg−1) 20 min before spinal anaesthesia. Results: Mean arterial blood pressure decreased 19% in both groups within 20 min after spinal anaesthesia. Heart rate did not change in either group. Plasma renin concentration increased from 7.3 ± 2.1 to 12.8 ± 4 pg ml−1 during spinal anaesthesia in nonACEI patients (P

This study compares the haemodynamic and hormonal responses during haemorrhage of conscious dogs pre-treated with an endothelin-A (ET-A) receptor inhibitor. The dogs were studied in two different randomized groups: the control group and a group that was given the ET-A receptor antagonist ABT-627 (as a bolus of 1 mg x kg of body weight(-1) followed by 0.01 mg x kg body weight(-1) x min(-1) intravenously). The time-course was the same for both groups: after a 1 h baseline period (pre-haemorrhage), blood (25 ml x kg of body weight(-1)) was withdrawn within 5 min. Haemodynamics were continuously recorded and hormone levels measured after 1 h (post-haemorrhage). Thereafter, the blood withdrawn was retransfused within 5 min and haemodynamics again observed for 1 h (post-retransfusion). In ABT-627-treated dogs, the decrease in mean arterial pressure from 87+/-3 to 64+/-3 mmHg (P

Postoperative nausea and vomiting (PONV) has a high incidence in children and requires prophylactic and therapeutic strategies.PONV can be reduced by the avoidance of nitrous oxide, volatile anesthetics, and the reduction of postoperative opioids. The use of dexamethasone, 5-HT3 antagonists, or droperidol alone is potent, but combinations are even more effective to reduce PONV. Droperidol has a Food and Drug Administration warning. Hence, dexamethasone and 5-HT3 antagonists should be preferred as prophylactic drugs. It is further reasonable to adapt PONV prophylaxis to different risk levels. Prolonged surgery time, inpatients, types of surgery (e.g. strabismus and ear-nose-throat surgery), and patients with PONV in history should be treated as high risk, whereas short procedures and outpatients are to be treated as low risk.Concluding from the existing guidelines and data on the handling of PONV in children at least 3 years, the following recommendations are given: outpatients undergoing small procedures should receive a single prophylaxis, outpatients at high risk a double prophylaxis, inpatients with surgery time of more than 30 min and use of postoperative opioids should get double prophylaxis, and inpatients receiving a high-risk surgical procedure or with other risk factors a triple prophylaxis (two drugs and total intravenous anesthesia). Dimenhydrinate can be used as a second choice, whereas droperidol and metoclopramide can only be recommended as rescue therapy.

The noble gas xenon seems to have minimal cardiovascular side-effects and so may be an ideal anaesthetic agent when investigating cardiovascular physiology. In comparison with standard modern anaesthetics, we investigated the haemodynamic and hormonal effects of xenon in Beagle dogs. After a 30 min baseline period, anaesthesia was induced with propofol and maintained with either (1) 1.2% isoflurane/70% nitrous oxide (N2O), (2) 0.8% isoflurane/0.5 µg/kg/min remifentanil or (3) 63% xenon/0.5 µg/kg/min remifentanil ( n = 6 per group). Haemodynamics were recorded and blood samples taken before and 60 min after induction. Mean arterial blood pressure (MAP) was higher in conscious dogs than during isoflurane/N2O (86 ± 2 vs. 65 ± 2 mmHg, mean ± SEM) and isoflurane/remifentanil anaesthesia (95 ± 2 vs. 67 ± 3 mmHg), whereas MAP did not decrease significantly in response to xenon/remifentanil anaesthesia (96 ± 4 vs. 85 ± 6 mmHg). Bradycardia was present during isoflurane/remifentanil (54 ± 2/min) and xenon/remifentanil (40 ± 3/min), but not during isoflurane/N2O anaesthesia (98 ± 3/min, P < 0.05). Xenon/remifentanil anaesthesia induced the highest reduction in cardiac output (CO) (–61%), and the highest increase in systemic vascular resistance (+120%) among all treatment groups ( P < 0.05). A simultaneous increase in endogenous adrenaline and noradrenaline concentrations could only be observed in the xenon/remifentanil group, whereas angiotensin II and vasopressin concentrations increased in all groups. In conclusion, xenon/remifentanil anaesthesia maintains MAP but reduces heart rate and CO and is associated with a considerable stimulation of vasopressor hormones in Beagle dogs. Therefore, xenon/remifentanil exerts a new quality of adverse haemodynamic effects different from volatile anaesthetics and may not perform better during studies of cardiovascular physiology.

Percutaneous central venous cannulation of small infants is a challenging procedure. The use of ultrasound guidance has been shown to increase the success rate generally in children and to decrease the incidence of associated complications. To demonstrate that this technique is also suitable in very small infants we describe the case of a preterm neonate of 850 g body weight (BW), in which percutaneous central venous cannulation was performed successfully using ultrasound imaging for guidance.

The Compressed Baryonic Matter (CBM) experiment at the future FAIR accelerator complex at Darmstadt is being designed for a comprehensive measurement of hadron and lepton production in heavy-ion collisions from 8-45 AGeV beam energy, producing events with large track multiplicity and high hit density. The setup consists of several detectors including as tracking detectors the silicon tracking system (STS), the muon detector (MUCH) or alternatively a set of Transition Radiation Detectors (TRD). In this contribution, the status of the track reconstruction software including track finding, fitting and propagation is presented for the MUCH and TRD detectors. The track propagation algorithm takes into account an inhomogeneous magnetic field and includes accurate calculation of multiple scattering and energy losses in the detector material. Track parameters and covariance matrices are estimated using the Kalman filter method and a Kalman filter modification by assigning weights to hits and using simulated annealing. Three different track finder algorithms based on track following have been developed which either allow for track branches, just select nearest hits or use the mentioned weighting method. The track reconstruction efficiency for central Au+Au collisions at 25 AGeV beam energy using events from the UrQMD model is at the level of 93-95% for both detectors.