Anaesthesia

Even before inpatient admission, the patient can have an informative consultation with the anaesthetist in the anaesthesia outpatient clinic.

During this consultation the anaesthetist asks about pre-existing conditions, reviews all available findings, carries out a physical examination, discusses with the patient the optimal medication before the planned procedure and, if necessary, orders additional examinations. In the informed-consent discussion, the anaesthetist explains the planned measures in detail and agrees the appropriate anaesthetic procedure with the patient. This is also an opportunity to address any open questions. Competent advice is the highest aspiration of the anaesthesiology team.

For patients with particular risk factors and concomitant conditions requiring treatment, the anaesthetist initiates steps to improve the patient’s preoperative condition in order to reduce the surgical and anaesthetic risk.

The aim of our measures is to make the surgical phase as comfortable and safe as possible for all patients. This is achieved, on the one hand, by using state-of-the-art anaesthetic techniques and, on the other, by employing sophisticated monitoring methods. In addition to eliminating pain, the anaesthetist is responsible for maintaining vital functions (particularly breathing and the cardiovascular system) and for creating optimal conditions for the operating surgeon.

In our department, all modern methods of general and regional anaesthesia are used during surgical procedures. In addition to the very safe and well-proven inhalation anaesthesia (balanced anaesthesia), total intravenous anaesthesia (TIVA) can also be used as an alternative procedure; it is particularly valuable in patients predisposed to postoperative nausea.

To eliminate pain during surgical procedures, neuraxial techniques (epidural catheter) or peripheral nerve blocks are used in addition to general anaesthesia, sometimes in combination. This noticeably reduces the amount of anaesthetic needed during the operation and effectively relieves postoperative wound pain. At the same time, the rate of postoperative complications after major procedures can be significantly reduced. Some procedures (e.g. caesarean sections) are also performed under regional anaesthesia alone. This is usually a spinal or epidural anaesthetic.

As we wish to avoid the administration of donor blood as far as possible, in selected procedures the patient's own blood lost from the wound is collected, processed and returned to the patient (cell saving). To further increase the safety of our patients and to achieve an optimal depth of anaesthesia, we use a neuromonitoring system for all our patients. By analysing brain waves using EEG, this allows the depth of anaesthesia to be optimally controlled for maximum patient comfort. In this way, unintended wakefulness during anaesthesia (awareness) can be avoided.

After every procedure under general or regional anaesthesia, patients are monitored in the recovery room by specially trained staff for as long as necessary. There, the pain therapy already started during surgery is continued and optimised. Once they are fully responsive, have stable circulation and breathing, and are largely free of pain, they are transferred to the general ward.

For outpatient procedures, patient care and discharge home are handled by the APV (Outpatient Patient Care, Ambulante Patientenversorgung).

After very major operations, treatment can be continued by specially trained intensive care nurses on the interdisciplinary intensive care and high-dependency unit, which is equipped with state-of-the-art technology and run by the Department of Anaesthesiology.

A birth with as little pain as possible is particularly important to us, and lumbar epidural anaesthesia (PDA) plays a key role in this. The woman giving birth remains awake and can actively influence, support and follow the course of labour at every stage.

Even in difficult births, this anaesthetic procedure makes a natural delivery possible, which is clearly our preferred mode of birth.

Of course, if necessary, a pain-free caesarean section can be initiated at any time via the pain catheter or with spinal anaesthesia. The mother can consciously experience the birth and, together with her partner, hold her child in her arms immediately after the umbilical cord has been cut.

Despite careful dosing of the medicines, neuraxial regional anaesthesia can lead to circulatory problems with low blood pressure, which usually manifest as nausea with vomiting. The Department of Anaesthesiology has studied this problem very intensively and, as a result, has developed an antiemetic strategy with which these side effects can be reduced to a minimum. This represents a very considerable gain in comfort for mothers.

The modern pain management concept developed together with the Department of Obstetrics & Gynaecology contributes substantially to a course with little pain after a caesarean section. The pain medicines are tailored individually to the patient’s subjective perception of pain and to the particular features of the surgical procedure.