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OBJECTIVE: The primary objective of this nationwide survey carried out in department of cardiac anesthesia in Germany was to identify current practice with regard to neuromonitoring und neuroprotection. METHODOLOGY: The data are based on a questionnaire sent out to all departments of cardiac anesthesia in Germany between October 2007 und January 2008. The anonymized questionnaire contained 26 questions about the practice of preoperative evaluation of cerebral vessels, intra-operative use of neuromonitoring, the nature und application of cerebral protective measures, perfusion management during cardiopulmonary bypass, postoperative evaluation of neurological status, and training in the field of cerebral monitoring. RESULTS: Of the 80 mailed questionnaires 55% were returned and 90% of department evaluated cerebral vessels preoperatively with duplex ultrasound. The methods used for intra-operative neuromonitoring are electroencephalography (EEG, 60%) for type A dissections (38.1%), for elective surgery on the thoracic and thoraco-abdominal aorta (34.1% and 31.6%, respectively) and in carotid surgery (43.2%) near infrared spectroscopy (40%), evoked potentials (30%) and transcranial Doppler sonography (17.5%), with some centers using combined methods. In most departments the central nervous system is not subjected to monitoring during bypass surgery, heart valve surgery, or minimally invasive surgery. Cerebral protective measures used comprise patient cooling on cardio-pulmonary bypass (CPB 100%), extracorporeal cooling of the head (65%) and the administration of corticosteroids (58%), barbiturates (50%) and antiepileptic drugs (10%). Neuroprotective anesthesia consists of administering inhalation anesthetics (32.5%; sevoflurane 76.5%) and intravenous anesthesia (20%; propofol and barbiturates each accounting for 46.2%). Of the departments 72.5% cool patients as a standard procedure for surgery involving cardiovascular arrest and 37.5% during all surgery using CPB. In 84.6% of department CPB flow equals calculated cardiac output (CO) under normothermia, while the desired mean arterial pressure (MAP) varies between 60 and 70 mmHg (43.9%) and between 50 and 60 mmHg (41.5%), respectively. At body temperatures less than 18 degrees C CPB flow is reduced below the calculated CO (70%) while 27% of departments use normothermic flow rates. The preferred MAP under hypothermia is between 50 and 60 mmHg (59%). The results of intra-operative neuromonitoring are documented on the anesthesia record (77%). In 42.5% of the departments postoperative neurological function is estimated by the anesthesiologist. Continuing education sessions pertaining to neuromonitoring are organized on a regular basis in 32.5% of the departments and in 37.5% individual physicians are responsible for their own neuromonitoring education. CONCLUSION: The present survey data indicate that neuromonitoring and neuroprotective therapy during CPB is not standardized in cardiac anesthesiology departments in Germany. The systemic use of available methods to implement multimodal neuromonitoring would be desirable.

Background: During the preclinical period German medical students have little or no opportunities to make experiences in the operating theatre (OT); later these experiences are often provided in an unstructured way.Purpose: The course "OT visit for preclinical students" is planned to improve vertical integration within a structured learning environment. We checked the project for feasibility, acceptance and flaws. Method: The course consists of 3 parts: 1. Pre-course assignments. 2. The OT visit. 3. A short reflection and feedback.Results: 36 preclinical students participated in the course, we received oral feedback from all students and 24 written evaluation forms. Overall acceptance both by teachers and students was good or very good. We found the course to be feasible both for teachers and students. Some students found the pre-course assignments only "satisfactory" and some found the demands "slightly excessive". Conclusion: In terms of acceptance and feasibility, we should implement the course into our regular curriculum. We have to improve our pre-course assignments and offer some help for handling the huge amount of new impressions in the OT. We should look for a way to offer structured OT visits for a higher number of students. Hintergrund: Im vorklinischen Abschnitt haben Medizinstudierende in Deutschland kaum Gelegenheit, OP-Erfahrungen zu machen; später werden diese meist in unstrukturierter Form vermittelt.Vorhaben: Der Kurs "OP Besuch für Vorkliniker" soll die vertikale Integration in strukturierter Lernumgebung verbessern. Wir prüften Machbarkeit, Akzeptanz und mögliche Schwachpunkte.Methode: Der Kurs besteht aus 3 Teilen. 1. Vorbereitungsaufgaben. 2. OP-Besuch. 3. Kurze Reflexion und Feedback.Ergebnisse: 36 vorklinische Studierende nahmen teil, wir erhielten mündliches Feedback von allen und schriftliches Feedback von 24 Studierenden. Insgesamt war die Akzeptanz gut bis sehr gut. Die Machbarkeit für Studierende wie für Lehrer ist gegeben. Einige Studierende fanden die Vorbereitungsaufgaben nur "zufrieden stellend", und einige fanden die Anforderungen "etwas zu hoch".Schlussfolgerung: Aufgrund seiner Akzeptanz und Machbarkeit sollte der Kurs im Curriculum regelmäßig angeboten werden. Die Vorbereitungsaufgaben müssen noch optimiert werden. Wir müssen Hilfestellung anbieten, damit die große Menge neuer Eindrücke im OP besser verarbeitet werden kann. Wir sollten den Kurs einer größeren Studierendenzahl anbieten können.