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Background: An unconfirmed history of antibiotic allergies may negatively influence prescribing patterns for preoperative antibiotic prophylaxis and increase rates of postoperative wound infections through unnecessary use of alternative antibiotics. Methods: After a literature search, we developed a questionnaire for the structured collection of antibiotic allergy history in the anesthesia consultation center and tested it over 2 years at a tertiary care hospital under everyday conditions as part of a quality assurance project. All data were evaluated completely anonymously in the context of standard care. Results: After refining the questionnaire, we analyzed 4866 recorded optimized questionnaires, of which 51 were incomplete. An antibiotic allergy was denied 4312 times and affirmed 503 times, which corresponds to 10% in our sample. The most frequent single substances or groups in the 503 respondents with a positive history of antibiotic allergy were penicillin in 271 (54%), amoxicillin in 65 (13%), an unknown single agent in 50 (10%) and multiple substances in 25 (5%). The reported event occurred more than 10 years ago in 192 (38%) of the respondents, less than 10 years ago in 116 (23%), and 195 (39%) could not provide information. The time from exposure to symptom onset was less than 1h in 96 (19%), between 1 and 24 h in 75 (15%), more than 24 h in 106 (21%), and the remainder could not provide information. Allergy-specific treatment was recalled by 75 (15%) respondents, 287 (57%) reported not having received specific treatment, and the remainder could not recall. A specific allergy test was reported by 55 (11%) respondents, 337 (67%) said no allergy test had been made, and the rest could not recall. A substance-specific allergy passport was issued in 80 (16%) respondents. According to expert assessment, symptoms compatible with an IgE-mediated reaction were present in 96 (19%) of the respondents. An IgE-mediated reaction was considered possible in 70 (14%) and could be excluded by history in 337 (67%) of respondents. Out of 503 respondents with a positive history 51 (10%) could not remember the allergic substance but 7 (14%) of the 51 reported symptoms compatible with severe anaphylaxis or anaphylactic shock and 6 of the 51(12%) reported symptoms possibly related to an IgE-mediated reaction. Discussion: Our survey revealed approximately 10% of respondents reporting an antibiotic allergy, which is in the upper range of data published in international literature and corresponds most closely to American data. Thus, the topic is also relevant to German anesthesia consultation centers, given the high rate of respondents who could have been "delabeled" based on the comprehensive assessment of their history. More expert allergy testing is needed in patients who report symptoms related or probably related to an IgE-mediated reaction. In our opinion, a special issue exists in those patients who did not remember the exact antibiotic but reported symptoms compatible with severe anaphylaxis putting them at high risk of unintended re-exposure. [ABSTRACT FROM AUTHOR]

Currently, few robust data are available to provide estimates of the environmental footprint and in particular the CO2 emissions of medical devices; however, existing life cycle assessments largely indicate that reusable materials have more favorable emissions and environmental footprints compared to disposable items. Thus, the challenge for every anesthesiology department is to identify items that can be used as reusable products for ecological and other reasons. A prerequisite for the use of reusable items is hygienically correct reprocessing and packaging. Here, a distinction must be made between noncritical, semicritical and critical medical devices, depending on the type of use. In addition, a distinction must be made between categories A–C, depending on the complexity of the reprocessing. In this narrative review article common reusable items used in anesthesiology are categorized and a standardized decision algorithm for reprocessing routes is proposed. Special attention is also given to the packaging of medical devices, which can contribute to the ecological footprint to a relevant extent. This article further explains the framework under which reprocessing can take place and analyzes the current state of knowledge on the life cycle assessment of reprocessing reusable devices. This requires the special commitment of clinically active anesthesiologists to include ecological aspects in the decision to use disposable or reusable items. In the medium term, comprehensible ecological key numbers should be provided on every medical device to make the ecological costs of the articles understandable in addition to the monetary costs. [ABSTRACT FROM AUTHOR]

In a microbiological sample study of 15 wet-primed cardiopulmonary bypass circuits in standby mode for 72 hours under regular clinical conditions, no contamination of the priming fluid or the connectors could be detected. Hand contact surfaces of the machines demonstrated environmental microorganisms. These findings indicate the safe use of primed cardiopulmonary bypass circuits in standby mode for 72 hours. A surface disinfection of hand contact surfaces immediately before use is recommended. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the risk of transmission of vancomycin-resistant enterococci (VRE) through reusable breathing circuit of a transport ventilator.

A letter to the editor is presented in response to the article "Selective decontamination of the digestive tract: the mechanism of action is control of gut overgrowth," by L. Silvestri and colleagues in the 2012 issue.

A letter to the editor is presented regarding the use of transcutaneous phrenic and vagal nerve stimulator to treat persistent hiccups.

A letter to the editor is presented, related to desmopressin, for the treatment of Aspirin-induced Platelet Dysfunction.

Clostridium species cause several local and systemic diseases. Conventional identification of these microorganisms is in part laborious, not always reliable, time consuming or does not always distinguish different species, i.e., C. botulinum and C. sporogenes. All in, there is a high interest to find out a reliable, powerful and rapid method to identify Clostridium spp. not only on genus but also on species level. The aim of the present study was to identify Clostridium spp. strains and also to find differences and metabolic groups of C. botulinum by Matrix-Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS). A total of 123 strains of Clostridium spp. (C. botulinum, n = 40, C. difficile, n = 11, C. tetani, n = 11, C. sordellii, n = 20, C. sporogenes, n = 18, C. innocuum, n = 10, C. perfringens, n = 13) were analyzed by MALDI-TOF MS in combination with methods of multivariate statistical analysis. MALDI-TOF MS analysis in combination with methods of multivariate statistical analysis was able to discriminate between the different tested Clostridium spp., even between species which are closely related and difficult to differentiate by traditional methods, i.e., C. sporogenes and C. botulinum. Furthermore, the method was able to separate the different metabolic groups of C. botulinum. Especially, E gene-positive C. botulinum strains are clearly distinguishable from the other species but also from those producing other toxin types. Thus, MALDI-TOF MS represents a reliable and above all quick method for identification of cultivated Clostridium species. [ABSTRACT FROM AUTHOR]

Objective: The objective of this review is to analyze and describe the use of regional analgesia in the critically ill.Data Source: A Medline search from 1966 to 2004 using the search terms critically ill, nerve blocks, regional analgesia, and regional anesthesia, as well as a search in the Cochrane library, was performed, and standard international textbooks related to critical care and regional anesthesia were searched for practice recommendations.Study Selection: Studies, case reports, and review articles relevant to the topic were included.Data Extraction and Synthesis: Data were extracted and analyzed in a descriptive fashion.Conclusion: Regional analgesia using single-injection regional blocks and continuous neuraxial and peripheral catheters can play a valuable role in a multimodal approach to pain management in the critically ill patient to achieve optimum patient comfort and to reduce physiologic and psychological stress. By avoiding high systemic doses of opioids, several complications like withdrawal syndrome, delirium, mental status changes, and gastrointestinal dysfunction can be reduced or minimized. Because of limited patient cooperation during placement and monitoring of continuous regional analgesia, indications for their use must be carefully chosen based on anatomy, clinical features of pain, coagulation status, and logistic circumstances. High-quality nursing care and well-trained physicians are essential prerequisites to use these techniques safely in the critical care environment. [ABSTRACT FROM AUTHOR]