Dtsch Arztebl Int. 2026.

Epidural Analgesia in Labor: A Nationwide Evaluation of Utilization in Germany.

Lumbar epidural anesthesia (LEA) is considered the gold standard for the treatment of pain during vaginal delivery. Despite procedural advances and high maternal satisfaction in surveys, the extent of LEA utilization in Germany and its trend over time remain unclear.

Prehosp Emerg Care. 2026.

Landscape of Extracorporeal Cardiopulmonary Resuscitation in Germany. A Nationwide Retrospective Study.

Sudden cardiac death is a leading cause of death globally. Recent guidelines recommend considering extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest, but evidence regarding favorable outcomes remains scarce.

Medicina (Kaunas). 2026.

Transfusion Practice in Elderly Surgical Patients in Germany-A Secondary Data Analysis of over 21 Million Patients over a Decade.

: The aging population poses increasing challenges for perioperative care, particularly with respect to blood transfusion practices. This study evaluated transfusion patterns, associated risk factors, and outcomes among surgical patients aged 65 years and older. : All hospitalized surgical patients in Germany between 1 January 2013, and 31 December 2022, were included. Patients aged ≥ 65 years were categorized as transfused (having received red blood cells (RBCs)) or non-transfused. Patients with overlapping procedures or unknown surgical disciplines were excluded. Comorbidities, anemia, bleeding, complications, and blood product use were analyzed using ICD and OPS codes. : A total of 21,143,317 surgical patients aged ≥ 65 years met the inclusion criteria; 2,640,608 (12%) received at least one RBC transfusion. The median age was 79 (73-85) years overall, 79 (73-85) years among transfused patients, and 76 (70-81) years among non-transfused patients. Women accounted for 55.0% of cases. The highest median Elixhauser comorbidity score was observed in patients aged 80-84 years and was significantly higher in transfused patients. Essential hypertension was the most common risk factor, while acute kidney injury was the most frequent complication. Length of stay, ventilation hours, and ICU admission rates decreased with increasing age. Patients aged 65 years and older had an odds ratio of 3.99 (3.98-4.00) for receiving a transfusion. : In this observational study of surgical patients aged ≥ 65 years, the risk of receiving an RBC transfusion increased with age, whereas length of stay, ventilation time, and ICU admission rates decreased. These findings support individualized perioperative management strategies, emphasizing the appropriate evaluation and treatment of anemia and the rational use of blood products in older adults.

Blood Transfus. 2026.

Transfusion practice in elderly patients across surgical disciplines in Germany - a secondary data analysis of over 21 million patients.

Clinicians are increasingly confronted with elderly patients across nearly all surgical disciplines. Advanced age is an independent risk factor for complications, prolonged hospitalization, and particularly for red blood cell (RBC) transfusion. The elderly suffer more frequently from anemia, which is associated with higher perioperative transfusion requirements, increased complication rates, and mortality Surgical disciplines differ not only in primary diagnoses but also in the demographics of their typical patient population.

Intensive Care Med. 2026.

Patient blood management in general intensive care patients.

Critically ill and high-risk perioperative patients requiring intensive care are often multimorbid and depend on rapid, highly specialized management. While most comorbidities are difficult to modify in the acute setting, anemia, particularly iron-defi ciency anemia, represents a potentially modifiable risk factor. Clinicians are also often confronted with complex alterations in hemostasis that require rapid assessment and targeted therapeutic interventions, including the optimal use of blood products. This narrative review summarizes the current evidence on Patient Blood Management strategies, including anemia management, the use of small-volume tubes, and the appropriate use of blood products in intensive care unit patients.

Curr Opin Anaesthesiol. 2026.

Advances in the understanding and management of hospital-acquired anemia.

Hospital-acquired anemia (HAA) is a common complication associated with adverse outcomes, including increased transfusion requirements and prolonged hospital length of stay. The precise etiology of HAA remains elusive, and preventive or therapeutic strategies are inconsistently applied or lacking altogether. This review summarizes current evidence on the incidence, underlying mechanism, clinical consequences, and available interventions for HAA.

BMC Med Inform Decis Mak. 2026.

Anaesthesia professionals' perspectives on ECG interpretation and arrhythmia situation awareness with Visual Patient Heart: a qualitative multicentre study.

The Visual Patient Avatar concept transforms conventional patient monitoring data into a dynamic, animated representation of the patient, enhancing situation awareness of vital signs and measurement status. Rapid recognition and response to cardiac pathologies are critical in anaesthesia and critical care. Visual Patient Heart (VPH) integrates cardiac data from the Philips "ST/AR algorithm", a feature in Philips patient monitors, into visual design elements inside the heart element of the Visual Patient Avatar, specifically aiming to improve situation awareness of arrhythmias and ST-segment deviations.

Front Med (Lausanne). 2026.

Monitoring unfractionated heparin in ECMO and cardiac surgery: the search for a valid reference standard.

Unfractionated heparin remains the standard anticoagulant during cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO). Despite decades of clinical use, however, no universally validated reference method exists for measuring biologically active unfractionated heparin in these settings. Conventional assays such as the activated clotting time and the activated partial thromboplastin time lack specificity and standardisation. Consequently, anti-factor Xa (anti-Xa) assays are increasingly recommended as alternative methods (or even reference methods). Nevertheless, their validity as a true reference standard in CPB and ECMO has never been formally established. This situation creates a methodological paradox: an assay with context-dependent limitations is used to calibrate and validate other imperfect tests. Anti-Xa assays differ substantially in design, particularly regarding the inclusion of dextran sulphate. Dextran sulphate was introduced to prevent neutralisation of heparin by platelet factor 4. However, platelet factor 4 release also occurs during extracorporeal circulation. Depending on assay configuration and clinical context, anti-Xa measurements may therefore overestimate or underestimate biologically active heparin-especially at low concentrations or following protamine reversal. As a result, anti-Xa assays cannot be assumed to be interchangeable in CPB and ECMO. We argue that heparin monitoring in extracorporeal circulation requires conceptual re-evaluation. Distinct clinical scenarios must be differentiated, and rigorous validation studies are essential before any assay can be regarded as a true reference standard.

Br J Anaesth. 2026.

Responsible use of large language models in manuscript authorship, peer review, and editorial processes: a Delphi consensus among editors-in-chief of anaesthesia and pain medicine journals (RULE-AP).

This article presents a Delphi consensus developed by a panel of editors-in-chief of anaesthesiology and pain medicine journals to guide the responsible use of large language models (LLMs) in academic publishing. LLMs offer potential benefits for scientific writing, including language editing, summarisation, translation, information organisation, and support for non-native English speakers, but their misuse raises concerns about accuracy, transparency, confidentiality, and research integrity. Through a three-round modified Delphi process involving 53 editors-in-chief or their delegates, 59 statements were generated and categorised into guidance for authors, editors, reviewers, and publishers with a particular attention to LLM disclosure practices and perceived risks. The consensus recognises that LLMs are useful tools in academic publishing for authors, reviewers, and editors. However, their use must be guided by ethics, legality, and principles of transparency and accountability. LLMs may assist with limited editorial and authorial tasks provided that their use is fully disclosed and all outputs are verified by humans. The consensus also emphasises the inappropriateness of using LLMs to generate original or ideative content, which should remain a strictly human responsibility. Moreover, LLMs must not generate data, references, conclusions, or entire manuscripts, nor be used for editorial decisions or peer-review reports. Editors expressed concerns about 'hallucinations', erosion of critical skills, confidentiality breaches, and the proliferation of low-quality LLM-generated manuscripts. The resulting guidance highlights transparency, human accountability, and careful verification as essential principles for integrating LLMs into scholarly workflows while preserving the integrity of scientific publishing.

Mil Med. 2026.

Military Patient Blood Management as a Critical Factor in Combat-Related Septic Reconstructive Surgery: A Case Report.

Patient Blood Management (PBM) is an evidence-based, multidisciplinary strategy that aims to optimize hemoglobin levels, to minimize perioperative blood loss, and to reduce avoidable transfusions. In military medicine, combat-related traumatic injuries (CRTI) pose specific challenges, as wounded soldiers frequently develop multifactorial anemia because of acute and chronic blood loss, inflammation, malnutrition, and delayed access to care. Although blood transfusions are a common treatment, they carry medical risks and represent a scarce, logistically demanding resource, especially in deployed or resource-limited settings. This case report illustrates the importance of early anemia screening, differentiation, and targeted treatment with a PBM framework in septic reconstructive surgery. A 32-year-old Ukrainian soldier was admitted to the Emergency Department of the Military Hospital Berlin, Germany. Eight months ago, the soldier sustained a blast injury with a femoral fracture and stabilization by external fixation in his home country. Diagnostic work-up detected chronic osteomyelitis and previously untreated iron deficiency. During ongoing surgical and antimicrobial treatment, the anemia progressed postoperatively but was successfully managed with intravenous and oral iron supplementation, without the need for blood transfusion. This case highlights the importance of structured anemia management in military surgery, even in young and otherwise healthy patients, to improve clinical outcomes while preserving limited resources. This aspect is of relevance during large-scale combat operations with high numbers of casualties. In this context, anemia management relies on the simple identification of underlying causes and correction of deficiencies in iron, vitamin B12, or folate when present, offering an effective and easily applicable strategy before resorting to blood transfusion.

Int J Emerg Med. 2026.

Time to intubate with an innovative intubation device: a dual-center randomized crossover non-inferiority simulation study.

BACKGROUND: Endotracheal intubation is a high-stakes intervention in emergency airway management, with patient safety closely linked to first-pass success and avoidance of repeated attempts. The Frankfurt Intubation Device (FID) is a bougie-inspired intubation device intended to provide fast protection against aspiration once positioned in the trachea. METHODS: This dual-center randomized crossover simulation study used an easy-to-intubate airway manikin. Ninety participants were divided into three groups of different experience (anesthesiologists, non-physician critical care staff, and medical students) to perform intubation with the Frankfurt Intubation Device (FID) and a standard endotracheal tube with stylet in randomized order. The primary outcome was non-inferiority of time to airway protection, measured from laryngoscope insertion to inflation of a cuffed device positioned in the trachea (T2; Δ = 5 s). Secondary outcomes included first-pass success, tooth damage, and exploratory assessment of training effects, with additional time-based outcomes assessed descriptively. RESULTS: Across all participants, the FID was non-inferior to the endotracheal tube with stylet for T2 (mean paired difference − 0.77 s, 95% CI − 2.50 to 0.97; non-inferiority margin 5 s). Exploratory analyses demonstrated consistent non-inferiority for T2 across experience groups (G1–G3) and randomization sequences. First-pass success was high in both arms (FID 96.7% vs. ET+stylet 94.4%), while tooth damage occurred less frequently with the FID (7.8% vs. 14.4%). Training effects were observed in the simulator. CONCLUSION: In this standardized simulation study using an easy-to-intubate airway manikin, the Frankfurt Intubation Device demonstrated non-inferiority to conventional endotracheal intubation with stylet for time to airway protection. Secondary findings support continued staged evaluation of the FID, particularly in more challenging airway scenarios and among users with limited airway experience, where differences in procedural performance may become more apparent. TRIAL REGISTRATION: Not applicable (simulation study).

Anaesthesiologie. 2026.

[Not Available].

Transfus Med Hemother. 2026.

Beyond Iron Deficiency: Unveiling the Prevalence of Folate and Vitamin B12 Deficiencies in Major Surgical Patients.

Preoperative anaemia is associated with increased morbidity and mortality in surgical patients. While iron deficiency is a well-recognized cause, the contribution of other nutritional deficiencies, such as folate and vitamin B12, remains underexplored. Therefore, this study aimed to assess the prevalence and role of folate and vitamin B12 deficiencies in preoperative anaemia among patients undergoing major surgery.

Arch Gynecol Obstet. 2026.

Short-term maternal outcomes after intraoperative administration of prophylactic oxytocin during cesarean sections: a retrospective cohort study with a comparison of different administration protocols.

The objective of this study was to evaluate the impact of different intraoperative prophylactic oxytocin regimens on maternal blood loss during cesarean section, and to compare effects in procedures performed before versus after onset of labor.

JMIR Form Res. 2026.

Using a Wearable-Based Animated Patient Avatar to Improve Patients' Perception of Vital Signs: Multicenter Computer-Based Study.

Visual patient avatars are an innovative patient monitoring technology that can be used to translate numerical and waveform data into intuitive, avatar-based representations of patient conditions. Previous research indicates that this technology improves health care providers' situational awareness compared to conventional monitoring methods. As patient-worn continuous vital sign monitoring continues to evolve, we introduce the Visual Patient Wearable device to provide avatar-based visualization tailored to this application.